Profilaxis para sangrado gastrointestinal en pacientes del servicio de medicina interna de un hospital universitario / Gastrointestinal bleeding prophylaxis in internal medicine patients of a univeristy hospital

Introducción: Los medicamentos antiulcerosos son utilizados frecuentemente en pacientes hospitalizados, sin embargo, a menudo este uso no está indicado. Objetivo: Describir la frecuencia de prescripción e indicación de medicamentos para prevenir el sangrado gastrointestinal en pacientes hospitalizados. Materiales y métodos: Estudio de corte trasversal, descriptivo, prospectivo del servicio de Medicina Interna de la Sociedad de Cirugía de Bogotá- Hospital de San José de Bogotá, Colombia. Se excluyeron pacientes con diagnóstico de sangrado gastrointestinal o antecedente de alergia a los medicamentos antiulcerosos. Se recolectaron datos demográficos, así como fármacos prescritos. Se determinó si la indicación del fármaco era adecuada y se identificó el tipo de error de prescripción. Resultados: Se incluyeron 179 pacientes, 102 (57%) mujeres. Promedio de edad de 61,3 años (±20,2). El principal diagnóstico de ingreso fue enfermedad infecciosa 76 (42,4%). Del total de pacientes, 165 (92,17%) recibieron medicamento para prevención del sangrado gastrointestinal. La indicación fue adecuada en 75 pacientes (41,89%). El error más frecuente fue el uso en pacientes de bajo riesgo de sangrado, 101 (97,1%). Conclusión: Un alto porcentaje de los pacientes recibió medicación para la prevención del sangrado gastrointestinal. En aproximadamente la mitad de estos no estaba indicada.

Introduction: Anti-ulcer medications are frequently used in hospitalized patients, yet their use is not usually indicated. Objective: To describe the frequency of prescription and indication of medications to prevent gastrointestinal bleeding in hospitalized patients. Materials and methods: A cross-sectional, descriptive, prospective study was carried out in the Internal Medicine service of the Surgery Society of Bogota-San Jose Hospital of Bogota (Colombia). Excluded patients were those with either a gastrointestinal bleeding diagnosis or a history of allergy to anti-ulcer medications. Demographic data and information regarding prescribed medications were collected. It was determined whether the medicine indication was adequate and the type of prescription error was identified. Results: 179 patients were included in the study, 57% (102) of which were women. The average age was 61.3 (±20.2) years old. Infectious disease was the main admission diagnosis (76; 42.4%). A 92.17% (165) of the total number of patients received medications to prevent gastrointestinal bleeding. This indication was adequate for 75 (41.89%) patients. The most frequent error was their use in bleeding low-risk patients (101; 97.1%). Conclusion: A high percentage of patients received medication to prevent gastrointestinal bleeding. However, in about half of these patients it was not indicated.

Drug utility pattern of antiulcer agents used in osteoarthritis patients at tertiary care hospital

Background: Osteoarthritis is the most common form of joint disease and the leading cause of pain in elderly people. Osteoarthritis (OA) is a progressive and painful chronic disease that mainly affects knee, hand and hip joints.Aim of study was to evaluate current trend of antiulcer drugs and to assess the group of antiulcer agents use in osteoarthritis patient.Methods: A prospective observational study was conducted in a tertiary care hospital for period of twelve months in collaboration with department of orthopaedics. Patients data recorded in case report form and analysed to study prescription pattern and related information Results: Total of 630 cases were enrolled in this study. Prescribed antiulcer drugs in OA were ranitidine, omeprazole, pantoprazole, rabeprazole, sucralfate and esomeprazole. Most commonly prescribed drug was Ranitidine i.e. 80.79% followed by omeprazole i.e. 8.42% pantoprazole i.e. 3.97% rabeprazole i.e. 3.81%, sucralfate i.e. 2.53% and esomeprazole i.e. 0.48% respectively. In this study, the commonest group prescribed was H2 blockers i.e. 80.79% followed by proton pump inhibitors i.e. 16.68%, and ulcer healing agent i.e. 2.53% respectively.Conclusions: Most commonly prescribed drug was ranitidine followed by omeprazole, pantoprazole, rabeprazole, sucralfate and esomeprazole respectively. In this study, the commonest group prescribed was H2 blockers followed by proton pump inhibitors, and ulcer healing agent respectively.

