Anti Ulcerent Drugs

Brand Name: Seclo(sqaure),PPI(ACME),cOSEC(drug),

Losectil(SKF),Omenix(incepta),

Omep(Aristopharma),Procap(orion)

Preparation: 10/20 mg cap, 40mg Inj

Oral
Peptic ulcer
Adult: 20 or 40 mg/day in severe cases for 4 wk (duodenal ulcer)

or for 8 wk (gastric ulcer).
Maintenance: 10-20 mg/day.
All doses to be taken once in the morning.

NSAID-associated ulceration
Adult: 20 mg once in the morning.

Gastro-oesophageal reflux disease
Adult: 20 mg/day for 4 wk may continue for another 4-8 wk

if necessary. Refractory oesophagitis:

40 mg/day.
Maintenance: 20 mg/day (after healing of oesophagitis); 10

mg/day (acid reflux).

All doses to be taken once in the morning.

Zollinger-Ellison syndrome
Adult: Initially, 60 mg once in the morning, adjust as required.

Dose Range: 20-120 mg/day.
Doses >80 mg are administered in 2 divided doses.

Prophylaxis of acid aspiration during general anaesthesia
Adult: 40 mg given in the evening and another 40 mg

2-6 hr pre-op.

Acid-related dyspepsia
Adult: 10 or 20 mg once in the morning for 2-4 wk.

Erosive oesophagitis
Adult: 20 mg/day for 4-8 wk. Maintenance of healing:

20 mg/day for up to 12 mth.
All doses to be taken once in the morning.

H.pylori infection
Adult: As triple therapy: 20 mg bid or 40 mg once daily

combined w/ amoxicillin 500 mg

and metronidazole 400 mg both tid or combined w/

clarithromycin 250 mg and metronidazole 400 mg

(or tinidazole 500 mg) both bid or combined w/

amoxicillin 1 g and clarithromycin 500 mg both bid.
Duration: 7 or 10 days.
As 2-wk dual therapy: 20 mg bid or 40 mg/day

combined w/ either amoxicillin 750 mg

to 1 g bid or w/ clarithromycin 500 mg tid.

Intravenous
Gastro-oesophageal reflux disease; Gastric and

duodenal ulcers; NSAID-associated ulceration
Adult: 40 mg once daily infused over 20-30 min or

slow inj over 5 min until oral admin is possible.

Zollinger-Ellison syndrome
Adult: Initially, 60 mg/day, adjust according to

response. Daily doses >60 mg/day

should be given in 2 divided doses.

Elderly: No dosage adjustment needed.

Hepatic impairment: 10-20 mg/day.

Oral
GERD
Indicated for treatment of GERD
<1 year: Safety and efficacy not established

> 1 year
5-10 kg: 5 mg PO qDay
10-20 kg: 10 mg PO qDay
>20 kg: 20 mg PO qDay

Erosive Esophagitis
Indicated for treatment and to maintain healing

of erosive esophagitis

caused by acid-mediated GERD
<1 month: Safety and efficacy not established

Aged 1 month to <1 year
3 to <5 kg: 2.5 mg qDay
5 to <10 kg: 5 mg qDay
>10 kg: 10 mg qDay
May treat for up to 6 weeks

Aged 1-16 years
5 to <10 kg: 5 mg PO qDay
10 to <20 kg: 10 mg PO qDay
>20 kg: 20 mg PO qDay
May treat for 4-8 weeks

Renal impairment: No dosage adjustment needed.

Delayed-release cap: Should be taken on an empty

stomach. Take at least 1 hr before meals.

Swallow whole, do not chew/crush. For patients w/

difficulty swallowing, cap may be carefully

opened & entire contents sprinkled in a spoonful 

of applesauce. Swallow drug/food mixt w/o

chewing immediately after prep. Drug/food mixt

should not be stored for future use.

Powd for oral susp: Should be taken on an empty

stomach. Take on an empty

stomach at least 1 hr before a meal.
MUPS tab: May be taken with or without food.
Cap: Should be taken with food. Take immediately

before a meal.

