page74
De-Noltab
c
(Astellas)
Tablets
, f/c, tripotassium dicitratobismuthate 120 mg,
net price 112-tab pack = £5.09. Counselling, see below
Electrolytes
K
+
2 mmol/tablet
Dose
2 tablets twice daily
or
1 tablet 4 times daily; taken for 28
days followed by further 28 days if necessary;
maintenance not
indicated but course may be repeated after interval of 1 month;
CHILD not recommended
Counselling
To be swallowed with half
a glass of
water;
twice-
daily dosage to be taken 30 minutes before breakfast and main
evening meal; four-times-daily dosage to be taken as follows: one
dose 30 minutes before breakfast, midday meal and main evening
meal, and one dose 2 hours after main evening meal; milk should
not be drunk by itself during treatment but small quantities may
be taken in tea or coffee or on cereal; antacids, fruit, or fruit juice
should not be taken half an hour before or after a dose;
may
darken tongue and blacken faeces
SUCRALFATE
Indications
see under Dose
Cautions
administration of sucralfate and enteral
feeds should be separated by 1 hour;
interactions:
Appendix 1 (sucralfate)
Bezoar formation
Following reports of
bezoar formation
associated with sucralfate, caution is advised in seriously ill
patients,
especially those receiving concomitant enteral
feeds or those with predisposing conditions such as delayed
gastric emptying
Renal impairment
use with caution;
aluminium is
absorbed and may accumulate
Pregnancy
no evidence of harm;
absorption from
gastro-intestinal tract negligible
Breast-feeding
amount probably too small to be
harmful
Side-effects
constipation;
less frequently
diarrhoea,
nausea,
indigestion,
flatulence,
gastric discomfort,
back pain,
dizziness,
headache,
drowsiness,
bezoar
formation (see above), dry mouth and rash
Dose
. Benign gastric and duodenal ulceration and chronic
gastritis,
ADULT
and
CHILD
over 15 years, 2 g twice daily
(on rising and at bedtime)
or
1 g 4 times daily 1 hour
before meals and at bedtime, taken for 4–6 weeks or in
resistant cases up to 12 weeks; max.
8 g daily
. Prophylaxis of stress ulceration,
ADULT
and
CHILD
over
15 years, 1 g 6 times daily;
max. 8 g daily
.
CHILD
under 15 years see
BNF for Children
Antepsin
c
(Chugai) A
Tablets
, scored, sucralfate 1 g, net price 50-tab pack =
£5.77.
Label:
5
Note
Crushed tablets may be dispersed in water
Suspension
,
sucralfate,
1 g/5 mL,
net price 250 mL
(aniseed- and caramel-flavoured) = £5.77.
Label:
5
1.3.4
Prostaglandin analogues
Misoprostol,
a synthetic prostaglandin analogue has
antisecretory and protective properties, promoting heal-
ing of
gastric
and duodenal
ulcers
.
It
can prevent
NSAID-associated ulcers, its use being most appropriate
for the frail or very elderly from whom NSAIDs cannot
be withdrawn.
For comment on the use of misoprostol to induce abor-
tion or labour [unlicensed indications], see section 7.1.1.
MISOPROSTOL
Indications
see notes above and under Dose
Cautions
conditions where hypotension might preci-
pitate severe complications (e.g.
cerebrovascular dis-
ease,
cardiovascular disease)
Contra-indications
planning pregnancy (important:
see Women of Childbearing Age, and also Pregnancy,
below)
Women of
childbearing age
Manufacturer
advises that
misoprostol should not be used in women of childbearing
age unless the patient requires non-steroidal anti-inflamm-
atory (NSAID) therapy and is at high risk of complications
from NSAID-induced ulceration. In such patients it is advised
that misoprostol should only be used if the patient takes
effective contraceptive measures
and has been advised of the
risks of taking misoprostol if pregnant
.
Pregnancy
avoid—potent uterine stimulant (has been
used to induce abortion) and may be teratogenic;
important: see also Women of Childbearing Age,
above
Breast-feeding
no information available—manufac-
turer advises avoid
Side-effects
diarrhoea (may occasionally be severe
and require withdrawal, reduced by giving single
doses not exceeding 200 micrograms and by avoiding
magnesium-containing antacids); also reported:
abdominal pain,
dyspepsia,
flatulence,
nausea and
vomiting,
abnormal vaginal bleeding (including inter-
menstrual bleeding,
menorrhagia,
and postmenopau-
sal bleeding),
rashes,
dizziness
Dose
. Benign gastric and duodenal ulceration and NSAID-
associated ulceration,
ADULT
over 18 years,
800 micr-
ograms daily (in 2–4 divided doses) with breakfast (or
main meals) and at bedtime; treatment should be
continued for at least 4 weeks and may be continued
for up to 8 weeks if required
. Prophylaxis of NSAID-induced gastric and duodenal
ulcer,
ADULT
over 18 years,
200 micrograms 4 times
daily (if not tolerated, reduced to 200 micrograms 2–3
times daily,
but less effective)
Cytotec
c
(Pharmacia) A
Tablets
,
scored,
misoprostol 200 micrograms,
net
price 60-tab pack = £10.03.
Label:
21
With diclofenac or naproxen
Section 10.1.1
1.3.5
Proton pump inhibitors
Proton pump inhibitors inhibit gastric acid secretion by
blocking the hydrogen-potassium adenosine triphospha-
tase enzyme system (the ‘proton pump’) of
the gastric
parietal cell. Proton pump inhibitors are effective short-
term treatments for
gastric
and
duodenal
ulcers
;
they
are also used in combination with antibacterials for the
eradication of
Helicobacter pylori
(see p.
50 for specific
regimens).
Following endoscopic treatment
of
severe
peptic ulcer bleeding,
an intravenous, high-dose proton
pump inhibitor reduces the risk of
rebleeding and the
need for surgery. Proton pump inhibitors can be used for
the treatment
of
dyspepsia
and
gastro-oesophageal
reflux disease
(section 1.1).
Proton pump inhibitors are also used for the prevention
and treatment of NSAID-associated ulcers (see p.
50). In
patients who need to continue NSAID treatment after an
54
1.3.4 Prostaglandin analogues
BNF 61
1
Gastro-intestinal system