Efficacy and Safety of AlbisD Compared With Omeprazole 20 mg in Patients With Non-erosive Reflux Disease: A Randomized, Open-label, Active-controlled, Pilot Study

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are frequently used to treat non-erosive reflux disease (NERD), but their effect is limited. It is not known whether a potential alternative, AlbisD, containing ranitidine hydrochloride, sucralfate hydrate, and tripotassium dicitrato bismuthate, is effective and safe in treating NERD. The aim of the study is to evaluate the efficacy and safety of AlbisD compared with omperazole in patients with NERD. METHODS: This was a multicenter, randomized, open-label, parallel-group, non-inferiority comparative study. A total of 126 patients with NERD were randomly allocated to either AlbisD twice daily or omeprazole 20 mg once daily for 4 weeks from February 2016 to August 2016. The study patients had histories of heartburn or regurgitation of moderate severity (> score 2) and a frequency of at least 2 episodes per week, and had no mucosal breaks of the esophagus on endoscopy. The primary efficacy variable was complete cure of heartburn at week 4. Secondary efficacy variables evaluating symptoms of heartburn and acid reflux as well as safety profiles were compared in the 2 groups at week 2 and 4 after treatment. RESULTS: A total of 113 patients completed the study (57 and 56 in AlbisD and omeprazole groups, respectively). The proportion of patients with complete cure of heartburn at week 4 was not significantly different between the AlbisD and omeprazole groups (35.1% vs 32.1% respectively, P = 0.740). There were no significant differences between the 2 groups in the any secondary variables including proportions of days without heartburn or acid reflux over 4 weeks (including daytime and nighttime). Adverse events were similarly reported in the 2 groups (7 [12.3%] vs 6 [10.7%]), and there were no serious adverse events. CONCLUSIONS: The efficacy and safety of AlibsD in treating NERD patients are not inferior to those of omeprazole. Therefore, AlbisD can be an alternative to PPIs for NERD.

Evaluation of antiulcer activity of diltiazem in rats

Background: The risk factors for patients with cardiovascular diseases and gastrointestinal diseases overlap. Majority of the patients have both problems coexistent. Thus, there is need of medicine that can be used for both the diseases.Methods: Rats weighing 150-250gm of either gender were procured for the study from central animal house. The animals were divided into 7 groups. Control group (Distilled water 2ml), diclofenac sodium (12mg/kg), diltiazem (10mg/kg), diltiazem (30mg/kg), diltiazem (60mg/kg), ranitidine (8mg/kg), ranitidine (16mg/kg). After six hours, scarification of animals was done by cervical dislocation. Size of ulcer, number of gastric ulcers, mean gastric irritancy index, ulcer index, and ulcer scoring were the parameters that were studied.Results: Diltiazem in dose of 10, 30 and 60 mg/kg showed reduction in all parameters in dose dependent manner. Diltiazem (60mg/kg) showed marked reduction in mean diameter of ulcerated surface area (0.46±0.36), number of ulcers (4.10±2.05), size of ulcers (1.07±0.48), total mucosal surface area (7.60±1.38), and total ulcerated surface area (0.263±0.3). Diltiazem (60mg/kg) showed significant reduction of the parameters as compared to other doses of Diltiazem. Also, diltiazem (60mg/kg) was comparable to Ranitidine in all the parameters. Diltiazem (60mg/kg) also showed reduction in average number of ulcers, ulcer index, mean gastric irritancy index and ulcer scoring as compared to diclofenac sodium (12mg/kg).Conclusions: Diltiazem has shown to have ulcer prevention property; this can be useful in patients having concomitant cardiovascular and gastrointestinal problems.

Anti-ulcer effect of rhizome of Curcuma longa Linn, by the method of pyloric ligation

Background: Substantial part of the world population has been known for a long time to suffer from peptic ulcer disease. In the present study, Curcuma longa, a plant belonging to the Zingiberaceae family was chosen for investigating its anti-ulcer properties.Methods: The rhizomes of Curcuma longa were collected locally. The extract was prepared by soxhlet extraction with 50% ethanol. Albino rats of Wistar strain (120-200 grams) obtained from the animal house of medical college Thiruvananthapuram were used. Ranitidine was collected from Kerala Sate Drugs and Pharmaceutical LTD Alapuzha. Antiulcer study in rats were done using the method of pyloric ligation.Results: Antiulcer study in rats using the method of pyloric ligation, extract of Curcuma longa in 1000mg/Kg dose levels exhibited significant protection against shay ulceration. The results were comparable to that of standard drug Ranitidine.Conclusions: The present study with extract of Curcuma longa revealed that it has significant anti-ulcer activity.

Symmetrical Drug-Related Intertriginous and Flexural Exanthema: Two Cases and Brief Literature Review

It has been reported that there are a range of causative drugs related to symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The causative drugs reported so far include the following: antibiotics, intravenous immunoglobulin, chemotherapeutic agents, and biologics. In this study, we report two cases of SDRIFE and a review of the previous literature. We believe that our study makes a significant contribution to the literature because it demonstrates that intradermal injection of the Chinese herbal ball, and not its topical application, elicited a reaction that predicted the occurrence of SDRIFE. This finding is important for the diagnosis of SDRIFE in future studies. Our findings also provide evidence for a SDRIFE reaction after exposure to ranitidine and mosapride.

