Aluminum hydroxide (AlternaGEL) Therapeutic class - antiheartburn drug
Aluminum hydroxide (AlternaGEL) Pharmacologic class - antacid
Aluminum hydroxide Actions and Uses - -Aluminum compounds are minimally absorbed
-Neutralize stomach acid by raising pH of stomach contents
-Do not reduce volume of acid secretion
-Most effectively used in combination with other antinuclear drugs for symptomatic relief
of heartburn due to PUD or GERD
Aluminum hydroxide Administration - · Administer 2 hours or more before or after other
drugs
· Can impact the absorption of other drugs
· Pregnancy category C
Aluminum hydroxide (AlternaGEL) Pregnancy category - C
Aluminum hydroxide (AlternaGEL) Contraindications - · Patients with suspected bowel
obstruction
· Caution in patients who are malnourished, alcoholics, and who have CKD
Aluminum hydroxide Drug to drug interactions - impacts absorption of other drugs,
sodium polystyrene sulfonate may cause systemic alkalosis
Aluminum hydroxide (AlternaGEL) Lab test interactions - serum gastrin and urinary pH
may increase, phosphate may decrease
Aluminum hydroxide (AlternaGEL) Herbal/food interactions - may inhibit absorption of
dietary iron
Omeprazole (Prilosec) Therapeutic class - Antiulcer drug
Omeprazole (Prilosec) Pharmacologic class - proton pump inhibitor
,Omeprazole (Prilosec) Actions and Uses - - First PPI to be approved for PUD
- Available in Rx and OTC form
- Reduces stomach acid secretion by creating an irreversible bind to the enzyme H+, K+
-ATPase
- Used at higher dose and longer period for chronic hypersecretion of gastric acid
(Zollinger-Ellison syndrome)
- Zegerid: combo drug w/ omeprazole and sodium bicarb
Omeprazole (Prilosec) Administration - - PO only; approved for children age 2 and older
- Administer before breakfast, on empty stomach
- May be administered w/ antacids
- Capsules and tablets should not be chewed, divided or crushed
Omeprazole (Prilosec) Pregnancy category - Pregnancy Category C
Omeprazole (Prilosec) Onset - 1 hr, Can take 2hrs to reach therapeutic effect,
Omeprazole (Prilosec) Duration - - effects last up to 72hrs
- Used for 4-8 week therapy of active peptic ulcers and GERD; most patients are
symptom free after 2 weeks
Omeprazole (Prilosec) Adverse Effects - - Generally minor; headache, nausea,
diarrhea, abdominal pain
- Rare: blood disorders causing fatigue and weakness
- Therapy is usually limited to 2 months; atrophic gastritis & hypomagnesemia have
been reported with prolonged treatment
Omeprazole (Prilosec) Contraindications - - Hypersensitivity to PPI
- OTC not approved for under 18 years old
Omeprazole (Prilosec) Drug to drug interactions - PPI lowers levels of erlotinib,
nelfinavir, rilpivirine. Use w/ diazepam, phenytoin & CNS depressants may cause
increase blood levels of those drugs. Use w/ warfarin may increase likelihood of
bleeding. PPIs increase gastric pH and have potential to affect drugs that rely on low pH
(ampicillin, atazanavir, digoxin, iron salts, azole antifungals)
Omeprazole (Prilosec) Lab test interactions - May increase ALT, AST and serum
alkaline phosphatase
Omeprazole (Prilosec) Herbal/food interactions - Ginkgo & St. John's Wort may
decrease plasma concentration of omeprazole
Ranitidine (Zantac) Therapeutic class - Antiulcer drug
Ranitidine (Zantac) Pharmacologic class - H2 receptor antagonist
, Ranitidine (Zantac) Actions and Uses - - Blocks H2 receptors in the stomach to
decrease acid production
- Higher potency than cimetidine, allows once daily administration, usually at bedtime
- Adequate ulcer healing takes 4-8 weeks; those at high risk for PUD may continue drug
maintenance to prevent recurrence
- Also indicated for Zollinger-Ellison syndrome & erosive esophagitis
Ranitidine (Zantac) Administration - - Administer after meals
- Monitor liver & kidney function
- IV and IM forms available to treat acute, stress-induced bleeding ulcers
- Tritec: combo drug w/ ranitidine & bismuth citrate
- Available in dissolving tablet for treating GERD in children under 1 month
Ranitidine (Zantac) Pregnancy category - B
Ranitidine (Zantac) Onset - 30-60 min
Ranitidine (Zantac) Duration - 6-12 hrs
Ranitidine (Zantac) Adverse Effects - - Headache is most common
- Does not cross blood-brain barrier (no confusion or CNS depression that is seen w/
cimetidine)
- Rare: severe reduction in RBCs, WBCs & platelets
- High doses may result in impotence or loss of libido in men
Ranitidine (Zantac) Contraindications - - Hypersensitivity to H2 receptor antagonists
- Acute porphyria
- OTC use in children under 12
Ranitidine (Zantac) Drug to drug interactions - May reduce absorption of cefpodoxime,
ketoconazole & itraconazole. Antacids should not be given with 1 hour due to
decreased effectiveness. Smoking decreases effectiveness
Ranitidine (Zantac) Lab test interactions - May increase serum creatinine, AST, ALT,
LDH, alkaline phosphatase & bilirubin. May produce false positive for urine protein
Ranitidine (Zantac) Herbal/food interactions - vitamin B12 and iron deficiency may occur
due to being better absorbed in acidic environment
Psyllium (Metamucil) Therapeutic class - Bulk-type laxative
Psyllium (Metamucil) Pharmacologic class - herbal agent
Psyllium (Metamucil) Actions and Uses - - Derived from the seeds of plantain plant
- Indigestible, insoluble fiber
- Promotes passage of stool
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