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Drugs for pH control in upper gastrointestinal bleeding (1995)

BRIJNNER, G. ; LUNA, P. ; THIESEMANN, C.

Oxford, UK : Blackwell Publishing Ltd

Alimentary pharmacology & therapeutics 9 (1995), S. 0

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ISSN: 1365-2036

Source: Blackwell Publishing Journal Backfiles 1879-2005

Topics: Medicine

Notes: A few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic intervention, the other is the pharmacological approach of blocking the proton pump.The endoscopical techniques of adrenaline injection, fibrin-‘glue’ injection, polidocanol injection and heat coagulation can stop active bleeding in over 90% of cases. Pharmacologically, proton pump inhibitors can quickly achieve the optimal pH condition for support of the physiological cascade of haemostasis.The aim is to keep the intragastric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole after an initial loading dose of 40–80 mg.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1111/j.1365-2036.1995.tb00784.x

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Ciclosporin metabolite pattern in blood and urine of kidney graft patients in relation to liver function (1991)

Bleck, J. S. ; Schlitt, H. J. ; Christians, U. ; [et al.]

Springer

European journal of clinical pharmacology 40 (1991), S. 565-569

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ISSN: 1432-1041

Keywords: Ciclosporin ; metabolism ; metabolites ; liver dysfunction ; kidney transplantation

Source: Springer Online Journal Archives 1860-2000

Topics: Chemistry and Pharmacology , Medicine

Notes: Summary Ciclosporin, an immunosuppressant, is metabolized by the liver cytochrome P450 system. Changes in the pattern of its metabolites in blood and urine in patients with disturbed liver function have been studied. Forty seven kidney graft patients receiving 2.9 mg/kg/d ciclosporin b.i.d., and no additional medication that would interfere with ciclosporin metabolism, were allocated to three groups according to liver function: I with normal liver function (n=19), II with elevated liver enzyme activity or bilirubin concentration in serum (n=20), and III with cholestasis (n=8). Ciclosporin and 17 metabolites were determined in blood and 24 h-urine. In blood the trough concentrations of metabolites M19 and M1A were significantly higher in group III than in groups I and II. The total quantity of metabolites excreted in 24 h-urine was significantly different for H230, M4N69 and M1A (group III〉I=II). Renal excretion of the daily dose of ciclosporin in patients in group I was 2.7%, group II 3% and group III 5.7%. In group III compared to group I the ciclosporin metabolite pattern was shifted to a relatively higher concentration of M19 in blood and of H 230, M19 and M1A in urine. Since high ciclosporin metabolite concentrations appear to be associated with nephrotoxicity, the metabolite pattern in patients with impaired liver function should be monitored.