Drug Therapy for Peptic Ulcer Diseases II

This the continuation of my other post, that tackles the proton pump inhibitor with the main action is to decrease the gastric acid secretion thus helps in reducing ulcer progress. The other one is the cytoprotective medications with the primary action is to protect the mucosal lining thus eliminates gastric irritation.

Proton (Gastric Acid) Pump Inhibitor


Omeprazole ( Prilosec ) - decreases gastric acid secretion by slowing the hydrogen-potassium-adenosine triphosphate (H+,K+-ATPase) pump on the surface of the parietal cells. The patient should be infromed the long term use may cause ulcer or gastric tumors and bacterial invasion so that they are aware of this.

Cytoprotective Medications


Misoprostol( Cytotec ) - a synthetic prostaglandin, protects the gastric mucosa from ulcerogenic agents. It increases mucus production and bicarbonate levels to reduce acidity that may cause ulcer progresses. It is also used as preventive method inpatients using NSAIDs. It is advisable to take the drug with food to reduce gastrointestinal irritation. The patient should be inform about the side effects such as that might cause diarrhea and cramping  include uterine cramping. Not advisable to take during pregnancy and please tell your doctor so abortion may prevented.

Sucrafate ( Carafate ) - in the presence of gastric acid, sucralfate creates a viscous protective substance, forming a protective layer at the site of the ulcer, and prevents digestion by pepsin. May cause constipation or nausea so the patient should be inform. Approved to use it  for duodenal ulcers as a drug of choice, not  in gastric ulcers.

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Histamine (H2) Receptor Antagonists for Peptic Uclers

This are the drug of choice PUD. My last post was all about the drug therapy with its primary concern was Antibiotics and Bismuth salts. And now let us know the other drug classification that helps in treating PUD. The another class is the Histamine (H2) Receptor Antagonists and its primary action is to block the H2 receptor.

Cimetidine ( Tagamet ) - inhibits acid ( cause of ulcer ) secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. This drug is the least expensive of the H2 receptor antagonists thus it more affordable to the public. Because it is least expensive their must be a bigger side effects compared to other drugs. The patient should be warn the this may cause confusion, agitation or coma in the elderly. To those with renal  or hepatic insufficiency, it is advisable to tell the doctor about this so that they will be aware of the situation and change their drug of choice. Long term use may cause gynecomastia or enlarged breast in male, impotence to both sexes and diarrhea. The patient should be inform about this matter.

Ranitidine ( Zantac ) - inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. It has prolonged drug half-life in patients with renal and hepatic insufficiency. Causes fewer side effects than cimetidine. It is rarely causes constipation, diarrhea, dizziness and depression

Famotidine ( Pepcid ) - inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. Best choice for critically ill patients because it is known to have least risk of interaction with drugs other than cimetidine. It is unclear if other H2 receptor antagonists are as safe as famotodine. It does not alter drug metabolism in the liver. It has prolonged drug half-life in patients with renal and hepatic insufficiency. It can be use for short term relief for gasttroesophageal reflux or heart burn. The good thing is it rarely causes constipation or diarrhea.

Nizantidine ( Axid ) -inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. Most doctors usually used it for duodenal ulcers as a drug of choice. It has prolonged drug half-life in patients with renal and hepatic insufficiency. Another good thing is it rarely causes sweating , increased liver enzymes, nausea and urticaria (skin irritation).

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Drug Therapy for Peptic Ulcer Diseases

Here are the list for the drug of choice with regards in treating peptic ulcer disease. I have mention before about the PUD in cancer patient as one of the complication might arise with patient ongoing on Chemotherapy.So, know its time to know the drugs that helps in aiding and healing peptic ulcer disease. First is the Antibiotics and Salts.


Antibiotics and Bismuth Salts

Tetracycline(plus metronidazole and bismuth salts) - exerts bacteriostatic effects to eradicate H.pylori bacteria, as one of the cause of ulcer  in the gastric mucosa. This drug may cause photosensitivity reaction so tell the patient to use sunscreen or eye glasses when going outside on a sunny day. Use with caution in patients with renal or hepatic impairment because it may harm our kidney and liver. When taken with milk or dairy products, medication effectiveness may be reduced thus it is advisable not take dairy products or milk during the medication.

Amoxicillin (plus metronidazole and bismuth salts or with high dose of proton pump inhibitor) - a bactericidal antibiotic that assists with eradicating H.pylori bacteria( causes ulcer) in the gastric mucosa. May cause diarrhea as an effects and patient should be oriented about this so that he or she will recognized it is the side effect of the drug. Do a health history by asking the patient if he or she allergic to penicillin. If she is allergic then don't give the frug

Metronidazole (Flagyl) - an amebicide that assists with eradicating H.pylori bacteria in the gastric mucosa. It is recommended to give meals before taking the drug to decrease gastrointestinal distress as one of the side effects.

Clarithromycin (Biaxin) (use with proton pump inhibitor or H2 receptor antagonist) - exerts bacterial effects to         eradicate H. pylori bacteria in gastric mucosa. Educate the patient that this drug may cause gastrointestinal upset.

Bismuth subsalicylate (Pepto-Bismol) (use with antibiotics) - supresses H.pylori bacteria in the gastric mucosa and helps mucosal lesions heal. this is given concurrently with antibiotics to cure H. pylori infection.

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