Bolus or Intravenous Infusion of Ranitidine: Effects on Gastric pH and Acid Secretion

Abstract

On the basis of both efficacy and cost, intermittent bolus injections should be discontinued and replaced by continuous intravenous infusion in hospitalized patients requiring treatment with histamine H2-receptor antagonists. If ranitidine is used, either 150 mg or 300 mg administered as a 24-hour continuous infusion is most effective.

Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation

“…Both a meta-analysis (19) and large randomized controlled trial (20) failed to show any reduction in recurrent bleeding rates. These findings may be due to the rapid onset of tolerance to the H 2 RAs (21,22), and their subsequent inability to maintain high intragastric pH, even with continuous infusion (11).…”

“…This is consistently achieved with a bolus of 80 mg followed by a continuous infusion of IV PPI, as used in key clinical studies (11). The optimal timing of administration of IV PPI is not known.…”

Is Prophylaxis for Stress Ulceration Useful?

“…These agents require frequent dosing, and there is some evidence to suggest that continuous infusions of the intravenous formulations may achieve better pH control than bolus administration. 21,22 Tolerance to H 2 -receptor antagonist acid inhibition develops within 72 hours of commencement. 23,24 Adverse effects include central nervous system disturbances, especially in elderly patients with intravenous administration.…”

Critical Review of Acid Suppression in Nonvariceal, Acute, Upper Gastrointestinal Bleeding

“…Collins and Langman [52] performed a meta-analysis of tenance of gastric pH4.0 for 65-85% of the day [47,48]. In general, the effects of even high-dose IV H 2 RA therapy 27 published and unpublished, randomized controlled trials (RCTs) of therapy.…”