Clinical Observation on Ceftriaxone Combined with Ranitidine in Treatment of Acute Pancreatitis / 现代生物医学进展

Objective:To investigate the clinical effect and mechanisms of ceftriaxone combined with ranitidine on the acute pancreatitis.Methods:92 cases of patients with acute pancreatitis were selected and randomly divided into the control group (n=46) and experimental group (n=46),the control group was treated with ceftriaxone,and the experimental group was treated with ranitidine based on the control group,the serum levels of intedeukin-6 (IL-6),c-reactive protein(CRP),platelet activating factor (PAF),superoxide dismutase (SOD),propylene glycol (MDA),gastric secrete element,stomach,heart rate (HR),mean arterial pressure (MAP),and the relief time of clinical manifestation and the clinical efficacy were observed and compared between the two groups.Results:After treatment,the serum levels ofIL-6,CRP,PAF,MDA,gastric secrete element and HR of experimental group were significantly lower than those of the control group (P＜0.05).The serum levels of SOD,stomach motion element and MAP of experimental group were higher than those of the control group (P＜0.05).The relief time of clinical manifestation and total efficiency of experimental group were better than those of the control group (P＜0.05).Conclusions:Ceftriaxone combined with ranitidine could effectively enhance the clinical efficacy of acute pancreatitis,which might be related to the anti-oxidation and anti-inflammation.

Physico-chemical evaluation of Gastroretentive Ranitidine Hydrochloride: An Anti-Ulcer Drug

Background  and  Objectives:  The  prevention  and  treatment  of  peptic  ulcers  has  become  an important challenge in the current medicine  world.   Modern progress in novel drug delivery system aims to improve the efficacy of the drug molecule by formulating a dosage form of RHCL. One of the most feasible approaches for achieving a prolonged and predictable drug delivery profile in GI tract is to control the gastric residence time.  Therefore, a multi-unit gastro retentive dosage form of RHCL capable of floating on simulated gastric fluid for more than 12 hours was formulated and evaluated.Materials  and  Methods:  Nine  batches  of  the  light  liquid  paraffin  entrapped  emulsion  gel  beads were  prepared  by  a  new  emulsion  gelation  technique  using  sodium  alginate  and  xanthan  gum  as polymers.  The  polymeric  solution  was  extruded  into  Calcium  chloride  solution  by  the  use  of  21G needles.  Morphology  of  beads,  drug  content,  drug  entrapment  efficiency,  floating  lag  time  and buoyancy were studied. Compatibility study of Ranitidine HCl with polymers used in the formulation was performed using DSC and FT-IR.Results:  Mean  surface  diameter  were  between  1.220  ±  2.259%  (F1)  to  1.230  ±  2.316%  (F9)  and floating lag time were between 6 minute (F9) to 11 minute (F1). All formulations were buoyant for more than 12 hours in simulated gastric  fluid  at  37ºC.  The  drug  content  and  drug  entrapment efficiency  among  the  formulations  were  between  17.48%~19.68%  and  71.06%  ~84.32% respectively. Formulation F1 showed lowest drug content and drug entrapment efficiency while F9 showed highest drug content and drug entrapment efficiency. F4 showed most acceptable sustained drug release profile.Conclusion:  The gastro retentive drug delivery system designed as floating beads was found to be satisfactory drug delivery system for Ranitidine HCl to improve the bioavailability of the drug.

ADMINISTRATION OF H2 BLOCKERS IN NSAID INDUCED GASTROPATHY IN RATS: effect on histopathological changes in gastric, hepatic and renal tissues

ABSTRACT Background Nonsteroidal anti-inflammatory drugs induces gastric mucosal lesions because of its acidic properties. Ranitidine, an H2 receptor antagonist, has proved beneficial in patients with gastric ulcers. Objective The present study was performed to assess the effect of administering ranitidine in Nonsteroidal anti-inflammatory drugs (diclofenac, nimesulide) induced gastropathy, and their effect on the histopathology of stomach, kidney and liver. Methods Diclofenac, nimesulide, and ranitidine were administered in doses of 2, 4, and 6 mg/kg, p.o. once daily for 14 days, and their effect on gastric volume, acidity, mean ulcer number, and gastric pH. In addition, histopathological examination was also performed on sections of stomach, kidney and liver. Results Following the administration of diclofenac or nimesulide, all the gastric parameters were significantly altered as well as the histopathology of stomach, liver and kidney. In the control group, the renal sections showed normal glomeruli with no thickening of glomerular basement membrane, while in diclofenac alone, nimesulide alone, and ranitidine with nimesulide groups, the thickening of glomerular basement membrane was observed. These alterations were observed to be reversed in the ranitidine with diclofenac group. In the sections from the liver, the control group showed anastomosing plates and cords of cuboidal hepatocytes with round well stained nuclei and abundant cytoplasm. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, mild dilatation of sinusoids is seen coupled with prominence of central vein. In the diclofenac alone and nimesulide alone groups, the proximal and distal convoluted tubules show mild focal tubular necrosis. In the gastric sections, the control group showed several folds forming villi, and the epithelial lining surface of the mucosa. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, the duodenum showed scattered inflammatory cells composed predominantly of lymphocytes. In diclofenac alone and nimesulide alone group, the sections from the gastric areas showed partial necrosis and mild chronic inflammation respectively. Conclusion The study, therefore, has provided therapeutic rationale towards simultaneous administration of H2 receptor blocker ranitidine with diclofenac to be more beneficial as compared to ranitidine with nimesulide, to minimise the gastric intolerance of diclofenac in long term treatment of inflammatory conditions.