Peptic ulcer, H. pylori infection, Gastro-oesophageal

reflux disease, Zollinger-Ellison syndrome,

Oesophagitis, Acid-related dyspepsia,

NSAID-associated ulceration

Known hypersensitivity to any of its component.

1-10%
Headache (7%),Abdominal pain (5%),Diarrhea (4%),

Nausea (4%),Vomiting (3%),Flatulence (3%)

,Dizziness (2%),Upper respiratory infection (2%),

Acid regurgitation (2%),Constipation (2%),

Rash (2%),Cough (1%)

Frequency Not Defined
Fracture of bone, osteoporosis-related,

Hepatotoxicity (rare),

Agranulocytosis,Anorexia,Gastric polyps

,Hip fracture,Alopecia,Atrophic gastritis,

Interstitial nephritis (rare),

Pancreatitis (rare),Rhabdomyolysis

,Taste perversion,Abnormal dreams,Toxic

epidermal necrolysis (rare)

Potentially Fatal: Anaphylaxis.

Proton Pump Inhibitor

Category: Not Classified
pregnancy_description

Omeprazole is a substituted benzimidazole gastric

antisecretory agent and is also known as PPI.

It blocks the final step in gastric acid secretion by

specific inhibition of H+/K+ ATPase enzyme

system present on the secretory surface of the

gastric parietal cell. Both basal and

stimulated acid are inhibited.

Increased risk of hypomagnesaemia w/ diuretics.

May increase INR and prothrombin time w/ warfarin.

Increased risk of digoxin-induced cardiotoxic effects.

May increase plasma concentration benzodiazepines

(e.g. diazepam), clarithromycin and methotrexate.

Decreased absorption of itraconazole, ketoconazole,

posaconazole, dasatinib, iron salts. May prolong elimination

of diazepam, cilostazol, phenytoin and ciclosporin.

May reduce the antiplatelet effect of clopidogrel.

Potentially Fatal: May decrease plasma concentrations and

pharmacological effects of rilpivirine, nelfinavir and atazanavir.

Per Unit Price: Tk. 4.03
Package: 96's pack

GERD Without Erosive Esophagitis
20 mg PO qDay for 4 weeks; consider an additional 4 weeks of treatment if

symptoms do not resolve completely in the first 4 weeks

GERD With Erosive Esophagitis
20-40 mg PO qDay for 4-8 weeks

If oral therapy inappropriate or not possible: 20-40 mg qDay IV up to 10 days;

switch to PO once patient able to swallow
Maintenance: 20 mg PO qDay for up to 6 months

Risk Reduction of NSAID-Associated Gastric Ulcer
20-40 mg PO qDay for up to 6 months

NSAID-Induced Gastric Ulcer
20 mg PO qDay for 4-8 weeks

Zollinger-Ellison Syndrome
80 mg PO divided q12hr (initial); adjust regimen to efficacy; up to 240 mg PO qDay, OR
120 mg PO q12hr administered to patients

Elderly: No dosage adjustment needed.

Hepatic Impairment
Oral administration
Mild to moderate (Child-Pugh A/B): No dosage adjustment required
Severe (Child-Pugh C): Not to exceed 20 mg/day

GERD Without Erosive Esophagitis
Oral
<1 year: Safety and efficacy not established
1-12 years: 10-20 mg PO qDay for up to 8 weeks
>12 years: 20-40 mg PO qDay for up to 8 weeks

GERD With Erosive Esophagitis (Healing)
<1 month: Safety and efficacy not established

1 month to 1 year
3.5 kg: 2.5 mg PO qDay for up to 6 weeks
>3.5-7.5 kg: 5 mg PO qDay for up to 6 weeks
>7.5 kg: 10 mg PO qDay for up to 6 weeks

1-12 years
<20 kg: 10 mg PO qDay for 8 weeks
>20 kg: 10-20 mg qDay for 8 weeks

>12 years
20-40 mg PO qDay for 4-8 weeks
Maintenance: 20 mg PO qDay up to 6 months

Renal impairment: No dosage adjustment needed.

