Sucralfate Ranitidine

Drug therapy, if necessary, may be initiated with aluminum, calcium, or magnesium antacids sucralfate or cimetidine or ranitidine. Lansoprazole, omeprazole, and metoclopramide are also options if the patient does not respond to histamine-2 receptor blockers. 

Moore JG, Cobum JW, Sanders MC, et al. 1995. Effects of sucralfate and ranitidine on aluminum concentrations in elderly volunteers. Pharmacotherapy 15 742-746. 

Gastrointestinal drugs. Avoid cimetidine and omeprazole which inhibit the clearance of R warfarin, and sucralfate which may impair its absorption. Ranitidine may be used but INR should be checked if the dose is high. Most antacids are safe. 

Side effects Side effects such as erosions, superficial ulceration or mucosal necrosis can be expected in > 80% of cases. Sucralfate, cimetidine, ranitidine and omeprazole (116) as well as fibrin adhesive have been used both for prevention and to promote healing. From a morphological viewpoint, these inflammatory tissue reactions are to a certain extent necessary to induce thrombosis and vessel wall fibrosis. Fever, leucocytosis, chest pain and tension occur as frequent yet usually insignificant concomitant reactions. Dysphagia or dysfunction of the oesophagus are of no clinical significance. The develop-... 

H2-receptor antagonists are preferred for prophylaxis of SRMB. A large landmark study demonstrated that intravenous ranitidine was superior to oral sucralfate in preventing SRMB. Moreover, ranitidine did not increase the risk for nosocomial pneumonia, as the incidence of pneumonia was no different between the two treatment groups. In itself, critical illness places the patient at risk for nosocomial pneumonia. Also there are potential problems associated with sucralfate therapy (e.g., constipation, clogging tubes, hypophosphatemia, and drug interactions). ... 

Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. NEngl J Med 1998 338 791-797. 

Bismuth-containing preparations (e.g., those containing colloidal bismuth subcitrate) have effects similar to those of sucralfate, apparently because of their similar physical properties and coating effects. A combination of ranitidine-bismuth citrate is used with clarithromycin for eradication of H. pylori in the treatment and prevention of recurrence of duodenal ulcers. Combinations of bismuth subcitrate with other antibiotics and with H2 antihistamines also are used. Bismuth subsalicylate is used in this way as well. 

Piscitelli SC, Goss TF, Wilton JH, D Andrea DT, Goldstein H, Schentag JJ. Effects of ranitidine and sucralfate on ketoconazole bioavaUabiUty. Antimicrob Agents Chemother (1991) 35, 1765-71. 

NixD, Schentag J. Lomefloxacin (L) absorption kinetics when administered with ranitidine (R) and sucralfate (S). Intersci Conf Antimicrob Agents Chemother ( 9%9) 29, 317. 

Most in vitro and human studies have found that sucralfate does not affect the absorption of either cimetidine, ranitidine,or roxatidine, but two studies found 22 to 29% reductions in ranitidine bioavaiiabiiity due to concurrent use of sucraifate. There is no ciear reason for avoiding concurrent use. 

Mullersman G, Gotz VP, Russell WL, Derendorf H. Lack of clinically significant in vitro and in vivo interactions between ranitidine and sucralfate. JPharm Sci (1986) 75, 995-8. 

Maconochie JG, Thomas M, Michael MF, Jenner WR, Tanner RJN. Ranitidine sucralfate interaction study. Clin Pharmacol Ther (1987) 41, 205. 

Kimura K, Sakai H, Yoshida Y, Kasano T, Hirose M. Effects of concomitant drugs on the blood concenttation of a histamine H2 antagonist (the 2nd report) - concomitant or time lag administration of ranitidine and sucralfate, Nippon okakibyo Gakkai Zasshi (1986) 83, 603-7. 

Hematologic A 60-year-old man took omeprazole 20 mg/day and sucralfate 1 g tds for a diffuse gastritis [SO ]. After 9 days he had a moderate neutropenia. Omeprazole was withdrawn, and all other medications were continued and 5 days later his neutrophil count rose. One year later he was given pan-toprazole 40 mg/day with close hematological monitoring and 2 days later developed a marked neutropenia. Pantoprazole was immediately replaced with ranitidine and 3 days later the neutrophil count rose. 

Prod hom G, Leuenberger P, Koerfer J, et al. Nosocomial pneumonia In mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Ann Intern Med 1994 120 653-662. 

Messori A, Tripoli S, Vaiani M, et al. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for jnevention of stress ulcer meta-analysis of randomised controlled trials. BMJ 2003 32 1103-1106. 

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