Ranitidine—Bolus or infusion prophylaxis for stress ulcer

Morris, David L.; Markham, Sarah; Beechey, A. P. G.; Hicks, Fiona; Summers, Karn; Lewis, Pamela; Stannard, Victoria; Hutchinson, A. A.; Byrne, Andrew

doi:10.1097/00003246-198803000-00004

Cited by 26 publications

(6 citation statements)

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“…Intravenous ranitidine is widely used as a prophylactic agent for stress ulcer–related bleeding in patients in an ICU 10 . Different intravenous regimens, repeated bolus injections, and primed continuous infusions have been used in patients in ICUs and tested in healthy volunteers 11 , 12 , 13 , 14 , 15 , 16 , 17 . However, the clinical responses and the conclusions drawn from these trials have often been contradictory 7 , 18 .…”

mentioning

confidence: 99%

Pharmacodynamic modeling of the acid inhibitory effect of ranitidine in patients in an intensive care unit during prolonged dosing: Characterization of tolerance

Mathôt

Geus

1999

Clinical Pharmacology & Therapeutics

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mentioning

confidence: 99%

Pharmacodynamic modeling of the acid inhibitory effect of ranitidine in patients in an intensive care unit during prolonged dosing: Characterization of tolerance

Mathôt

Geus

1999

Clinical Pharmacology & Therapeutics

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“…Most studies show that 75% to 100% of patients in the ICU have abnormalities of the gastric mucosa within hours after admission [4,5,11,14,15] and that 35% to 100% of critically ill patients have gastric juice samples that test positive for blood [16,17]. However, occult blood in the gastric juice does not predict impending hemorrhage [16].…”

Section: Stress-related Injurymentioning

confidence: 99%

“…However, occult blood in the gastric juice does not predict impending hemorrhage [16]. The mucosal changes are mostly small erosions that usually do not lead to hemodynamically significant GI bleeding (Fig.…”

Section: Stress-related Injurymentioning

confidence: 99%

Stress-related mucosal disease

Spirt¹

2003

Curr Treat Options Gastro

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Stress-related mucosal disease (SRMD) includes stress-related injury (superficial mucosal damage) and stress ulcers (focal deep mucosal damage). Both types are caused by mucosal ischemia, and both show a propensity for the acid-producing corpus and fundus. Prophylaxis of stress ulcers may reduce major bleeding but, so far, has not been shown to improve survival. The most widely used drugs for stress-related injury are the intravenous histamine H(2)-receptor antagonists. Proton pump inhibitors (PPIs) are the most potent acid-suppressive pharmacologic agents. The available PPIs significantly increase gastric pH for up to 24 hours after one dose. Tolerance does not develop, and adverse effects are few. Preliminary studies have demonstrated a significant reduction in SRMD bleeding for patients receiving PPI prophylaxis. PPIs may become an effective tool for reducing the incidence of SRMD in critically ill patients.

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“…115 Continuous infusion of H 2 -receptor antagonists without a loading dose does not achieve pH control as rapidly as intermittent infusion. 161 However, control of pH is better maintained with continuous infusion provided a loading dose is given to quickly achieve concentrations 169 146 6.1 ± 4.9 yrs Critically ill 11.7 ± 5. necessary for optimal efficacy. [162][163][164] In critically ill children, gastric pH was the same regardless of whether ranitidine was given intermittently (1 mg/kg) or by continuous infusion (3.6 mg/kg/day).…”

Section: Pharmacodynamicsmentioning

confidence: 99%

Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients

Crill

Hak

1999

Pharmacotherapy

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Similar to adults, children under physiologic stress can develop an imbalance in defensive (mucosal layer, motility) and aggressive (gastric acid, bile salts, enzymes) factors responsible for maintaining a healthy gastrointestinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defensive factors, thereby permitting damage by aggressive factors to upper gastrointestinal epithelium that may progress to stress ulceration and acute upper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to developing ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by disease, gestational and postnatal age, and exposure to and type of enteral feedings, thereby confounding the development and prophylaxis of UGIB in neonates and infants. In addition, pharmacotherapy decisions are often complicated by drug administration issues and adverse effects.

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Ranitidine—Bolus or infusion prophylaxis for stress ulcer

Cited by 26 publications

References 0 publications

Pharmacodynamic modeling of the acid inhibitory effect of ranitidine in patients in an intensive care unit during prolonged dosing: Characterization of tolerance

Pharmacodynamic modeling of the acid inhibitory effect of ranitidine in patients in an intensive care unit during prolonged dosing: Characterization of tolerance

Stress-related mucosal disease

Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients

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