Delayed-release cap: Should be taken on an empty stomach. Take on an

empty stomach 1 hr before meals.
Tab: May be taken with or without food.

Heartburn, Acid Related Dyspepsia, Peptic ulcer disease, Zollinger-Ellison syndrome,

Gastroesophageal reflux disease (GERD), Helicobacter pylori infection, Erosive Esophagitis,

Gouty arthritis, Duodenal and Gastric Ulcer.

Esomeprazole is contraindicated in patients with known hypersensitivity to any

component of the formulation or to substituted Benzimidazoles.

>10%
Headache (2-11%)

1-10%
Flatulence (10%),Indigestion (6%),Nausea (6%),Abdominal pain (1-6%),Diarrhea (2-4%),Xerostomia (3-4%),

Dizziness (2-3%),Constipation (2-3%),Somnolence (1-2%),Pruritus (1%)

<1%
Blood and lymphatic system disorders: Agranulocytosis, pancytopenia
Blurred vision,
GI disorders: Pancreatitis, stomatitis, microscopic colitis
Hepatobiliary disorders: Hepatic failure, hepatitis with or without jaundice
Anaphylactic reaction/shock
GI candidiasis
Hypomagnesemia

Musculoskeletal disorders: Muscular weakness, myalgia, bone fracture
Nervous system disorders: Hepatic encephalopathy, taste disturbance
Psychiatric disorders: Aggression, agitation, depression, hallucination
Interstitial nephritis
Gynecomastia
Bronchospasm

Skin and subcutaneous tissue disorders: Alopecia, erythema multiforme, hyperhidrosis,

photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis (sometimes fatal fatal)

Proton Pump Inhibitor

Category: Not Classified
pregnancy_description

Esomeprazole is a PPI that suppresses gastric acid secretion by inhibiting H+/K+ ATPase

in the gastric parietal cell. It is the S-isomer of omeprazole.

Increased risk of digoxin-induced cardiotoxic effects. Increased risk of hypomagnesaemia w/

diuretics. May increase INR and prothrombin time w/ warfarin. May increase serum

concentration of tacrolimus, saquinavir, methotrexate. May interfere the elimination of

drugs metabolised by CYP2C19 (e.g. diazepam). May decrease the bioavailability of

ketoconazole, erlotinib and Fe salts. Potentially Fatal: May decrease serum concentration

and pharmacological effects of rilpivirine, atazanavir and nelfinavir. May decrease the

antiplatelet effects of clopidogrel.

Per Unit Price: Tk. 7
Package: 90's pack

Erosive Esophagitis Associated With GERD
Treatment: 40 mg PO qDay for 8-16 weeks
Maintenance of healing: 40 mg PO qDay
Alternatively, 40 mg IV qDay for 7-10 days

Short-term Treatment of GERD
Oral therapy inappropriate or not possible: 40 mg

IV infusion over 15 minutes qDay

for 7-10 days; switch to PO once patient able to swallow

Zollinger-Ellison Syndrome
40 mg PO qDay; up to 240 mg/day administered in

some patients
80 mg IV infusion q8-12hr up to 7 days; switch to

PO once patient able to swallow

Peptic Ulcer Disease
Duodenal ulcer: 40 mg PO qDay for 2-4 weeks
Gastric ulcer: 40 mg PO qDay for 4-8 weeks

Elderly: No dosage adjustment needed.

Hepatic impairment: Max: 20 mg/day or 40 mg on

alternate days.

Erosive Esophagitis Associated With GERD
<5 years: Safety and efficacy not established
>5 years
15 kg to <40 kg: 20 mg PO qDay for up to 8 weeks
40 kg or greater: 40 mg PO qDay for up to 8 weeks

Renal impairment: No dosage adjustment needed.

