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     TOC   |  DRUGS  |  GI  
 

        

GI Drugs  

H2 Antagonists  | Proton Pump Inhibitors | Anti-Helicobacter-pylori Rx | Campylobacter jejuni Rx |
Clostridium difficile Rx | Anti-emetics | Anti-spasmotic Rx | Constipation Rx  
H2 Antigonist Drugs for PUD/ Gastritis
  • Pepcid (Famotidine) 20-40 mg tab, 40 mg/5ml suspension. Dose 20 mg bid or 40 mg hs
  • Tagamet (Cimetidine) 200-300-400-800 mg tab; 300 mg/5ml; IV soln. Dose 300 mg tid, 400 mg bid or 800 mg hs; 900 mg/d IV infusion
  • Zantac (Ranitidine) 150-300 mg tab; 75 mg/5ml syrup. Dose 150 mg bid or 300 mg hs; 50 mg q6 8h IVPB
  • Axid (nizatidine) 150 mg tablet. Dose 150 mg bid or 300 mg hs

 

GI cocktail of 10-15 ml 1% viscous lidocaine and 15-30 mL antacid has been suggested to rule out esophageal pain, but positive response does not clearly rule out cardiac pain
Proton Pump Inhibitors:
  • Protonix® (Pantoprazole ) 40 mg tab 1-2x/day PO or 80 mg q12h IV
  • Prilosec® (Omeprazole) 10-20 mg tab 1-2x/day
  • Prevacid® (Lansoprazole) 15-30 mg cap QD
  • Aciphex® (Rabeprazole) 20 mg tab once daily
  • Nexium® (Esomeprazole) capsule  20 or 40 mg cap once/day

 

Anti Helicobacter pylori Rx:
The following 3-drug regimen given for ONE WEEK is recommended as first-line therapy for eradication of H.pylori in patients who test positive:
  1. - Amoxicillin 1 gram BID (#28 x 500mg), plus
       (may use Metronidazole/Flagyl 500 mg BID if amoxicillin is not tolerated)
  2. - Clarithromycin (Biaxin) 500 mg BID (#14 x 500mg), plus
  3. - Omeprazole (Prilosec) 20 mg BID or Pantoprazole (Protonix) 40 mg BID (#14 x 40mg)

Omeprazole 20 mg + Flagyl 500 mg + Clarithromycin 250 mg    BID x 10 days
Peptobismuth 2 tab qid + tetracycline 500 mg qid (or Amoxicillin 500 mg qid) + Flagyl 250 mg qid x 2 wks.

 

Campylobacter jejuni Rx:
  • Cipro 500 mg bid x 5 days, or
  • Azithromycin 500 mg daily x 3 days, or
  • Erythromycin 500 mg qid x 5 days

 

Clostridium difficile Rx:
  • Metronidazole (Flagyl) 250 mg qid or 500 mg tid PO or IV for 7-10 days, or
  • Vancomycin 125 mg qid PO for 8-10 days

 

Anti-emetics
  • Compazine/Prochlorperazine 5-10 mg q8h PO or IM or IV slowly; 25 mg rectal suppository
  • Tigan/Trimethobenzamide 100-250 mg cap PO or 200 mg IM 3-4x/d; 200 mg rectal suppository
  • Reglan/Metoclopramide 10-15 mg 3-4x/d PO or IM or IV.
  • Vistaril/Hydroxyzine 25-100 mg PO, IM or IV
  • Phenergan/Promethazine 25 mg PO or IM, or supp. q4h
  • Benadryl/Diphenhydramine 25-50 mg PO, IM or IV
  • Zofran/Ondansetron 4-8 mg tab PO q8h, or 32 mg (or 0.15 mg/kg) IV infusion over 15 min q4-8h.
  • Scopolamine 0.1 mg IV or Transderm-Scop skin-patch q 72 h
  • Kytril/Granisetron 10 ug/kg IV over 5 min once/day
  • Cannabinoids as Marinol/dronabinol
  • Corticosteroid in combination with other antiemetics may be effective.
  • Inapsine (Droperidol) 0.625 - 1.25 mg IM or IV q 3-4 h prn (Caution prolonged QT interval)
  • Anzemet (Dolasetron) 100 mg PO daily prn
  • Propulsid/Cisapride 10-20 mg tab ac & hs - discontinued !

 

Anti-Spasmotic Rx:       
Bentyl (Dicyclomine) 10-20 mg qid
Donnatal (Phenobarbital-hyoscyamine-atropine-scopolamine) 1-2 tab 3-4x/day
Donnatal Extentab 1 tab bid
Librax (Librium-chlordiazepoxide/clidinium) 1-2 cap 3-4x/day
Levsin (Hyoscyamine) 0.125 - 0.25 mg q4h
Levbid (Hyoscyamine) 0.375 mg bid

 

Drugs for Constipation:
  1. Fluid & High fibers as Metamucil or Citrucil powder
  2. Laxatives -osmotic:
  3. Amitiza (Lubiprostone)
    - for adult with chronic idiopathic constipation 24 mcg capsule twice daily PO.
  4. Laxatives - stimulant:
    • Bisacodyl (Dulcolax, Correctol)  5-10 mg PO daily prn;  OTC 5 mg tab or 10 mg supp.
    • Cascara OTC 325 mg tab PO qhs prn or liquid
    • Castor oil 15 -30 mL PO prn
    • Senna (Senokot, Ex-Lax) 1 tsp or 2 tab PO prn PO
    • Lubiprostone (Amitiza) 24 mcg cap bid with meals prn constipation.

 

Drugs for Irritable Bowel Syndrome (IBS)
  • Zelnorm (Tegaserod) 6 mg tab bid before meal for Irritable Bowel Syndrome constipation
    -  Warning:  significant diarrhea with hypovolemia, hypotension & rare ischemic colitis may occur!


  • Amitiza (lubiprostone) 24 mcg BID with food - for chronic idiopathic constipation
  • Lotronex (Alosetron) 1 mg tab bid  - NOT RECOMMENDED !!
    - a potent selective serotonin receptor (5-HT3) antagonist that reduces pain & hypermotility.
    - some reported severe constipation & ischemic colitis  (Warnings! )


 

        

Anti-emetics:  
Anti-Emetic Medications
Type of Nausea           Useful Drug Class                Example of Drugs                                                                                          
Vestibular    or

Inflammation/ infection

Anticholinergics

Antihistamines

Phenergan (Promethazine) 12.5 - 25 mg PO a4h prn

Transdrm-Scop (Scopolamine) 1 patch q 72 h, Tigan (Trimethobenzamide) 250 mg PO q6-8h

Dysmotility Prokinetics Reglan (Metoclopramide) 5-20 mg PO  q 6-12 h prn
Toxins as opioids, etc. Antidopaminergics

5-HT3 Antagonists

Compazine (Prochlorperazine) 5-10 mg PO q 6-8 h prn

Inapsine (Droperidol) 0.625 - 1.25 mg IM or IV q 3-4 h prn (Caution prolonged QT interval)
Anzemet (Dolasetron) 100 mg PO daily prn
Zofran (Ondansetron) 8 mg PO 2-3x/day prn

      

                                                                  2009