RESUMO Contexto Anti-inflamatórios não esteroidais induzem lesões da mucosa gástrica devido às suas propriedades ácidas. Ranitidina, um antagonista dos receptores H2, revelou-se benéfico em pacientes com úlceras gástricas. Objetivo - O presente estudo foi realizado para avaliar o efeito da administração de ranitidina em gastropatia induzida por anti-inflamatórios não esteroidais (diclofenaco, nimesulida) e seu efeito sobre a histopatologia do estômago, dos rins e fígado. Métodos Diclofenaco, nimesulida e ranitidina foram administradas em doses de 2, 4 e 6 mg/kg, p.o. uma vez diariamente por 14 dias e seu efeito sobre o volume gástrico, acidez, significam o número de úlcera e o pH gástrico. Além disso, o exame histopatológico também foi realizado em seções do estômago, dos rins e fígado. Resultados Após a administração de diclofenaco ou nimesulida, todos os parâmetros gástricos foram significativamente alterados assim como a histopatologia do estômago, fígado e rim. No grupo controle, as seções renais mostraram glomérulos normais sem espessamento da membrana basal glomerular, enquanto em diclofenaco isolado, nimesulida isolado e grupos com ranitidina e nimesulida, foi observado espessamento da membrana basal glomerular. Estas alterações observou-se serem revertidas no grupo ranitidina com diclofenaco. As seções do fígado, o grupo controle mostrou placas e cordões de hepatócitos cuboidais anastomosados com núcleos bem demarcados e citoplasma abundante. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, leve dilatação dos sinusoides é vista acoplados com proeminência de veia central. Nos grupos diclofenaco e nimesulida sozinhos, túbulos proximais e distais contorcidos mostram necrose tubular focal leve. Nas secções gástricas, o grupo controle mostrou várias dobras formando vilosidades e a superfície do revestimento epitelial da mucosa. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, o duodeno mostrou dispersas células inflamatórias predominantemente compostas por linfócitos. Nos grupos diclofenaco e nimesulida sozinhos, as secções de áreas gástricas mostraram necrose parcial e inflamação crônica moderada respectivamente. Conclusão - O estudo, portanto, forneceu o fundamento terapêutico para administração simultânea de bloqueador de receptor H2 (ranitidina) com diclofenaco, sendo mais benéfica em comparação com ranitidina com nimesulida para minimizar a intolerância gástrica de diclofenaco no tratamento a longo prazo de condições inflamatórias.

Evaluation of the Pharmaceutical Quality of Different Brands of Ranitidine Tablets Manufactured in Bangladesh: A Pharmaceutical and Public Health Prospective.

Drug counterfeiting and production of substandard drug is a global problem. Substandard or counterfeit drugs are threat for the effective treatment of diseases and highly worsen the quality of life of patients. This study was aimed to assess the pharmaceutical quality of ranitidine hydrochloride tablets manufactured in Bangladesh. Tablets were collected from different parts of Bangladesh and quality parameters were evaluated according to the United States Pharmacopoeia and the British Pharmacopoeial methods. The potency of tablets was measured spectrophotometrically. Weight variation and disintegration time were performed according to pharmaceutical monographs. Among 43 brands tested, 8 failed to comply with the USP specification (active ingredient: 90±10%) due to containing of less amount of ranitidine of which 6 brands were spurious and 2 were substandard in nature. Two brands did not comply with the specification for weight variation of tablets whereas all brands passed disintegration time test. The findings clearly demonstrate the production of substandard ranitidine tablets in Bangladesh. The drug control authority of Bangladesh should take effective steps to prevent the production of substandard drugs to secure public health.

Pharmacoeconomic Evaluation of Pantoprazole and Ranitidine in the Treatment of Gastricesophagitis Reflux Disease / 中国药房

OBJECTIVE:To evaluate the pharmacoeconomics of pantoprazole vs. ranitidine in the treatment of gastricesophagitis reflux disease(GERD). METHODS:Retrieved from PubMed,EMBase,The Cochrane Library,CNKI,VIP and Wanfang database, RCTs about pantoprazole vs. ranitidine in the treatment of GERD were selected until Sept. 2014. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria,and extracted the data of included studies. Stata 12.0 soft-ware was used to estimate therapeutic efficacy index and cost,and cost-effectiveness analysis was performed with the decision tree model. RESULTS:A total of 7 RCTs were included,involving 1 389 patients. Cost-effectiveness analysis showed that for gradeⅠ-Ⅲ(by Savary-Miller standard)GERD,cost-effectiveness ratios of ranitidine were all lower than those of pantoprazole(gradeⅠ:18.86 vs. 57.93;gradeⅡorⅢ:35.58 vs. 146.13);gradeⅠ,Ⅱ,Ⅲincremental cost-effectiveness ratio(ICER)were 335.53,349.85,349.85. Sensitivity analysis supported this conclusion. CONCLUSIONS:Ranitidine is more economic therapy plan for gradeⅠ-Ⅲ GERD, but its ICER fluctuates greatly. Individual therapy plan should be formulated according to disease condition and economic condition.