Controlled-release: Should be taken on an empty

stomach. Take 1 hr

before meals. Swallow whole, do not chew/crush.
Normal release: May be taken with or without food.

IV Preparation
GERD with a history of erosive esophagitis
15-min infusion: Reconstitute with 10 mL NS, THEN

further dilute with 100 mL D5W, NS,

or LR to final concentration of 0.4 mg/mL

Zollinger-Ellison syndrome
15-min infusion: Reconstitute each vial with

10 mL NS, THEN
Combine 2 vials and further dilute with 80 mL D5W,

NS, or LR to total volume of 100 mL

(concentration 0.8 mg/mL)
2-min injection: Reconstitute with 10 mL NS to

final concentration of 4 mg/mL

IV Administration
Infuse over 15 min no more than 3 mg/min

(7 mL/min) for GERD and 6 mg/min (7 mL/min) for

pathologic hypersecretory conditions

Peptic ulcer disease, H. pylori infection,

Gastro-oesophageal reflux disease,

Zollinger-Ellison syndrome,

Oesophagitis, Acid-related dyspepsia,

NSAID-associated ulceration, ulcer resistant to H2 receptor

antagonists, Gastrointestinal (GI) bleeding from

stress, Prophylaxis for acid aspiration syndrome

during induction of anaesthesia

Concomitant use w/ rilpivirine, atazanavir and nelfinavir.

Lactation.

1-10%
Headache (>4%),Abdominal pain (4%),Facial edema (<4%),

Generalized edema (<2%),Chest pain (4%),

Diarrhea (4%),Constipation (<4%),Pruritus (4%),Rash (4%),

Flatulence (<4%),Hyperglycemia (1%),

Nausea (1%),Vomiting (>4%),Photosensitivity (<2%)

Frequency Not Defined
Angioedema,Atrophic gastritis,Anterior ischemic optic neuropathy,

Hepatocellular damage leading to

hepatic failure,Interstitial nephritis,Pancreatitis,Pancytopenia,

Rhabdomyolysis,Risk of anaphylaxis,

Stevens-Johnson syndrome,Fatal toxic epidermal necrolysis,

Erythema multiforme

Proton Pump Inhibitor

Category: Not Classified
pregnancy_description

Pantoprazole is a substituted benzimidazole, and also known

as PPI due to its property to block the

final step of acid secretion by inhibiting H+/K+ ATPase enzyme

system in gastric parietal cell. Both

basal and stimulated acid are inhibited.

Increased risk of digoxin-induced cardiotoxic effects. Increased

risk of hypomagnesaemia w/ diuretics.

May increase INR and prothrombin time of warfarin. May increase

serum concentration of methotrexate

and saquinavir. Delayed absorption and decreased bioavailability w/

sucralfate. Decreased absorption of

ketoconazole, itraconazole. Potentially Fatal: May decrease serum

levels and pharmacological effects

of rilpivirine, atazanavir and nelfinavir.

Per Unit Price: Tk. 5
Package: 70's pack

Oral
Gastro-oesophageal reflux disease
Adult: 20 mg daily for 4-8 wk. Maintenance:

10 or 20 mg/day.

All doses to be taken once in the morning.

Zollinger-Ellison syndrome
Adult: Initially, 60 mg once in the morning, adjusted

to max dose of 120 mg/day

if needed. Daily doses >100 mg should be given in

2 divided doses.

Peptic ulcer
Adult: 20 mg once in the morning for 4-8 wk

(duodenal ulcer) or for 6-12 wk (gastric ulcer).

H.pylori infection
Adult: 1-wk triple therapy: 20 mg bid combined w/

clarithromycin 500 mg bid and amoxicillin

1 g bid or combined w/ clarithromycin 250 mg

bid and metronidazole 400 mg bid.

Erosive oesophagitis
Adult: 20 mg/day for 4-8 wk. May continue for

another 8 wk if healing is incomplete.

Maintenance: 10 or 20 mg/day. All doses to

be taken once in the morning.

Elderly: No dosage adjustment needed.

