Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: NSAID THERAPY AND COPRESCRIPTION OF GPAs Part 1

Ulcer healing

Ulcer healingNumerous endoscopic studies have examined the healing of ulcers in patients taking NSAIDs. Ranitidine promotes NSAID-associated ulcer healing following 12 weeks of therapy. Healing was more effective when the patients stopped taking NSAIDs, suggesting that NSAIDs delay healing even when gastric acid is suppressed by ranitidine. While ranitidine was effective in preventing duodenal ulcers in NSAID users, it was found to be relatively ineffective in preventing gastric ulcers. A study of an H2-receptor antagonist (H2RA), famotidine, in high doses, found a significant reduction in gastric ulcers, indicating that a greater degree of acid suppression over that of standard-dose ^RAs is required to protect against NSAID-associated gastric damage. Two large, double-blind, randomized studies have investigated ulcer healing in patients requiring continued NSAID therapy. One study comparing omeprazole with ranitidine in standard doses reported significantly higher healing rates after four and eight weeks of treatment with omeprazole for duodenal ulcers (92% versus 81%, P=0.03) and gastric ulcers (84% versus 64%, P<0.001). A further comparative study found significantly higher healing rates after eight weeks of treatment with omeprazole than with misoprostol in patients with duodenal ulcers (93.2% versus 76.6%, P=0.001) and gastric ulcers (87.2% versus 72.8%, P<0.004). Moreover, omeprazole achieved a higher healing rate for duodenal ulcers than for gastric ulcers. The incidence of diarrhea was similar in patients who took omeprazole and those who took misoprostol in that trial (7.6% versus 8.4%). A subsequent study comparing lansoprazole with misoprostol reported a significantly higher incidence of diarrhea with misoprostol, which the authors attributed to the misoprostol treatment. Your drugs could cost you less – cephalexin 500mg to start the treatment soon.

A similar study in patients with gastric ulcers who were still taking NSAIDs reported a significantly higher healing rate with lansoprazole 30 mg daily than with ranitidine 150 mg bid. The 20% therapeutic gain for lansoprazole compared with ranitidine in that study is comparable with that reported for omeprazole compared with ranitidine.

This entry was posted in Coxibs and tagged Coxibs, Cyclooxygenase-2 inhibitors, Gastroprotective agents, Nonsteroidal anti-inflammatory drugs.