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1.3.1 H2-receptor antagonists, chelates and complexes

1.3.1 H2-receptor antagonists

Cimetidine tablets, syrup

Ranitidine tablets, syrup, injection, dispersible tablets

Notes:

1. Ranitidine IV should not be used in the managment of acute GI Bleeds.

2. These drugs have similar healing rates when used to treat duodenal and benign gastric ulceration. Choice should be made on the basis of safety and cost.

3. Ranitidine should be used in preference to cimetidine in patients currently taking warfarin, phenytoin, aminophylline or theophylline and those with a history of confusion.

4. Ranitidine injection should be diluted in 20mls Sodium Chloride 0.9% and given over a minimum of two minutes.

 

1.3.3 Chelates and complexes

Pepto-Bismol tablets – for use in Helicobacter pylori eradication regimens (Full Guideline) only
Sucralfate suspension, tablets 

Notes:

Sucralfate is potentially useful in severe GORD, or post-cholecystectomy, alongside of PPIs, where there is bile acid reflux. Also, after endoscopic oesophageal variceal sclerotherapy / banding-induced ulcer, especially if they are deep and large

 

1.3.4 Prostaglandin analogues

Misoprostol tablets

Notes:

1. There is no justification for routine prophylactic prescriptions of misoprostol in all patients taking NSAIDs. It should be considered only in the elderly and in those with a previously documented chronic gastric ulcer.

2. Proton Pump Inhibitors can also be used as prophylaxis in high risk patients who require continued NSAID therapy.

Link to the BNF section: 1.3.1 H2-receptor antagonists