Proton pump inhibitors
From WardWiki - Foundation Doctor Helper
Proton pump inhibitors are potent dyspepsia preparations that are very commonly used for dyspepsia and gastritis. They are very useful as adjuncts to antibiotics for H. pylori eradication and to heal ulcers. There is evidence of preventing rebleeding following OGD for which the Hong Kong protocol is used.
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Drug interactions
Caution must be exercised with coumarin anticoagulation and clopidogrel as drug interactions are seen. It seems that rabeprazole is probably the least important of the group as regards these interactions, with omprazole the most important.
Individual agents
Most trusts choose to stock one particular PPI and there seems little point in junior doctors prescribing another one in preference. Lanzoprazole and omeprazole remain popular.
Omepazole
- Oral: 10 - 20mg OD; usual to start at 20mg and reduce down to 10mg after a few weeks.
- Oral dispersible: Losec MUPS cost a fortune so only use if tablets not tolerated.
- IV: 20 - 40mg OD; usually only when oral medication not tolerated
- IV infusion post OGD; see Hong Kong protocol
Esomeprazole
- Oral: 20 - 40mg OD; use only when other PPIs have failed.
Lanzoprazole
- Oral: 15 - 30mg OD; usual to start at 30mg and reduce down to 15mg after a few weeks.
- Oral dispersible: Zoton Fastabs cost a fortune so only use if tablets not tolerated.
Pantoprazole
- Oral: 20 - 40mg OD; usual to start at 40mg and reduce down to 20mg after a few weeks.
- IV: 20 - 40mg OD; usually only when oral medication not tolerated
Rabeprazole
- Oral: 10 - 20mg OD; usual to start at 20mg and reduce down to 10mg after a few weeks.
Links
www.bnf.org
