What medications are prescribed for the treatment of peptic ulcers, including gastric and duodenal ulcers?

From the Guidelines

Treatment of Peptic Ulcers

For gastric ulcer and duodenal ulcer treatment, I recommend the following medications and dosages:

• Proton Pump Inhibitors (PPIs):
  • Omeprazole 20mg orally once daily for 8 weeks for duodenal ulcers and 12 weeks for gastric ulcers 1.
  • Alternatively, Pantoprazole 40mg orally once daily for 8 weeks for duodenal ulcers and 12 weeks for gastric ulcers.
• Histamine-2 (H2) blockers:
  • Ranitidine 150mg orally twice daily for 8 weeks for duodenal ulcers and 12 weeks for gastric ulcers.
• Antibiotics for Helicobacter pylori (H. pylori) eradication (if H. pylori positive):
  • Clarithromycin 500mg orally twice daily for 14 days 1.
  • Amoxicillin 1000mg orally twice daily for 14 days 1.
  • Metronidazole 500mg orally twice daily for 14 days 1.
• Bismuth subsalicylate for H. pylori eradication and ulcer protection:
  • Bismuth subsalicylate 525mg orally four times daily for 14 days.
• Sucralfate for ulcer protection:
  • Sucralfate 1g orally four times daily for 8 weeks for duodenal ulcers and 12 weeks for gastric ulcers, on an empty stomach.

Key Considerations

• The choice of medication and duration of treatment may vary depending on the patient's specific condition, medical history, and response to treatment 1.
• Patients should be advised to avoid NSAIDs and smoking, which can exacerbate ulcers 1.
• For patients with a history of bleeding ulcers, PPIs or other acid-suppressing medications may be necessary to prevent recurrence 1.
• Potassium-competitive acid blockers (P-CABs) may be considered for patients who do not respond to PPIs or have certain other conditions, but their use as first-line therapy is not generally recommended 1.

Important Notes

• H. pylori eradication is crucial in patients with H. pylori-positive peptic ulcers to prevent recurrence 1.
• PPIs are effective in healing peptic ulcers and preventing recurrence, especially when combined with H. pylori eradication therapy 1.
• NSAID avoidance is essential in patients with peptic ulcers, as these medications can exacerbate the condition 1.

From the FDA Drug Label

Treatment of Active Duodenal Ulcer 20 mg once daily 4 weeks Helicobacter pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence Triple Therapy Omeprazole 20 mg Amoxicillin 1000 mg Clarithromycin 500 mg Active Benign Gastric Ulcer 40 mg once daily 4 to 8 weeks

The medications prescribed for the treatment of peptic ulcers, including gastric and duodenal ulcers, are:

• Omeprazole: 20 mg once daily for 4 weeks for duodenal ulcers, and 40 mg once daily for 4 to 8 weeks for gastric ulcers
• Amoxicillin: 1000 mg twice daily for 10 days as part of triple therapy for Helicobacter pylori eradication
• Clarithromycin: 500 mg twice daily for 10 days as part of triple therapy for Helicobacter pylori eradication 2

From the Research

Medications for Peptic Ulcers

The following medications are prescribed for the treatment of peptic ulcers, including gastric and duodenal ulcers:

• Proton pump inhibitors (PPIs) such as omeprazole 3, 4, 5 and rabeprazole 4
• H2-receptor antagonists such as cimetidine 3, ranitidine 3, 4, 6, and famotidine 6
• Sucralfate 7, 6
• Antacids 7
• Misoprostol, a prostaglandin analogue 7, 6
• Colloidal bismuth subcitrate 7
• Antibiotics, such as amoxycillin and clarithromycin, for the eradication of Helicobacter pylori 5

Treatment Strategies

Treatment strategies for peptic ulcers include:

• Short-term treatment with PPIs or H2-receptor antagonists to heal ulcers and relieve symptoms
• Long-term maintenance therapy with H2-receptor antagonists or sucralfate to prevent recurrences
• Eradication of Helicobacter pylori infection with antibiotics to reduce recurrent ulcer disease
• Use of prophylactic therapy, such as misoprostol or PPIs, to prevent NSAID-induced gastroduodenal disorders 6

NSAID-Induced Ulcers

For NSAID-induced ulcers, treatment strategies include:

• Reduction or discontinuation of NSAID use
• Use of PPIs, such as omeprazole, to heal ulcers and prevent recurrences 6
• Use of misoprostol or H2-receptor antagonists to prevent NSAID-induced gastroduodenal disorders 6