Combined anti-muscarinic and H2 receptor blockade in the healing of refractory duodenal ulcer. A double blind study.

Developments in the inhibition of gastric acid secretion

“…Pirenzepine showed similar efficacy in the treatment of duodenal ulcers to cimetidine in two studies [10,11]. However, combination therapy of a H 2 RA and a M1‐antagonist does not lead to higher healing rates [12,13]. Pirenzepine (2 × 50 mg day −1 ) was slightly more effective at preventing duodenal ulcer relapse than placebo [14] and was not significantly different from cimetidine [15].…”

New Drugs: Peptic ulceration

“…Though initial studies have suggested encouraging results, others have failed to show any benefit from this combination. 8 The main problem with this drug is its small therapeutic window between treatment and toxic side effects. The healing properties of pirenzepine are at best similar to cimetidine but are associated with 197 appreciable side effects at the necessary dosage.…”

‘Difficult’ Duodenal Ulcer Patients: Clinical and Therapeutic Problems

“…In one Italian trial [33], the pirenzepine-cinretidine combination proved signifi cantly more effective than either of the two drugs administered singly. Conversely, in a large-scale British multicenter study, no dif ference in the healing rates was detected in patients treated with the pirenzepine-bbblocker combination in comparison to those receiving only cimetidine [28],…”

“…In the uncontrolled clinical trials, pro longing the existing FU-antagonist treatment at the same dose for periods ranging from 1 to 14 months has proved capable of healing a certain proportion of nonresponders, vary ing from 14 to 61% [6,7,27,28], Careful analysis of these studies reveals that the re sponse rate correlates inversely with the du ration of the initial TU-blocker treatment, with the result that the real efficacy of this therapeutic option is not easy to assess since it depends largely on the different defini tions of refractoriness used by various au thors.…”