echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Digestive System Information > 7 classic cases, take you to inventory the common irrational use of drugs in gastroenterology

    7 classic cases, take you to inventory the common irrational use of drugs in gastroenterology

    • Last Update: 2022-12-04
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com

    For medical professionals only



    Dry goods are full ~




    Rational drug use is the key to disease treatment, and there are many corresponding treatment drugs in the Department of Gastroenterology, and the situation of combined medication is common
    .
    Irrational use of drugs will affect the treatment of the disease and even lead to the
    deterioration of the disease.
    Below we summarize the common irrational drug use as follows through 7 cases, hoping to attract clinical attention
    .

    Case 1


    Case data: Patient female, 25 years old, 16 weeks
    of gestationClinical diagnosis: gastric ulcer
    prescription: Ilaprazole enteric-coated tablets 10mg qd
    .

    Analysis: Drug selection is not appropriate
    .
    Clinical data on the use of PPIs in pregnant women are limited
    .
    It is not recommended for pregnant women except for refractory and severe gastroesophageal reflux disease
    .
    Avoid using any PPIs
    in the first 1 month of pregnancy and the 1~3 months of pregnancy.
    According to the drug label, FDA pregnancy grading, and the latest clinical guidelines, only omeprazole is grade C and can be used
    during pregnancy.
    It is recommended that the patient should first adjust the living and diet, and if it cannot be relieved, he can take antacids such as sodium bicarbonate, aluminum magnesium carbonate and gastric mucosal protectors
    .
    When the above treatment effect is not good, the benefit and risk of the patient is fully assessed before the use of PPI is considered, and omeprazole
    is preferred.

    Table 1 Application of PPI in special populations [1] Remarks: *This part refers to the drug labels, FDA pregnancy grading and the latest clinical diagnosis and treatment guidelines of domestic original drugs


    Case 2


    Case data: Female patient, 68 years old
    Clinical diagnosis: coronary heart disease, gastric ulcer
    prescription: clopidogrel hydrogen sulfate tablets oral 75mg qd, injection with esomeprazole sodium intravenous infusion 20mg qd solvent sodium chloride injection 100ml
    Analysis: Drug selection is not appropriate
    .
    Clopidogrel is mainly metabolized by CYP2C19 to produce activity, and esomeprazole can compete with it during metabolism with CYP2C19, which reduces the efficacy of clopidogrel and increases the risk of adverse events of myocardial infarction, so this combination is not recommended
    .
    It is recommended to replace esomeprazole with drugs that have a relatively small effect on the antiplatelet effect of clopidogrel, such as pantoprazole, rabeprazole, etc
    .

    Case 3


    Case data: 3-day outpatient visit due to epigastric pain
    .
    He has a history of hypertension and diabetes for more than
    10 years.
    Denial of drug and food allergies
    such as penicillin and cephalosporin.
    ECG: sinus rhythm; Ventricular premature beats: prolongation
    of the Q-T interval.
    C13 Breath test (+), gastroscopy showing antral ulcer (stage H1),

    diagnosis: Helicobacter pylori infection
    prescription: omeprazole + clarithromycin + levofloxacin + colloidal pectin bismuth

    Analysis: At present, the consensus in China recommends bismuth quadruple (PPI + bismuth + 2 antibacterial drugs) as the main empirical treatment eradication program (see Table 2 for the recommended 7 regimens
    ).
    However, due to the large adverse reactions of tetracycline and furazolidone and the lack of access to drugs in most regions of China, it is difficult for the scheme containing tetracycline or furazolidone to be widely used in clinical practice
    .
    Therefore, amoxicillin, clarithromycin, metronidazole, and levofloxacin are more commonly used
    in comparison.
    Both clarithromycin and levofloxacin were associated with
    a significant prolongation of the QTc interval.
    One of the main metabolizing enzymes of omeprazole and clarithromycin is CYP3A4, which is also an inhibitor of the enzyme, and the combination of the two can compete for the metabolizing enzyme and the inhibitory effect of the enzyme to increase
    the blood concentration of each other.
    Increased clarithromycin plasma concentrations may further exacerbate the prolongation
    of the Q-T interval.
    For patients at risk of QTc prolongation, the American Gastroenterological Association (ACG) [2] recommends first-line therapy with bismuth quadruple therapy
    excluding clarithromycin and levofloxacin.