Hepatic impairment: No dosage adjustment needed.

Delayed-release capsule (sprinkles)
<1 year: Safety and efficacy not established
1-11 years (<15 kg): 5 mg PO qDay 30 minutes

before a meal, for up to 12 weeks;

may increase to 10 mg/day if inadequate response
1-11 years (>15 kg): 10 mg PO qDay 30 minutes

before a meal, for up to 12 weeks

Gastroesophageal Reflux Disease
Delayed-release tablet
<12 years: Safety and efficacy not established
>12 years: 20 mg PO qDay for up to 8 weeks

Renal impairment: No dosage adjustment needed.

Administer with or without meals

Peptic ulcer disease, H. pylori infection,

Gastro-oesophageal reflux disease,

Paediatric GERD

Rabeprazole is contraindicated in patients with

known hypersensitivity to Rabeprazole,

other PPIs or to any component of the formulation.

1-10%
Headache (2-10%),Constipation (2%),Diarrhea (2-5%),

Flatulence (3%),Pain (3%),

Pharyngitis (3%),Abdominal pain (4%)

<1%
Agitation,Agranulocytosis,Alopecia,Anemia,

Angioedema,Chest pain,Delirium,Erythema,

Hypokalemia,Hypomagnesemia,Hyponatremia,

Jaundice,Leukocytosis,

Leukopenia,Migraine,Osteoporosis related fracture,

Rhabdomyolysis,Stevens-Johnson

syndrome,Sudden death,Toxic epidermal necrolysis,

Abnormal taste

Proton Pump Inhibitor

Category: Not Classified
pregnancy_description

Rabeprazole is a PPI that suppresses gastric acid

secretion by inhibiting H+/K+ ATPase

at the secretory surface of the gastric parietal cell.

May decrease serum concentration of ketoconazole,

itraconazole and clopidogrel. Increased

risk of hypomagnesaemia w/ diuretics and digoxin.

May increase prothrombin time and INR of warfarin.

May increase plasma concentration of saquinavir and

methotrexate. Decreased serum levels w/ sucralfate.

Potentially Fatal: May decrease plasma concentrations

and pharmacological effects of rilpivirine and atazanavir.

Per Unit Price: Tk. 5
Package: 60's pack

Oral
Benign gastric and duodenal ulceration
Adult: 40 mg daily at bedtime for 4-8 wk or 20 mg bid. Maintenance:

20 mg at bedtime to prevent recurrence of duodenal ulceration.

Gastro-oesophageal reflux disease
Adult: 20 mg bid for 6-12 wk or up to 40 mg bid if there is oesophageal ulceration.

Maintenance: 20 mg bid to prevent recurrence.

Zollinger-Ellison syndrome
Adult: Initially, 20 mg 6 hrly, up to 800 mg/day if necessary.

Non-ulcer dyspepsia ; Heartburn
Adult: 10-20 mg once or bid.

Peptic Ulcer
1-16 years: 0.5 mg/kg PO at bedtime; not to exceed 40 mg/day

Gastroesophageal Reflux Disease
<3 months: 0.5 mg/kg PO once daily for up to 8 weeks
3-12 months: 0.5 mg/kg PO q12hr for up to 8 weeks
1-16 years: 1 mg/kg/day PO divided q12hr; individual dose not to

exceed 40 mg

Heartburn
<12 years: Not established
>12 years: 10-20 mg q12 hr; may take 15-60 min before eating foods that

could cause heartburn

Renal impairment:
CrCl (ml/min) Dosage Recommendation
<50 Reduce the dose by half or increase dosing interval to 36-48 hr.

May be taken with or without food.

Reconstitution: For IV inj: Famotidine 20 mg is diluted to a total of 5 or 10 mL w/

NaCl 0.9% inj or dextrose 5% or 10% inj, lactated Ringer's, water for inj soln to provide

a soln containing approx 4 or 2 mg/mL, respectively.
For intermittent IV infusion: Famotidine 20 mg is added to dextrose 5% inj 100 mL or

NaCl 0.9% inj, lactated Ringer's soln, water for inj soln to provide a soln containing

approximately 0.2 mg/mL.