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial / 世界急诊医学杂志（英文）

BACKGROUND:This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS:This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran?) and 40 mg pantoprazole (Pantpas?), given in a 100 mL saline solution by an intravenous rapid infusion within 2–4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS:A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4％) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4％) patients in the pantoprazole group and 8 (24.2％) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION:Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

Efficacy and Safety of Pantoprazole and Ranitidine in Treating Patients with Gastroesophageal Reflux Disease:A Meta-analysis / 医药导报

Objective To systematically review the effectiveness and safety of pantoprazole ( PAN ) vs. ranitidine (RAN) for patients with gastroesophageal reflux disease (GERD). Methods PubMed,Medline,EMbase,The Cochrane Library and three Chinese literature databases (CNKI,VIP and Wan fang) were retrieveed.Randomized controlled trials (RCTs) which compared the clinical outcomes of PAN group vs. RAN group for GERD were included. Two reviewers independently screened literatures in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodological quality of included studies.Then,meta-analysis was performed using RevMan 5.2 software. Results A total of 8 RCTs involving 1 590 patients were included.The results of meta-analysis showed that the PAN group was significantly superior to RAN group in terms of the healing rates and the relief rates of chief symptom for GERD of gradeⅠ-Ⅲ. While there was no significant difference in the incidence of adverse events between the two groups [GradeⅠ,RR=1.17,95%CI (0.80,1.70),P=0.43;GradeⅡorⅢ, RR=0.76,95%CI (0.43,1.36);P=0.36]. Conclusion Current evidence indicates that,pantoprazole is more effective than ranitidine for GERD of grade Ⅰ-Ⅲ,but both treatments are safe and well tolerated.

Efficacy of proton pump inhibitors and H2 blocker in the treatment of symptomatic gastroesophageal reflux disease in infants / 소아과

PURPOSE: Gastroesophageal reflux disease (GERD) occurs in pediatric patients when reflux of gastric contents presents with troublesome symptoms. The present study compared the effects of omeprazole and ranitidine for the treatment of symptomatic GERD in infants of 2-12 months. METHODS: This study was a clinical randomized double-blind trial and parallel-group comparison of omeprazole and ranitidine performed at Children Training Hospital in Tabriz, Iran. Patients received a standard treatment for 2 weeks. After 2 weeks, the patients with persistent symptoms were enrolled in this randomized study. RESULTS: We enrolled 76 patients in the present study and excluded 16 patients. Thirty patients each were included in group A (ranitidine) and in group B (omeprazole). GERD symptom score for groups A and B was 47.17±5.62 and 51.93±5.42, respectively, with a P value of 0.54, before the treatment and 2.47±0.58 and 2.43±1.15, respectively, after the treatment (P=0.98). No statistically significant differences were found between ranitidine and omeprazole in their efficacy for the treatment of GERD. CONCLUSION: The safety and efficacy of ranitidine and omeprazole have been demonstrated in infants. Both groups of infants showed a statistically significant decrease in the score of clinical variables after the treatment.

Effect of Pithecellobium dulce (Roxb.) Benth. fruit extract on cysteamine induced duodenal ulcer in rats.

The edible fruits of Pithecellobium dulce (Roxb.) Benth. are traditionally used for various gastric complications in India. Here, we investigated the antiulcer activity of hydroalcoholic fruit extract of P. dulce (HAEPD) by applying cysteamine induced duodenal ulcer model in rats. Duodenal ulcer was induced in male albino Wistar rats by oral administration of cysteamine @ 420 mg/kg body wt. as a single dose. The rats were pre-administered orally with HAEPD @ 200 mg/kg body wt. for 30 days prior to ulcer induction. Rats pre-administered with ranitidine @ 30 mg/kg body wt. served as reference drug control. Ulcer score, thiobarbituric acid reactive substances (TBARS), glycoproteins, superoxide dismutase, catalase and glutathione peroxidase and reduced glutathione levels were measured in the duodenum. Rats pre-administered with the HAEPD showed significantly reduced ulcer score comparable to that of ranitidine pretreated rats. The co-administration of HAEPD lowered the TBARS level and also restored the levels of glycoproteins, enzymatic and non-enzymatic antioxidants. Histopathological observations confirmed the presence of inflammation, necrosis and hemorrhagic spots in the duodenum of ulcer control rats which were significantly reduced due to HAEPD treatment. No abnormal alterations were observed in normal rats treated with HAEPD at the dosage studied. The results demonstrated antioxidant and cytoprotective nature of P. dulce, and thereby its significant anti ulcer property.

Uso de inhibidores de la bomba de protones y antagonistas de los receptores H2 de histamina como profilaxis en úlceras por estrés: ¿una práctica justificada? / Use of proton pump inhibitors and Histamine-2 receptor antagonists in stress ulcers: a justified practice? / Uso de inibidores da bomba de prótons e antagonistas dos receptores H2 de histamina como profilaxia em úlceras por estresse: uma prática justificada?

