GASTROINTESTINAL TRACT
Hyperacidity, GERD, and ulcers 8A
pH-dependent drugs (eg, ketoconazole, iron,
ampicillin). Monitor warfarin. May give antacids
concomitantly. IV form chelates metal ions. May
cause false (;) urine THC test.
Adverse reactions: Headache, GI upset, dizziness,
arthralgia, inj site reactions; also children: upper
respiratory infection, fever, rash, abdominal pain;
rare: cyanocobalamin deficiency.
How supplied: Tabs– 90; Susp– 30 packets/box;
Vials (40mg)– 1
;RABEPRAZOLE
ACIPHEX Janssen
Proton pump inhibitor. Rabeprazole sodium 20mg;
delayed-release, e-c tabs.
Indications: Triple therapy (w. amoxicillin ;
clarithromycin) for H. pylori eradication in duodenal
ulcer disease. Short-term treatment of erosive or
ulcerative gastroesophageal reflux disease (GERD) or
duodenal ulcers. Treatment of symptomatic GERD in
patients ;
12 years of age. Maintenance of healing
and reduction in relapse rates of heartburn symptoms
in erosive or ulcerative GERD. Long-term treatment of
pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome).
Adults: Swallow whole. ;
18 years: Triple therapy:
rabeprazole 20mg ; amoxicillin 1g ; clarithromycin
500mg, all twice daily (w. AM and PM meals) for 7
days. GERD healing: 20mg once daily for 4–8 weeks;
may repeat for 8 more weeks. GERD symptoms: 20mg
once daily for 4 weeks; may repeat for 4 more weeks.
GERD maintenance: 20mg once daily. Duodenal ulcer
healing: 20mg once daily after breakfast for up to 4
weeks. Hypersecretory conditions: initially 60mg once
daily; titrate; doses up to 100mg once daily or 60mg
twice daily have been used.
Children: ;
12 years: not recommended. ;
12
years: Short-term treatment of GERD: 20mg once
daily for up to 8 weeks.
Warnings/Precautions: Severe hepatic
impairment. Pregnancy (Cat.B). Nursing mothers: not
recommended.
Interactions: May alter absorption of gastric
pH-dependent drugs (eg, ketoconazole, digoxin).
May give antacids concomitantly. May antagonize
atazanavir (not recommended). Monitor warfarin,
cyclosporine.
Adverse reactions: Headache, pain, pharyngitis,
flatulence, infection, constipation. Children: also
nausea.
Note: See amoxicillin entry for more information.
See clarithromycin entry for more information.
How supplied: Tabs– 30, 90
;RANITIDINE
ZANTAC GlaxoSmithKline
H2 blocker. Ranitidine (as HCl) 150mg, 300mg; tabs.
; Also: Ranitidine
ZANTAC EFFERDOSE
Ranitidine (as HCl) 25mg; effervescent tabs; contains
phenylalanine, sodium ( 30.52mg per tab).
Also: Ranitidine
;
ZANTAC SYRUP
Ranitidine (as HCl) 15mg/mL; peppermint flavor;
contains alcohol 7.5%.
Indications: Active duodenal or benign gastric ulcer.
Maintenance of healing of duodenal or gastric ulcer.
Pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome and systemic mastocytosis). GERD.
Erosive esophagitis. Maintenance of healing of
erosive esophagitis.
Adults: Efferdose: dissolve 1 tab in 5mL of water.
;16yrs: Active duodenal ulcer: 150mg twice daily
or 300mg once daily after evening meal or at
bedtime for up to 8wks; maintenance: 150mg at
bedtime. Active benign gastric ulcer, hypersecretory
conditions or GERD: 150mg twice daily; max 6g daily
in hypersecretory conditions. Maintenance of healing
of gastric ulcer: 150mg at bedtime. Limit to 6wks
in benign gastric ulcer. Esophagitis: 150mg 4 times
daily; reevaluate after 12wks; maintenance of healing
of erosive esophagitis: 150mg twice daily. Renal
impairment (CrCl ;50mL/min): 150mg every 24hrs
or more often if needed. Coincide a dose for end of
hemodialysis. May give antacids concomitantly.
Children: Efferdose: dissolve 1 tab in 5mL of water.
;1month: not recommended. ;1month–16yrs:
Treatment of duodenal or gastric ulcers: 2–4mg/kg
per day in two divided doses; max 300mg/day.
Maintenance of healing of duodenal or gastric ulcers:
2–4mg/kg per day once daily; max 150mg/day.
GERD, erosive esophagitis: 5–10mg/kg per day
usually in two divided doses. Renal impairment (CrCl
;50mL/min): reduce dose; see literature.
; Also: Ranitidine
ZANTAC INJECTION
Ranitidine (as HCl) 25mg/mL; IM or IV inj; contains
phenol.
Indications: Hospitalized patients with pathological
hypersecretory conditions, intractable duodenal ulcer.
Short-term alternative to oral therapy.
Adults: ;16yrs: 50mg every 6–8 hrs by IM inj,
or intermittent IV bolus (dilute; give over 5 min), or
intermittent IV (dilute; give over 15–20 min); usual
max 400mg/day. Continuous IV infusion, or for
Zollinger-Ellison: see literature. Renal impairment
(CrCl ;50mL/min): 50mg every 18–24hrs or more
often if needed (intermittent only). Coincide a dose
for end of hemodialysis.
Children: ;1month: not recommended.
;1month–16yrs: Treatment of duodenal ulcer:
2–4mg/kg per day in divided doses every 6–8hrs;
max 50mg every 6–8hrs.
; Also: Ranitidine
ZANTAC INJECTION PREMIXED
Ranitidine (as HCl) 1mg/mL in sodium chloride
0.45%; IV infusion; preservative-free.
Adults: For slow IV drip only. ;16yrs: Intermittent
infusion: 50mg every 6–8hrs (infuse over 15–20min);
usual max 400mg/day. Continuous IV infusion, or
for Zollinger-Ellison: see literature. Renal impairment
(CrCl;50mL/min): 50mg every 18–24hrs or more
