Drugs in digestive diseases and their influence on driving
Prokinetics
Some prokinetic drugs such as cinitapride, clebopride, and metoclopramide cause somnolence, sedation and in some cases dyskinesia, that interfere with driving.
Metoclopramide also increases the effects of phenothiazines and other antidopaminergics on the central nervous system.
Their co-administration with tranquilizers, hypnotics, and narcotics potentiates the sedative effects.
Other drugs used as antiemetics are serotonin antagonists (5HT3), such as ondansetron. It does not affect motor function, nor cause sedation
During the treatment with metoclopramide, situations requiring special alert should be avoided, such as driving cars, since it can cause somnolence or sedation.
Antacids
The antacids almagate and magaldrate do have no effects on driving, but can influence the absorption of other drugs coadministered such as tetracyclines, digoxin, benzodiazepines, dicoumarol, indomethacin, ciprofloxacin and iron.
Antacids are over-the-counter drugs that provide a fast symptom relief.
The patients take them indiscriminately, do not know their interferences with other drugs prescribed and potentiating their side effects or worsening the actual underlying disease.
H2 antagonists
H2 antagonists such as ranitidine do have no direct effects on the ability to drive, but can in some cases cause confusion, depression, headache, dizziness, arthralgia, myalgia, and blurred vision due to accommodation disorders.
Calcium and magnesium salts
Calcium carbonate and magnesium salts are sold over-the-counter, cause immediate symptom relief and do not influence the ability to drive.
Despite their lack of interference with driving, prolonged, excessive self-medication in patients addict to these drugs for symptom relief can provoke metabolic disorders with hypercalcemia, hypophosphatemia, alkalosis and nephrolithiasis.
These drugs, when reacting with the stomach acid, release CO2 that causes abruptly flatulence, gastric distention and belching.
The driving position often worsens the symptoms of dyspepsia.
These drugs are frequently taking while driving to relieve the symptoms, causing the uncomfortable flatulence that is relieved by belching.
Until gas release occurs, the driver loses concentration in the car, road, and environment, as he is particularly concerned with finding a position that improves his uncomfortable situation.
This driver frequently unfastens the safety belt in an attempt to avoid oppressing the epigastrium, and this gesture, added to the lack of attention, makes driving a dangerous act.
Proton pump inhibitors
Omeprazole, lansoprazole, pantoprazole, and its derivatives are drugs not likely to affect the ability to drive.
As they are metabolized in the liver, they can prolong the elimination of benzodiazepines, warfarin, and phenytoin, enhancing their side effects.
Proton pump inhibitors cause adverse reactions on few occasions, including arthralgia, muscle weakness, myalgia, headache, dizziness, paresthesia, dizziness, somnolence, and insomnia.
In rare cases, confusion, agitation, depression, and dementia occur.
Constipation, diarrhea, nausea, vomiting, flatulence, bronchospasm, and blurred vision sometimes appear.
Antipropellants
Loperamide does not affect mental alertness, but in some cases can cause somnolence, tiredness, and lightheadedness, so driving is not recommended in these cases.
Scopolamine, with anticholinergic effect, is used to reduce intestinal spasms and accordingly pain. It is virtually devoid of side effects, though in some cases mydriasis and transient visual accommodation disorders can occur.
Otilonium bromide is a synthetic anticholinergic, that in sensitive people can cause tiredness, nausea and epigastralgia.
Mebeverine is an antispasmodic with direct effect on the gastrointestinal smooth muscle, that relieves spasms but without the negative effect of other anticholinergics on glaucoma and prostate hypertrophy.