1.3 Ulcer-healing drugs

1.3 Ulcer-healing drugs
Esomeprazole tablets 40mg *	R
Lansoprazole fastabs 15mg, 30mg	F	Only for patients with swallowing difficulties or feeding tubes
Misoprostol tablets 200mcg **	F
Omepazole capsules 20mg	F	Formulary Choice
Omeprazole injection 40mg	F	See Guidelines
Ranitidine injection 50mg/2ml	F
Ranitidine tablets 150mg	F
Ranitidine dispersible tablets 150mg	F
Sucralfate tablets 1g	F
*Esomeprazole is reserved for use only by consultant gastroenterologists, post OGD and for patients with severe reflux oesophagitus unresponsive to conventional high dose PPI
**Rheumatology/Geriatricians. It should not be prescribed for premenopausal women.

SMUHT Policy

1. All new prescriptions for a PPI should be for omeprazole.

2. If a patient has difficulty swallowing, or has a feeding tube, lansoprazole Fastabs should be prescribed.

3. Patients admitted on other PPIs should either be:

   • maintained on the same PPI

   • reviewed for potential dose reduction

   • switched to omeprazole after discussion with patient

  4. There is the potential for omeprazole & lansoprazole to interact with warfarin. Rabeprazole lacks this potential and is an appropriate choice for a patient taking warfarin.

Important points from NICE guidance on the use of PPIs

• After healing of documented ulcer, symptoms should be controlled with the lowest effective dose PPI.

• In severe GORD, a healing dose of PPI should be followed by the lowest dose that maintains control of symptoms. Full dose should be maintained in complicated GORD.

• In mild GORD, try antacids, alginates or an H₂ antagonist first.

• Do not use PPIs routinely in non-ulcer dyspepsia.

• Use the least expensive appropriate PPI

• The use of PPIs refers to those which have been licensed for that use

Cost of proton pump inhibitors (in ascending order, for 28 days)

PPIs licensed for listed indications