Basics of Anti-Peptic Ulcer Drugs

1. ANTI-PEPTIC ULCER
DRUGS
Department of Pharmacy
University of Peshawar

2. CLASSIFICATION
 REDUCTION OF GASTRIC ACID SECRETION
 NEUTRALIZATION OF GASTRIC ACID SECRETION
 ULCER PROTECTIVES
 ANTI BACTERIAL (H-PYLORI)

3. REDUCTION OF GASTRIC ACID
SECRETIONS
a. Cimetidine
b. Ranitidine
c. Famotidine
d. Nizatidine
e. Roxatidine
a. Dicyclomin
b. Pirenzipine
c. Propantheline
d. Oxyphenonium
a. Omeprazole
b. Esomeprazole
c. Pantoprazole
d. Rabeprazole
e. Lansoprazole
a. Misoprostol
HISTAMNE H2 ANTAGONISTS ANTI-CHOLINERGICS
PROTON PUMP INHIBITORS PROSTAGLANDIN ANALOGUE

4. RANITIDINE
FORMS & STRENGTH
• Injection: 50mg/2ml
• Suspension/syrup:
150mg/10ml
• Tablet: 75mg, 150mg,
300mg
DOSAGE
ORAL
Adult: 50mg twice daily or
300mg once daily
Children: Under 2 years not
recommended. Over 2 years
2mg-4mg/kg twice daily (Max
300mg/day)
I/V
Adult: 50mg twice daily
BRANDS
• Zantac (GSK)
• Ranulcid (Merck)
• Nulcer (Bosch)

5. RANITIDINE
M.O.A
It blocks H2 receptor of the
parietal cells resulting in
decreased activity of
proton pump by cAMP
mediated pathway.
INDICATIONS
•Duodenal ulcer
•NSAID’s induced ulcer
•H-pylori associated ulcer
•Esophageal reflux
•Chronic dyspepsia
SIDE EFFECTS
•Constipation
•Headache
•Insomnia
•Agitation
•Confusion
•Rash
•Visual changes
•Bleeding
•Yellow coloration of eyes,
skin

6. PRODUCTS

7. CIMETIDINE
FORMS & STRENGTH
• Injection: 200mg/2ml
• Suspension/syrup:
100mg/200mg per 5ml
• Tablet: 200mg, 400mg,
800mg
DOSAGE
ORAL
Adult: 800mg once daily or
400mg twice daily
I/V
Adult: 200mg every 6 hours
BRANDS
• Tagamet (GSK)
• Bacimet (Davis)
• Cimet (Ferozsons)

8. CIMETIDINE
M.O.A
It blocks H2 receptor of the
parietal cells resulting in
decreased activity of
proton pump by cAMP
mediated pathway.
INDICATIONS
•Stress ulcer
•Duodenal ulcer
•Reflux esophagitis
•Zollinger-ellison
syndrome
•Hyperacidity
•Heart burn
SIDE EFFECTS
•Diarrhoea
•Dizziness
•Rashes
•Gynacomastia
•Confusion
•Acute pancreatitis
•Pancytopenia
•Headache
•Anaphylaxis

9. PRODUCTS

10. OMEPRAZOLE
FORMS & STRENGTH
• Capsule/tablet: 10mg,
20mg, 40mg
• Infusion: 40mg
DOSAGE
ORAL
Adult: 20mg-40mg once daily
Children: not recommended
I/V
Adult: 40mg once daily
BRANDS
• Prilosec (Astrazeneca)
• Omezol (Bosch)
• Risek (Getz)

11. OMEPRAZOLE
M.O.A
It is a selective and
irreversible proton pump
inhibitor. It suppresses
stomach acid secretion by
specific inhibition of the
H+/K+ ATPase system
found at the secretory
surface of gastric parietal
cells.
INDICATIONS
•Esophageal reflux disease
•Duodenal ulcer
•Gastric ulcer
•Zollinger-Ellison
syndrome
•Prophylaxis of acid
aspiration
SIDE EFFECTS
•Headache
•GI upset
•Skin rash
•Parasthesia
•Insomnia
•Arthralgia
•Liver enzyme inducer
•Increase risk of GI
infections

12. PRODUCTS

13. ESOMEPRAZOLE
FORMS & STRENGTH
• Capsule/tablet: 20mg,
40mg
• Suspension:
10mg/sachet
• Infusion: 40mg
DOSAGE
ORAL
Adult: 20mg-40mg once daily
I/V
Adult: 20-40mg once daily
BRANDS
• Esso (Shaigan)
• Nexum (Getz)
• Somezol (Davis)

