Other antiulcer drugs
Other antiulcer drugs
Research continues on the usefulness of other drugs in treating peptic ulcer disease. Two other drugs currently in use are:
- misoprostol (a synthetic form of prostaglandin E1)
- sucralfate.
Pharmacokinetics
Each drug has a slightly different pharmacokinetic property.
Absorption, metabolism, and excretion
After an oral dose, misoprostol is absorbed extensively and rapidly. It’s metabolized to misoprostol acid, which is clinically active, meaning that it can produce a pharmacologic effect. Misoprostol acid is highly protein-bound and is excreted primarily in urine.
Sucralfate is minimally absorbed from the GI tract and is excreted in stool.
Pharmacodynamics
The actions of these drugs vary.
Nay-saying NSAIDs
Misoprostol protects against peptic ulcers caused by NSAIDs by reducing the secretion of gastric acid and boosting the production of gastric mucus, a natural defense against peptic ulcers.
Safe and sound
Dangers of misoprostol use during pregnancy
Use of misoprostol during pregnancy can lead to premature birth, birth defects, or fetal abortion. When used after the 8th week of pregnancy to induce labor or abortion, misoprostol can cause uterine rupture as well. Misoprostol-induced abortions may be incomplete. For these reasons, the drug is contraindicated for gastric ulcer prevention during pregnancy.
Protective paste
Sucralfate works locally in the stomach, rapidly reacting with hydrochloric acid to form a thick, pastelike substance that adheres to the gastric mucosa and, especially, to ulcers. By binding to the ulcer site, sucralfate actually protects the ulcer from the damaging effects of acid and pepsin to promote healing. This binding usually lasts for 6 hours.
Pharmacotherapeutics
Each of these drugs has its own therapeutic use.
Warning!
Adverse reactions to other peptic ulcer drugs
Misoprostol
- Diarrhea (common and usually dose-related)
- Abdominal pain
- Gas
- Indigestion
- Nausea and vomiting
Sucralfate
- Constipation
- Nausea and vomiting
- Metallic taste
Making it less complicated
Misoprostol prevents gastric ulcers caused by NSAIDs in the patient at high risk for complications resulting from gastric ulcers.
In the short run
Sucralfate is used for the short-term treatment (up to 8 weeks) of duodenal or gastric ulcers and for the prevention of recurrent ulcers or stress ulcers.
Drug interactions
Misoprostol and sucralfate may interact with other drugs.
- Antacids may bind with misoprostol or decrease its absorption. However, this effect doesn’t appear to be clinically significant.
- Antacids may reduce the binding of sucralfate to the gastric and duodenal mucosa, reducing its effectiveness.
- Cimetidine, digoxin, norfloxacin, phenytoin, fluoroquinolones, ranitidine, tetracycline, and theophylline decrease the absorption of sucralfate
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