Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
Healing/maintenance of healing of erosive esophagitis (EE). Treatment of heartburn from nonerosive gastroesophageal reflux disease (GERD).
Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux.
Adverse Reactions/Side Effects
GI: abdominal pain, diarrhea, flatulence, nausea, vomiting.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.
Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.
Instruct patient to report bothersome or prolonged GI side effects such as nausea, vomiting, diarrhea, flatulence, and abdominal pain.
Absorption: Well absorbed following oral administration.
Metabolism and Excretion: Extensively metabolized by the liver (CYP2C19 and CYP3A4 enzyme systems are involved); patients who are poor metabolizers may have higher blood levels; no active metabolites. No renal elimination.
TIME/ACTION PROFILE (blood levels)
|ROUTE ||ONSET ||PEAK* ||DURATION |
|PO ||unknown ||1–2 hr (1st); 4–5 hr (2nd) ||24 hr |
Contraindicated in: Hypersensitivity; Severe hepatic impairment; Geri: Avoid nursing.
Use Cautiously in: Moderate hepatic impairment (daily dose should not exceed 30 mg); Safe use in children <18 yr not established.
Drug-Drug: ↓ levels of atazanavir; do not administer concurrently. May ↓ absorption of drugs requiring acid pH for absorption, including ampicillin, digoxin, iron salts, and ketoconazole. May ↑ effect of warfarin.
PO (Adults): Healing of EE—60 mg once daily for up to 8 wk; maintenance of healing of EE—30 mg once daily for up to 6 mo; GERD—30 mg once daily for 4 wk.
PO (Adults): Moderate hepatic impairment—daily dose should not exceed 30 mg.
Delayed-release capsules: 30 mg, 60 mg.