14. ESOMEPRAZOLE
M.O.A
It is a selective and
irreversible proton pump
inhibitor. It suppresses
stomach acid secretion by
specific inhibition of the
H+/k+ ATPase system
found at the secretory
surface of gastric parietal
cells.
INDICATIONS
•Reflux esophagitis
•GERD
•H-pylori associated ulcer
•NSAID’s induced ulcer
SIDE EFFECTS
•Headache
•GI upset
•Skin rashes
•Xerostomia
•Angioedema
•Anaphylaxis

15. PRODUCTS

16. DICYLOMINE
FORMS & STRENGTH
• Tablet: 20mg
• Syrup: 10mg/5ml
DOSAGE
ORAL
Adult: 10-20mg thrice daily
Children: 6months-4 years,
2.5-5ml before each feed. 4-
12 years, 5-10ml 4 times daily
BRANDS
• Blisscolic (Bliss)
• Bentyl (Axcan)
• Bentylol (Aptalis)

17. DICYLOMINE
M.O.A
It blocks M3 receptor of
the parietal cells resulting
in decreased activity of
proton pump by cAMP
mediated pathway.
INDICATIONS
•Flatulance
•Abdominal discomfort
•Ulcer
SIDE EFFECTS
•Xerostomia
•Polydipsia (thirst)
•Dizziness

18. PRODUCTS

19. MISOPROSTOL
FORMS & STRENGTH
• Tablet: 100mcg, 200mcg
DOSAGE
ORAL
Adult: 800mcg in 2-4 divided
doses
Children: not recommended
BRANDS
• Cytotec (Searle)
• Prosotec (Atco)
• S.T.mom (Zafa)

20. MISOPROSTOL
M.O.A
It increases mucous,
bicarbonate secretion of
stomach.
INDICATIONS
•Gastric & duodenal ulcer
•NSAID’s associated ulcer
•Abortifacient
SIDE EFFECTS
•Diarrhoea
•Abdominal pain
•Dyspepsia
•Flatulance
•Menorrhagia
•Rashes
•Dizzines

21. PRODUCTS

22. NEUTRALIZATION OF GASTRIC ACID
SECRETIONS
a. Sodium bicarbonate
b. Sodium citrate
a. Magnesium hydroxide
b. Magnesium trisilicate
c. Aluminum hydroxide
d. Calcium carbonate
SYSTEMIC ANTACIDS NON-SYSTEMIC ANTACIDS

23. SODIUM BICARBONATE
FORMS & STRENGTH
• Powder: sodium
bicarbonate 1.7gm,
Sodium citrate 0.6gm,
citric acid 0.7gm,
tartaric acid 0.8gm
DOSAGE
ORAL
Adult: 2-3 sachets 2-3 times
daily
Children: 1 sachet 2-3 times
daily
BRANDS
• Citro soda (Abbott)
• ENO fruit salt (GSK)

24. SODIUM BICARBONATE
M.O.A
It neutralizes gastric acid
INDICATIONS
•Constipation
•Indigestion
•Flatulance
•Urinary alkalinizer
SIDE EFFECTS
•Nausea
•Vomiting
•Alkalosis

25. PRODUCTS

26. ALU & MAG HYDROXIDE
FORMS & STRENGTH
• Suspension: Aluminum
hydroxide 215mg,
Magnesium hydroxide
80mg, simethacone
25mg
DOSAGE
ORAL
Adult: 1-2 teaspoon between
meals and At bedtime
Children: 5-12 years, half of
the adult dose
BRANDS
• Dijex MP (Abbott)
• Gelusil (Johnson &
Johnson)

27. ALU & MAG HYDROXIDE
M.O.A
It neutralizes gastric acid
INDICATIONS
•Constipation
•Indigestion
•Flatulance
SIDE EFFECTS
•Nausea
•Vomiting

28. PRODUCTS

29. a. Sucralfate
b. Colloidal bismuth sub-citrate
a. Amoxicillin
b. Clarithromycin
c. Metronidazole
d. Tenidazole
e. Tetracycline
ULCER PROTECTIVES ANTI BACTERIAL (H-PYLORI)

30. SUCRALFATE
FORMS & STRENGTH
• Suspension:
500mg/1gm per 5ml
• Tablet: 250mg, 500mg,
1gm
DOSAGE
ORAL
Adult: 1gm 4 times daily
Children: not recommended
BRANDS
• Ulsanic (Highnoon)
• Crafilm (Pacific)
• Carafate (Aptalis)

31. SUCRALFATE
M.O.A
It forms a protective layer
on the surface of gastric
mucosa.
INDICATIONS
•Acute & chronic ulcer
•Gastric erosion
•Bile reflux
SIDE EFFECTS
•Constipation
•Diarrhoea
•GI upset
•Xerostomia
•Rash

