: 推 jackeyman:請問如果服用NSAID期間併用H2-blocker 或是PPI 是否會減 09/16 16:37
: → jackeyman:少ulcer的發生率 ？ 09/16 16:38
以下是從uptodate節錄下來的
Mucosal damage by aspirin and NSAIDs is primarily a consequence of inhibition
of COX-1 in the upper GI tract. COX-1 inhibition reduces mucosal generation
of protective prostaglandins such as PGE2.Strategies to avoid this damage
include using antiinflammatory or analgesic drugs that have minimal effects
on COX-1 at usual doses, such as selective COX-2 inhibitors, acetaminophen,
or non-acetylated salicylates, and prescribing either a prostaglandin E
analog such as misoprostol or a potent inhibitor of gastric acid production
such as a proton pump inhibitor together with the NSAID. Some of these
strategies, though effective, are expensive and may not be cost-effective
[69] and in the case of selective COX-2 inhibitors may impart an increased
risk of cardiovascular disease.
大意是說 可以使用misoprostol或是PPI來預防
但是就是比較貴
至於H2-blocker
我在Micromedex找尋Ranitidine的資料
Ranitidine 150 milligrams orally twice daily for 6 to 8 weeks has been
effective in reducing incidence of non-steroidal drug-induced gastroduodenal
ulceration (Ehsanulleh et al, 1988; Simon et al, 1988)(Malchow-Moller, 1987).
However, short-term ranitidine therapy (fewer than 7 days) may not protect
against gastrointestinal damage secondary to non-steroidal anti-inflammatory
therapy (Stalnikowicz et al, 1989).
意思就是說 短期的Ranitidine治療是沒有用的
要吃到6-8個禮拜才有用......
文獻是這樣寫
不過我倒是不清楚實際上醫院的作法為何
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