IV Administration
Infuse at rate no faster than 10 mg/min

Heartburn, Peptic ulcer, Dyspepsia, Urticaria, Zollinger-Ellison syndrome,

Gastroesophageal reflux disease (GERD)

Hypersensitivity.

1-10%
Headache (4.7%),Diarrhea (1.7%),Dizziness (1.3%),Constipation (1.2%)

Frequency Not Defined
Body as a whole: Fever, asthenia, fatigue
Cardiovascular: Arrhythmia, AV block, palpitation; prolonged QT interval in patients

with impaired renal function, has been reported very rarely
Gastrointestinal: Cholestatic jaundice, hepatitis, liver enzyme abnormalities, vomiting,

nausea, abdominal discomfort, anorexia, dry mouth
Hematologic: Rare cases of agranulocytosis, pancytopenia, leukopenia, thrombocytopenia
Hypersensitivity: Anaphylaxis, angioedema, orbital or facial edema, urticaria, rash,

conjunctival injection
Musculoskeletal: Rhabdomyolysis, musculoskeletal pain including muscle cramps, arthralgia

Nervous system/psychiatric: Grand mal seizure; psychic disturbances, which were

reversible in cases for which follow-up was obtained, including hallucinations, confusion,

agitation, depression, anxiety, decreased libido; paresthesia; insomnia; somnolence;

convulsions, in patients with impaired renal function, have been reported very rarely
Respiratory: Bronchospasm, interstitial pneumonia
Skin: Toxic epidermal necrolysis/Stevens-Johnson syndrome (very rare), alopecia,

acne, pruritus, dry skin, flushing
Special senses: Tinnitus, taste disorder

Rare cases of impotence and rare cases of gynecomastia

H2 antagonists

Category: Not Classified
pregnancy_description

Famotidine competitively blocks histamine at H2-receptors thus reducing basal, nocturnal and

stimulated gastric acid secretion. Pepsin secretion is reduced resulting in decreased peptic activity.

Antacids slightly decrease the bioavailability of famotidine. May reduce serum concentration

of ketoconazole and itraconazole.

Per Unit Price: Tk.
Package: 50's / 100's pack

Adult: PO Gastric Hyperacidity, Heartburn: Up to 1 g/day.

Hyperphosphataemia in chronic renal failure Up to 10 g/day in divided doses

w/ meals.

10-20 mL PO between meals & qHS

May be taken with or without food.

Heartburn, Reflux oesophagitis, Hyperacidity, Peptic ulcer, Constipation, Indigestion

Hypersensitivity to aluminium salts.

>10%
Aluminum oxide,Chalky taste,Constipation,Fecal impaction,Stomach cramps

Frequency Not Defined
Aluminum oxide,Nausea,Vomiting,Aluminum intoxication,Hypophosphatemia,Osteomalacia,

Magnesium oxide,Diarrhea,Hypermagnesemia

Antacids

Category: C
pregnancy_description

Alumunium hydroxide acts on the HCl in the stomach by neutralization, forming

aluminium chloride salt

and water. Magnesium hydroxide increases peristaltic activity causing osmotic retention

of fluids, thus resulting in bowel evacuation. It also reduces stomach acid by reacting with

hydrochloric acid to form Mg chloride.

Aluminium Hydroxide: Enhanced absorption with citrates or ascorbic acid. Decreases absorption

of allopurinol, tetracyclines, quinolones, cephalosporins, biphosphonate derivatives, corticosteroids,

cyclosporin, delavirdine, Fe salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine,

phosphate supplements, phenytoin, phenothiazines, trientine. Magnesium Hydroxide: Decreases

absorption of tetracyclines and biphosphonates. Separate administration of these and other drugs

by around 2 hr.

Per Unit Price: Tk. 1
Package: 200's pack