page77
PANTOPRAZOLE
Indications
see under Dose
Cautions
see notes above; interactions: Appendix 1
(proton pump inhibitors)
Hepatic impairment
max.
20 mg daily in severe
impairment and cirrhosis—monitor liver function
(discontinue if deterioration)
Renal impairment
max.
oral dose 40 mg daily
Pregnancy
manufacturer advises avoid unless poten-
tial benefit outweighs risk—fetotoxic in
animals
Breast-feeding
manufacturer advises avoid unless
potential benefit outweighs risk—small amount pre-
sent in milk in
animal
studies
Side-effects
see notes above;
also hyperlipidaemia,
weight changes
Dose
. By mouth, benign gastric ulcer,
ADULT
over 18 years,
40–80 mg daily in the morning for 4 weeks, continued
for further 4 weeks if not fully healed
Gastro-oesophageal reflux disease,
ADULT
and
CHILD
over 12 years,
20–80 mg daily in the morning for 4
weeks,
continued for further 4 weeks if not fully
healed;
maintenance 20 mg daily,
increased to 40 mg
daily if symptoms return
Duodenal ulcer,
ADULT
over 18 years, 40–80 mg daily
in the morning for 2 weeks,
continued for further 2
weeks if not fully healed
Duodenal ulcer associated with
Helicobacter pylori
,
see eradication regimens on p.
50
Prophylaxis of NSAID-associated gastric or duodenal
ulcer in patients with an increased risk of gastroduo-
denal complications who require continued NSAID
treatment,
ADULT
over 18 years, 20 mg daily
Zollinger–Ellison syndrome (and other hypersecre-
tory conditions),
ADULT
over 18 years, initially 80 mg
once daily adjusted according to response (
ELDERLY
max. 40 mg daily); daily doses above 80 mg given in 2
divided doses
. By intravenous injection over at least 2 minutes
or
by
intravenous infusion,
ADULT
over 18 years,
duodenal
ulcer,
gastric ulcer,
and gastro-oesophageal reflux,
40 mg daily until oral administration can be resumed
Zollinger–Ellison syndrome (and other hypersecre-
tory conditions),
ADULT
over 18 years, initially 80 mg
(160 mg if rapid acid control required) then 80 mg
once daily adjusted according to response; daily doses
above 80 mg given in 2 divided doses
Pantoprazole
(Non-proprietary) A
Tablets
,
e/c,
pantoprazole 20 mg,
net price 28-tab
pack = £1.79;
40 mg,
28-tab pack = £2.82.
Label:
25
Note
Pantoprazole 20 mg tablets can be sold to the public for
the short-term treatment of reflux symptoms (e.g. heartburn)
in adults over 18 years, max.
daily dose 20 mg for max.
4
weeks
Protium
c
(Nycomed) A
Injection
, powder for reconstitution, pantoprazole (as
sodium salt),
net price 40-mg vial = £5.11
RABEPRAZOLE SODIUM
Indications
see under Dose
Cautions
see notes above; interactions: Appendix 1
(proton pump inhibitors)
Hepatic impairment
manufacturer advises caution in
severe hepatic dysfunction
Pregnancy
manufacturer advises avoid—no informa-
tion available
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see notes above;
also cough,
influenza-
like syndrome, and rhinitis;
less commonly
chest pain
and nervousness;
rarely
anorexia and weight gain
Dose
. Benign gastric ulcer, 20 mg daily in the morning for 6
weeks, continued for further 6 weeks if not fully healed
. Duodenal ulcer,
20 mg daily in the morning for 4
weeks, continued for further 4 weeks if not fully healed
. Gastro-oesophageal reflux disease,
20 mg once daily
for 4–8 weeks; maintenance 10–20 mg daily;
symp-
tomatic treatment in the absence of oesophagitis,
10 mg daily for up to 4 weeks, then 10 mg daily when
required
. Duodenal and benign gastric ulcer associated with
Helicobacter pylori
,
see eradication regimens on
p.
50
. Zollinger–Ellison syndrome, initially 60 mg once daily
adjusted according to response (max.
120 mg daily);
doses above 100 mg daily given in 2 divided doses
.
CHILD
not recommended
Pariet
c
(Janssen-Cilag,
Eisai) A
Tablets
,
e/c,
rabeprazole sodium 10 mg (pink), net
price 28-tab pack = £11.56;
20 mg (yellow), 28-tab
pack = £19.55.
Label:
25
1.4
Acute diarrhoea
1.4.1 Adsorbents and bulk-forming drugs
1.4.2 Antimotility drugs
The priority in acute diarrhoea, as in gastro-enteritis, is
the prevention or reversal of fluid and electrolyte deple-
tion. This is particularly important in infants and in frail
and elderly patients.
For
details of
oral
rehydration
preparations,
see section 9.2.1.2.
Severe depletion of
fluid and electrolytes requires immediate admission to
hospital and urgent replacement.
Antimotility drugs (section 1.4.2) relieve symptoms of
acute diarrhoea.
They are used in the management of
uncomplicated acute
diarrhoea
in adults;
fluid and
electrolyte replacement
may be necessary in case of
dehydration.
However,
antimotility
drugs
are
not
recommended for acute diarrhoea in young children.
Antispasmodics (section 1.2) are occasionally of value in
treating abdominal cramp associated with diarrhoea but
they should not be used for primary treatment.
Anti-
spasmodics
and antiemetics
should be
avoided in
young children with gastro-enteritis because they are
rarely effective and have troublesome side-effects.
Antibacterial drugs are generally unnecessary in simple
gastro-enteritis because the complaint usually resolves
quickly without them, and infective diarrhoeas in the UK
often have a viral
cause.
Systemic bacterial
infection
does, however, need appropriate systemic treatment; for
drugs used in campylobacter enteritis,
shigellosis,
and
salmonellosis, see Table 1, section 5.1. Ciprofloxacin is
occasionally used for
prophylaxis
against
travellers’
diarrhoea, but routine use is not recommended. Lacto-
bacillus preparations have not been shown to be effec-
tive.
BNF 61
1.4 Acute diarrhoea
57
1
Gastro-intestinal system