32. PRODUCTS

33. AMOXICILLIN
FORMS & STRENGTH
• Capsule/tablet: 250mg,
500mg, 750mg, 1gm
• Drop paed:
125mg/1.25ml
• Injection: 250mg,
500mg powder in vial
• Suspension: 125mg,
250mg, 375mg, 500mg
• Tablet chewable:
200mg, 400mg
DOSAGE
ORAL
Adult: 250mg thrice daily in
severe conditions 500mg
thrice daily
Children: 1month-1 year,
62.5mg every 8 hours. 1-5
years, 125mg every 8 hours
BRANDS
• Amoxil (GSK)
• Wymox (Pfizer)
• Zeemox (Searle)

34. AMOXICILLIN
M.O.A
It acts by inhibiting the
synthesis of bacterial cell
walls i-e trans peptidase
inhibitor enzyme is
inhibited.
INDICATIONS
•H-pylori associated ulcer
•RTI
•UTI
•Soft tissue infections
•Gonorrhea
•Endocarditis
SIDE EFFECTS
•Hypersensitivity reaction
•GI upset
•Cholestatic jaundice
•Pseudomembranous
colitis
•Hematologic & CNS
effects

35. PRODUCTS

36. CLARITHROMYCIN
FORMS & STRENGTH
• Drops: 125mg/5ml
• Suspension: 125mg,
250mg per 5ml
• Capsule/tablet: 250mg,
500mg
DOSAGE
ORAL
Adult: 500mg once daily or
250mg twice daily with food
Children: all twice daily
under 1 year, 7.5mg/kg
1-2 years, 62.5mg
3-6 years, 125mg
7-9 years, 187.5mg
10-12 years, 250mg
BRANDS
• Klaricid (Abbott)
• Maclacin (Bosch)
• Claritek (Getz)

37. CLARITHROMYCIN
M.O.A
Clarithromycin
prevents bacteria from
growing by interfering
with their protein
synthesis. It binds to the
subunit 50S of the
bacterial ribosome, thus
inhibiting the translation of
peptides.
INDICATIONS
•Lower & upper
respiratory tract infections
•Skin & soft tissue
infections
•H-pylori associated ulcer
SIDE EFFECTS
•GI upset
•Paresthesia
•Stomatitis
•Tooth discoloration
•Headache
•Arthralgia
•Rash
•Allergic reactions
•Hepatic dysfuction

38. PRODUCTS

39. METRONIDAZOLE
FORMS & STRENGTH
• Infusion: 500mg/100ml
• Suspension: 200mg/5ml
• Tablet: 200mg, 400mg
DOSAGE
ORAL
Adult: 200mg-800mg thrice
daily
Children: under 1 year, not
recommended
1 year (+), 7.5mg/kg thrice
daily
IV
Adult: 500mg thrice daily
Children: 7.5mg/kg thrice
daily
BRANDS
• Flagyl (Sanofi Aventis)
• Metrozine (Searle)
• Meronide (Irza)

40. METRONIDAZOLE
M.O.A
It inhibits nucleic acid
synthesis by disrupting the
DNA of microbial
cells. This function only
occurs when
metronidazole is partially
reduced free radicals are
formed which in turn react
with nucleic acid resulting
in death of the bacteria.
INDICATIONS
•Infection due to
anaerobic organisms
(Pseudomembranous
colitis)
•Amoebic dysentery
•Liver abscess
•Acute ulcerative gingivitis
•Trichomoniasis
•Non-specific vaginitis
SIDE EFFECTS
•GI upset
•Furred tongue
•Taste alteration
•Dark urine
•Neuropathy
•Seizures (chronic use)

41. PRODUCTS

42. TRIPLE THERAPY REGIMEN
 Triple therapy consists of two antibiotics and one proton pump inhibitor for 7-
14 days. The duration of the regimen including Rabeprazole is 7 days, the
duration of the other regimens is 10-14 days.
MEDICATION DOSAGE
Clarithromycin 500mg twice daily
Amoxicillin 1gm twice daily
Metronidazole 500mg twice daily
Rabeprazole 20mg twice daily
Esomeprazole 40mg once daily
Omeprazole 20mg twice daily

43. QUADRUPLE THERAPY REGIMEN
 Quadruple therapy consists of bismuth, two antibiotics and one proton pump
inhibitor or H2-blocker for 14 days. They are used when bacteria may be
resistant to clarithromycin.
MEDICATION DOSAGE
Bismuth 30ml liquid 3-4 times daily
Metronidazole 250mg 4 times daily
Tetracycline 500mg 4 times daily
Rabeprazole 20mg twice daily
Esomeprazole 40mg once daily
Omeprazole 20mg twice daily
Rabeprazole 20mg twice daily