    Table 2 The combination, dosage and usage of antibacterial drugs recommended by the fifth consensus of China in the Hp eradication quadruple regimen [3].


    Case 4


    Case data: Patient female, 49 years old
    Clinical diagnosis: gastric ulcer
    prescription: sucralfate suspension gel 1g bid, rabeprazole sodium enteric-coated tablets 10mg QD
    analysis: PPI acid inhibitory effect is strong and long-lasting, so it is not suitable to use other antacids or antacids
    during medication.
    Antacids (sucralfate (sucralfate , aluminum hydroxide, magnesium oxide, sodium bicarbonate) need to function under acidic conditions, lose the acidic environment and cannot exert efficacy, and sucralfate can also interfere with the absorption of PPI and reduce its bioavailability
    .
    If the two are combined, the interval between doses should be more than
    2 hours.


    Case 5


    Case data: Patient female, 76 years old
    Clinical diagnosis: hypertension, gastric ulcer
    prescription: compound reserpine triamterene tablets 1 tablet QD, rabeprazole sodium enteric-coated tablets 10mg QD
    analysis: Reserpine can promote excessive secretion of gastric acid, inducing or aggravating gastric ulcer bleeding
    .
    Therefore, patients with stomach diseases should avoid using antihypertensive drugs containing reserpine when choosing antihypertensive drugs, and the instructions of these drugs are also clearly marked "prohibited in patients with gastric and duodenal ulcers"
    .

    Case 6


    Case data: Patient female, 68 years old
    Clinical diagnosis: chronic gastritis with erosion
    prescription: lansoprazole 30mg, solvent: 5% glucose injection 250mL
    .

    Analysis: Inappropriate choice of solvent
    .
    PP is highly dependent on pH, and the injections contain NaOH to adjust pH to increase stability
    .
    Glucose is an acidic solution, and using it as a solvent will cause lansoprazole to be unstable and easy to discolor, so it should be formulated using 0.
    9% sodium chloride injection
    .

    Case 7


    Case data: Patient male, 58 years old
    , clinical diagnosis: liver cirrhosis decompensated with esophageal varices, gastric ulcer
    prescription: esomeprazole enteric-coated tablets 40 mg PO bid.


    Analysis: Esomeprazole enteric-coated tablets should be reduced in patients with severe liver function impairment, and the maximum daily dose should be limited to 20 mg
    in patients with decompensated cirrhosis and esophageal varices.

    Where to see more cutting-edge information on digestive liver disease? Come to the "doctor's station" and take a look 👇


    References:

    [1] Guangdong Pharmaceutical Association.
    Prophylactic use of proton pump inhibitors and prescription streamlining expert guidance[J].
    Clinical Medical Research and Practice, Vol.
    4, No.
    21, Cover 3, 2019.

    [2] Helicobacter pylori and peptic ulcer science group, Chinese Society of Gastroenterology Branch, National Helicobacter pylori research cooperation group.
    Fifth National Consensus Report on the Management of Helicobacter Pylori Infection.
    Chinese Journal of Internal Medicine.
    2017.
    56(7):532-545.

    [3] Nguyen CT,Davis KA,Nisly S,Li J.
    Treatment of Helicobacter pylori in Special Patient Populations.
    Pharmacotherapy.
    2019 Aug 10.
    doi:10.
    1002/phar.
    2318.

    [4] National Health Commission of the People's Republic of China.
    Guidelines for the clinical application of proton pump inhibitors(2020 edition)[J].
    Chinese Journal of Practical Rural Doctors,2021,28(1):9.
    )


    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.