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Ranitidine controls nocturnal gastric acid breakthrough in patients on omeprazole

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eMediNexus    25 October 2021

It has been noted that proton pump inhibitors given twice a day may not be able to provide complete nocturnal acid suppression. Around three-fourth of normal individuals and patients experience acid breakthrough, or a reduction in intragastric pH to <4 for an hour or more, at night.

Peghini et al therefore compared the impact of a third omeprazole dose administered at bedtime with the effect of ranitidine at bedtime on residual nocturnal acid secretion in patients on twice a day omeprazole therapy.

The study included 12 subjects who underwent overnight intragastric pH monitoring after 7 days of treatment with omeprazole, 20 mg twice a day, followed by varied treatment supplements at bedtime, including placebo, additional omeprazole 20 mg, ranitidine 150 mg, and ranitidine 300 mg.

Findings of the study -

  • Administration of additional omeprazole at bedtime led to a reduction in the percentage of time with intragastric pH of <4 from 48% to 31% (P < 0.005), in comparison with omeprazole twice daily with placebo at bedtime.
  • Ranitidine, given at bedtime, led to a greater reduction in this parameter: 5% with 150 mg and 6% with 300 mg (P <0.01 vs. omeprazole twice daily and at bedtime).
  • The results were similar for percentage of time with intragastric pH <3.
  • Eleven participants had acid breakthrough with placebo at bedtime; 7 had acid breakthrough with omeprazole given at bedtime (P = NS); 4 had it with ranitidine 150 mg administered at bedtime; and 3 with ranitidine 300 mg at bedtime (P < 0. 05, ranitidine vs. placebo) (Fig. 1).

Conclusion of the study -

Clearly, administration of ranitidine at bedtime appeared to be more effective compared to bedtime omeprazole for residual nocturnal acid secretion in patients who were on omeprazole twice daily. The finding also indicates that fasting breakthrough nocturnal acid secretion in patients on twice daily omeprazole therapy is related to histamine in all probability.

1: Placebo at bedtime; 2: Omeprazole at bedtime; 3: Ranitidine 150 mg at bedtime; 4: Ranitidine 300 mg at bedtime; y axis: Patients (n)

Source: Peghini PL, Katz PO, Castell DO. Ranitidine controls nocturnal gastric acid breakthrough on omeprazole: a controlled study in normal subjects. Gastroenterology. 1998 Dec;115(6):1335-9.

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