Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
GERD/erosive esophagitis. Hypersecretory conditions, including Zollinger-Ellison syndrome. With amoxicillin and clarithromycin to eradicate Helicobacter pylori in duodenal ulcer disease or history of duodenal ulcer disease. Decrease risk of gastric ulcer during continuous NSAID therapy.
Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. Healing of duodenal ulcers. Decreased incidence of gastric ulcer during continuous NSAID therapy.
Adverse Reactions/Side Effects
CNS: headache. GI: abdominal pain, constipation, diarrhea, dry mouth, flatulence, nausea.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.
Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.
Instruct patient to report bothersome or prolonged side effects, including headache or GI effects (nausea, constipation, diarrhea flatulence, abdominal pain, dry mouth).
Absorption: 90% absorbed following oral administration; food decreases absorption.
Metabolism and Excretion: Extensively metabolized by the liver (cytochrome P450 [CY P450] system, primarily CYP2C19 isoenzyme); <1% excreted unchanged in urine.
Contraindicated in: Hypersensitivity; OB: Lactation (not recommended).
Use Cautiously in: Severe hepatic impairment (daily dose should not exceed 20 mg); Geri: Increased risk of hip fractures in patients using high doses for >1 year; OB: Pregnancy (use only if clearly needed); Pedi: Children <1 yr (safety not established).
Drug-Drug: May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin, iron salts, and digoxin. May ↑ risk of bleeding with warfarin (monitor INR and PT).
Gastroesophageal Reflux Disease
PO (Adults): Healing of erosive esophagitis—20 or 40 mg once daily for 4–8 wk; maintenance of healing of erosive esophagitis—20 mg once daily; symptomatic GERD—20 mg once daily for 4 wk (additional 4 ...