La introducción de los moduladores de acidez gástrica como profilaxis contra las úlceras por estrés en pacientes críticos se ha \r\nido convirtiendo en una práctica de rutina tanto en la unidad de cuidados intensivos como fuera de esta; sin embargo, el desco\r\n-\r\nnocimiento de la fisiopatología de la enfermedad, las indicaciones de uso de moduladores de pH como profilácticos, los riesgos \r\nasociados a la prescripción indiscriminada y de las guías disponibles sobre esta práctica han llevado a un uso descontrolado \r\nde medicamentos como omeprazol y ranitidina, lo cual aumenta los costos para los hospitales y predispone a los pacientes a \r\npresentar enfermedades como neumonía. Con el objetivo de revisar los factores de riesgo asociados a esta patología, la eficacia \r\nde esta medida, sus indicaciones y posibles complicaciones tanto dentro como fuera de las unidades de cuidados intensivos, se \r\nrealizó una revisión de la literatura. Esta incluyó artículos disponibles en diferentes bases de datos que hicieran referencia al manejo \r\nprofiláctico de úlceras por estrés desde 1980 hasta 2014. Se encontró que, según la literatura actual, el uso de la profilaxis contra \r\núlceras por estrés es una práctica muy debatida en el caso de los pacientes críticos y, lo que es más importante, en los no críticos \r\naún no existen recomendaciones de uso o factores de riesgo establecidos. Por esta razón, la extrapolación de esta conducta a \r\npacientes fuera de la unidad de cuidados intensivos es injustificada hasta el momento.

The introduction of acid gastric modulators in critical patients \r\nas prophylaxis against stress ulcers has increasingly become \r\na routine practice both in the intensive care unit and outside \r\nof it. However, lack of knowledge about topics including \r\nthe physiopathology of the disease, directions for use of pH \r\nmodulators as a prophylactic, the associated risk of over-pre\r\n-\r\nscription, and guidelines available about this practice has led \r\nto an overuse of drugs like omeprazole and ranitidine, making \r\nhospitalization more expensive and predisposing patients \r\nto diseases like pneumonia. The objective of this article is \r\nto review the risk factors associated with this pathology, the \r\nefficacy of this action, and the complications and indications \r\ninside and outside of intensive care units using all available \r\ndata through 2014. In the end we conclude that at this time \r\nand with the new evidence, the use of prophylaxis against \r\nstress ulcers in critical patients is a widely debated practice and \r\nmore importantly there are no recommendations for its use or \r\nestablished risk factors in the non-critical population, leading \r\nus to conclude that extrapolation to patients outside of inten\r\n-\r\nsive care is not justified up to date.

A introdução dos moduladores de acidez gástrica como \r\nprofilaxia contra as úlceras por estresse em pacientes críticos \r\nconverteu-se em prática de rotina tanto na unidade de cuidados \r\nintensivos como fora desta. No entanto, o desconhecimento \r\nda fisiopatologia da doença, as indicações de uso de modula\r\n-\r\ndores de pH como profiláticos, os riscos associados à prescrição \r\nindiscriminada e as orientações disponíveis sobre esta prática \r\nlevaram a um uso descontrolado de medicamentos como \r\nomeprazol e ranitidina, aumentando o custo para os hospi\r\n-\r\ntais e predispondo os pacientes a doenças como pneumonia. \r\nCom o objetivo de revisar os fatores de risco associados a esta \r\npatologia, a eficácia desta medida, suas indicações e possí\r\n-\r\nveis complicações tanto dentro como fora das unidades de \r\ncuidado intensivo, foi realizada uma revisão da literatura. Esta \r\nincluiu artigos disponíveis em diferentes bancos de dados que \r\nse referiram ao manuseio profilático de úlceras por estresse, \r\ndesde 1980 até 2014. Descobriu-se que, segundo a literatura \r\natual, o uso de profilaxia contra úlceras por estresse é uma \r\nprática muito debatida no caso dos pacientes críticos e, o que \r\né mais importante, para os não críticos ainda não existem reco\r\n-\r\nmendações de uso ou fatores de risco estabelecidos. Por este \r\nmotivo, a extrapolação desta conduta com pacientes fora da \r\nunidade de cuidados intensivos é injustificada até o momento.

Pharmacological evaluation of anti-ulcer activity of Cymbopogon fl exuosus.

Background: Peptic ulcer disease is a worldwide problem. Currently, there is no cost-effective treatment to relieve pain, heal the ulcer and prevent ulcer recurrence. Hence, there is a dire need to search and fi nd a suitable treatment from natural sources. The present study was designed to investigate the anti-ulcer activity of ethanol extract of the leaves of Cymbopogon fl exuosus. Methods: The ethanol extract of the leaves of Cymbopogon fl exuosus was prepared by hot extraction method. Anti-ulcer activity was evaluated in rats and method employed was pylorus ligation. Animals were divided into four groups of six animals each. The animals of Group I served as normal control (vehicle) which received normal saline (5 ml/kg b.wt., p.o). Group II and III received 200 and 400 mg/kg b.wt. of ethanol extract, respectively. The animals of Group IV served as standard control which received ranitidine (15 mg/kg bd.wt.). At the end of study parameters like ulcer index, free acidity, total acidity, acid volume, and pH were determined. Results: The ethanol extract showed a signifi cant reduction in the total acidity, free acidity, and acid volume. The effi cacy of plant extract at high dose was comparable with the standard drug - ranitidine. Conclusion: Our study results support the ethnomedical use of leaves of C. fl exuosus.

