From the Guidelines
For the treatment of gastric ulcer and duodenal ulcer, I would prescribe the following medications:
- Famotidine: 40 mg orally once daily at bedtime or 20 mg orally twice daily for 6-8 weeks for duodenal ulcer and 8-12 weeks for gastric ulcer, as shown to be effective in the FAMOUS trial 1.
- Antacids: As needed for symptom relief, such as aluminum hydroxide or magnesium hydroxide.
- Sucralfate: 1 gram orally four times daily for 8-12 weeks, especially if the patient has a history of bleeding or perforation.
- Proton pump inhibitors (PPIs): May be considered as an alternative to famotidine, such as omeprazole 20 mg orally once daily or lansoprazole 30 mg orally once daily for 6-8 weeks for duodenal ulcer and 8-12 weeks for gastric ulcer, as recommended by the 2009 ACC/AHA guidelines 1. It's essential to note that Helicobacter pylori (H. pylori) eradication therapy should be considered if the patient tests positive for the infection, which typically consists of a combination of antibiotics, such as amoxicillin, clarithromycin, and metronidazole, along with a PPI or famotidine for 7-14 days, as recommended by the WSES guidelines 1 and the Annals of Internal Medicine consensus recommendations 1. Additionally, potassium-competitive acid blockers (P-CABs) may be considered for secondary ulcer prophylaxis, but their use as first-line therapy is not currently recommended due to higher costs and limited availability 1.
From the FDA Drug Label
Famotidine tablets are indicated in adult and pediatric patients 40 kg and above for the treatment of: • active duodenal ulcer. • active gastric ulcer. • symptomatic non-erosive gastroesophageal reflux disease (GERD). • erosive esophagitis due to GERD, diagnosed by biopsy.
The medications prescribed for gastric and duodenal ulcers include Famotidine.
- Famotidine is indicated for the treatment of active duodenal ulcer and active gastric ulcer 2.
- Other medications that may be prescribed for these conditions are not mentioned in the provided drug labels.
- Ranitidine is mentioned as a comparison in one of the trials, but it is not explicitly stated as an indicated treatment for gastric and duodenal ulcers in the provided text 2.
From the Research
Medications for Gastric and Duodenal Ulcers
The following medications are prescribed for gastric and duodenal ulcers:
- Famotidine, an H2 receptor antagonist, has been shown to be effective in treating acute duodenal and gastric ulcers 3
- Omeprazole, a H+/K(+)-ATPase inhibitor, is more effective than H2-receptor antagonists in healing duodenal ulcers and is also effective in treating gastric ulcers 4, 5
- Ranitidine, another H2 receptor antagonist, has been shown to accelerate the rate of spontaneous ulcer healing in both duodenal and gastric ulcers 6
- Cimetidine, an H2 receptor antagonist, is also used to treat duodenal and gastric ulcers, although it may have more side effects than ranitidine 3, 6
- Gefarnate, an agent that promotes mucosal defense mechanisms, has been shown to be less effective than famotidine and ranitidine in treating acute duodenal ulcers 3
- Sucralfate, an agent that promotes mucosal defense mechanisms, is equivalent to H2 antagonists in the treatment of duodenal ulcers and probably gastric ulcers 7
- Colloidal bismuth subcitrate, an agent that promotes mucosal defense mechanisms, is comparable to other agents in the acute treatment of duodenal ulcers and likely gastric ulcers 7
- Antacids, such as low- to medium-dose Al-containing antacids, are inexpensive and efficacious in duodenal ulcer therapy 7
Dosages and Treatment Regimens
The following dosages and treatment regimens have been studied:
- Famotidine: 20 mg b.i.d. or 40 mg at bedtime 3
- Omeprazole: 20-40 mg/day 4, 5
- Ranitidine: 150 mg daily 6
- Cimetidine: 200 mg q.i.d. or 400 mg nocte 3, 6
- Sucralfate: 1 g four times daily 7
- Colloidal bismuth subcitrate: 120 mg four times a day 7
- Antacids: low- to medium-dose Al-containing antacids, dosage not specified 7