5E Hyperacidity, GERD, and ulcers

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Date: Winter 2014
From: MPR Pharmacists' Edition(Vol. 8, Issue 4)
Publisher: Haymarket Media, Inc.
Document Type: Article
Length: 8,952 words
Lexile Measure: 680L

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COUNSELING NOTES

Antibiotic Interactions: Antibiotics may reduce the efficacy of oral contraceptives. Bactericidal drugs are primarily active against actively dividing cells. Therefore, bacteriostatic antibiotics (eg, tetracyclines) may interfere with the action of bactericidal antibiotics (eg, penicillins).

Antibiotic Adverse Reactions: Pseudomembranous colitis may occur following the administration of antibacterial agents. This may range in severity from mild to life-threatening. This diagnosis should be considered in patients who present with diarrhea subsequent to antibiotic therapy. Mild cases usually respond to discontinuing the drug; more severe cases may need supportive care and/or therapy with an agent effective against Clostridium difficile. Anti-motility drugs should be avoided since they may precipitate toxic megacolon. Also, overgrowth of nonsusceptible organisms, including fungal overgrowth (superinfection) may occur with the prolonged use of antibiotics.

* ACIPHEX Eisai Rx

Proton pump inhibitor. Rabeprazole sodium 20mg; delayed-release, e-c tabs.

Also: ACIPHEX SPRINKLE 5 Rabeprazole sodium 5mg, 10mg; delayed-release, caps

Indications: Triple therapy (w. amoxicillin + clarithromycin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment of erosive or ulcerative gastroesophageal reflux disease (GERD) or duodenal ulcers. Short-term treatment of symptomatic GERD in patients [greater than or equal to] 12 years of age. Maintenance of healing and reduction in relapse rates of heartburn symptoms in erosive or ulcerative GERD. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome). Treatment of GERD in pediatric patients 1-11 years of age.

Adults: Swallow tabs whole. [greater than or equal to] 18yrs: Triple therapy: rabeprazole 20mg + amoxicillin 1g + clarithromycin 500mg, all twice daily (w. AM and PM meals) for 7 days. GERD healing: 20mg once daily for 4-8 weeks; may repeat for 8 more weeks. GERD symptoms: 20mg once daily for 4 weeks; may repeat for 4 more weeks. GERD maintenance: 20mg once daily. Duodenal ulcer healing: 20mg once daily after breakfast for up to 4 weeks. Hypersecretory conditions: initially 60mg once daily; titrate; doses up to 100mg once daily or 60mg twice daily have been used.

Children: Sprinkle caps: take 30 minutes before meal. Open capsule and sprinkle contents on a small amount of soft food (eg, applesauce, fruit or vegetable based baby food, yogurt) or into a small amount of liquid (eg, infant formula, apple juice, pediatric electrolyte solution). <1yr: not recommended. Treatment of GERD: 1-11yrs (<15kg): 5mg once daily for up to 12 weeks; may increase to 10mg if inadequate response; ([greater than or equal to] 15kg):10mg once daily for up to 12 weeks. Tabs: swallow whole. Treatment of symptomatic GERD: [greater than or equal to] 12yrs: 20mg tab once daily for up to 8 weeks.

Warnings/Precautions: Gastric malignancy. Increased risk of osteoporosis-related fractures of the hip, wrist or spine with long-term and multiple daily dose PPI therapy. Severe hepatic impairment. Monitor magnesium levels with long-term therapy. Pregnancy (Cat.B). Nursing mothers: not recommended.

Interactions: May alter absorption of gastric pH-dependent drugs (eg, ketoconazole, digoxin). Concomitant digoxin or drugs that cause may hypomagnesemia (eg, diuretics): consider monitoring magnesium levels. May give antacids concomitantly. May antagonize atazanavir (not recommended). Monitor warfarin, cyclosporine. May...

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Gale Document Number: GALE|A404896022