Comparação entre a ranitidina e o omeprazol em relação a possíveis interações medicamentosas com o clopidogrel em pacientes portadores de doenças arterial coronária estável / Possible drug interaction between clopidogrel and ranitidin or omeprazole in patients with stable coronary artery disease: a comparative study

INTRODUÇÃO: Os Inibidores de Bombas de Prótons (IBP´s) são comumente prescritos a pacientes em uso de dupla antiagregação plaquetária (DAP) com ácido acetilsalicílico (AAS) e clopidogrel. Entretanto, esta classe de medicamentos, especialmente o omeprazol, tem sido associada à redução da potência antiplaquetária do clopidogrel, levando em muitos casos ao uso de ranitidina como alternativa. MÉTODOS: Foram analisados pacientes com doença arterial coronária (DAC) estável em uso de AAS 100 mg uma vez ao dia. A agregabilidade plaquetária foi medida no momento basal e após uma semana de terapia com clopidogrel na dose de 75 mg uma vez ao dia. Após essa fase inicial, os participantes foram randomizados de modo duplo-cego e duplo-mascarado para omeprazol 20 mg duas vezes dia ou ranitidina 150 mg duas vezes ao dia, sendo os testes de agregação plaquetária novamente repetidos após uma semana. A agregabilidade foi avaliada com a utilização dos seguintes métodos: VerifyNow P2Y12® (Accumetrics - San Diego, CA, EUA, meta principal do estudo), utilizando-se Unidades de Reatividade ao P2Y12 ("P2Y12 Reactivity Units" - PRU) e Inibição Percentual da Agregabilidade (IPA) na descrição da agregabilidade; agregometria de sangue total (AST) por bioimpedância utilizando os reagentes ADP e colágeno, sendo a agregabilidade medida em Ohms; "Platelet Function Analyser" 100® (Siemens Healthcare Diagnostics®, Newark, Delaware, EUA) utilizando o cartucho de colágeno/ADP, com a agregabilidade avaliada pelo tempo de fechamento do orifício em segundos. Além disso, foi feita dosagem de tromboxano B2 (TXB2) sérico na última visita a fim de se avaliar o efeito do AAS. RESULTADOS: Oitenta e cinco pacientes foram incluídos na análise final, sendo 41 no grupo omeprazol e 44 no grupo ranitidina. Houve redução significativa da IPA após o acréscimo de omeprazol (de 26,3 ± 32,9% para 17,4 ± 33,1%; P = 0,025), enquanto o grupo ranitidina não demonstrou modificação significativa (de 32,6 ± 28,9% para...

BACKGROUND: Proton-pump inhibitors (PPIs) are often prescribed to patients taking dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and clopidogrel. However, this class of medication, especially omeprazole, has been associated with a reduction of clopidogrel efficacy, leading many to substitute omeprazole with ranitidine. METHODS: The present study analyzed patients with stable coronary artery disease (CAD) in use of ASA 100 mg daily. Platelet aggregability was measured at baseline and after one week of clopidogrel 75 mg daily. Then, the subjects were randomized, in a double-blinded, doubledummy fashion, to omeprazole 20 mg twice a day or ranitidine 150 mg twice a day. After one more week, aggregability tests were repeated. Platelet aggregability was evaluated by the following methods: VerifyNow P2Y12TM (Accumetrics - San Diego, California, USA, main endpoint of the study), with aggregability depicted as percent Inhibition of Platelet Aggregation (IPA) and as P2Y12 Reactivity Units (PRU); whole blood aggregometry by bioimpendance using ADP and collagen with aggregability measured in Ohms; and Platelet Function Analyser 100TM (Siemens Healthcare Diagnostics, Newark, Delaware, USA) using collagen/ADP cartridge with aggregability measured in time to closure in seconds. Besides that, serum thromboxane B2 dosage was done on the last visit to evaluate ASA effect. RESULTS: Eighty-five patients were included in final analysis (41 in the omeprazole group and 44 in the ranitidine group). IPA was significantly decreased after addition of omeprazole (from 26.3% ± 32.9 to 17.4% ± 33,1; P = 0.025), with no significant changes being observed in the ranitidine group (from 32.6% ± 28.9 to 30.1% ± 31.3; P = 0.310). When taking into account PRU values, there was a numerical, but statistically non-significant increase in the omeprazole group (from 159.73 ± 83.06 to 173.54 ± 72.29; P = 0.116), with a very slight difference in the ranitidine group (from 153.61 ±...

Pantoprazole and ranitidine in treatment of duodenal ulcer: a systematic review and pharmacoeconomics analysis / 中国药学杂志

OBJECTIVE: To systematically review the effectiveness and safety of pantoprazole in comparison with ranitidine for patients with duodenal ulcer, and evaluate the cost of the two drugs. METHODS: PubMed, Medline, EMbase, the Cochrane Library and three Chinese literature databases (VIP, CNKI and WanFang) were searched. Randomized controlled trials (RCTs) that compared the clinical outcomes of pantoprazole (PAN) group vs. ranitidine (RAN) group for duodenal ulcer were included. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software and cost-effectiveness analysis was performed with the decision tree model. RESULTS: A total of six RCTs involving 1 225 patients were included. The results of meta-analysis showed that PAN was superior to RAN in the 2-week or 4-week ulcers healing rates [RR = 1.61, 95% CI (1.44, 1.80), P<0.000 01 and RR = 1.18, 95% CI(1.12, 1.23), P <0.000 01, respectively]. Compared with RAN groups, PAN group had significantly higher rates of pain and gastrointestinal symptoms relief[RR = 1.31, 95% CI (1.15, 1.39); P<0.000 01 and RR = 1.18, 95% CI(1.08, 1.28), P = 0.000 3, respectively]. While there was no significant difference in the incidence of adverse events between the PAN and the RAN groups [RR = 1.35, 95% CI (0.87, 2.10), P = 0.19]. And the cost-effectiveness ratio was lower in the RAN group than in the PAN group (29.33 vs 53.90). CONCLUSION: Current evidence indicates that, pantoprazole is an effective scheme for duodenal ulcer, and ranitidine is considered as an economic choice. Both treatments are safe and well tolerated.

Metabolic profile and ruminal and abomasal pH in sheep subjected to intravenous ranitidine / Perfil metabólico ruminal e pH abomasal em ovinos tratados com ranitidina por via intravenosa

Brazilian sheep production has intensified, predisposing sheep to an increased incidence of digestive disorders, such as abomasal ulcers. Ranitidine is used to prevent and treat this disease; however, there is little information on the parenteral use of this drug in adult ruminants. Few data exist on the concomitant metabolic changes and the behavior of the digestive system associated with its use. For this study, five healthy male sheep with ruminal and abomasal cannulas were used. A 5x5 Latin square experiment with a 2x2+1 factorial arrangement of the treatments was performed. Sheep treated with drug doses of 1 or 2mg/kg ranitidine administered intravenously every 8 or 12 hours were compared with the control group, was treated intravenously with 1 mL of physiological solution per 25 kg every 12 hours. Higher total protein concentrations, hemoglobin levels, as well as increased aspartate aminotransferase activity and increased abomasal pH for up to 150 min following drug administration were observed in all animals that received the drug, regardless of dose and frequency. The animals treated every 12 hours showed a decrease in leukocyte number compared with the control group and with the animals treated every 8 hours. Increased serum creatinine concentrations were observed in the animals treated every 8 hours. Treatments of 1mg/kg every 8 hours and 2mg/kg every 12 hours increased the red blood cell count and decreased the serum pepsinogen. All protocols studied were safe for healthy sheep, but 1mg/kg ranitidine every 8 hours and 2mg/kg ranitidine every 12 hours were the most effective protocols for gastric protection.(AU)

A ovinocultura brasileira tem se intensificado, o que predispõe os animais à maior incidência de transtornos digestivos, como a úlcera de abomaso. A ranitidina é utilizada na prevenção e tratamento desta afecção, no entanto há pouca informação sobre a indicação parenteral deste fármaco para ruminantes adultos. São escassas as informações a respeito das alterações metabólicas e do comportamento do sistema digestório associados ao seu uso. Para este estudo foram utilizados cinco ovinos, machos, hígidos, providos de cânula ruminal e abomasal. O delineamento foi Quadrado Latino 5x5 com arranjo fatorial de tratamentos 2x2+1. Os ovinos tratados com as doses de 1 e 2mg/kg de ranitidina administrada por via intravenosa a cada 8 ou 12 horas foram comparados aos animais do grupo controle, tratados por via intravenosa com 1mL de solução fisiológica por 25 kg a cada 12 horas. Maiores concentrações de proteína total e hemoglobina, maiores atividades de AST e aumento do pH abomasal por até 150 minutos foram observados em todos os animais que receberam o fármaco, independentemente de dose e frequência. Os animais tratados a cada 12 horas mostraram diminuição do número de leucócitos comparados aos animais tratados a cada 8 horas e aos animais do grupo controle. Observou-se aumento das concentrações de creatinina nos animais tratados a cada 8 horas. Os tratamentos 1mg/kg a cada 8 horas e 2mg/kg a cada 12 horas aumentaram o número de hemácias e diminuíram as concentrações séricas de pepsinogênio. Todos os protocolos estudados foram seguros para ovinos sadios, porém 1mg/kg de ranitidina a cada 8 horas e 2mg/kg a cada 12 horas mostraram-se mais eficientes quanto à proteção gástrica.