THE POTENTIAL CLINICAL ROLE OF INTRAVENOUS OMEPRAZOLE

The efficacy of intravenous omeprazole has been investigate in a number of clinical applications. In critically ill patients with bleeding peptic ulcer, which developed despite prophylactic measures for stress ulcer, bleeding stopped in 16 out of 19 patients treated with omeprazole given as a 40-mg i.v. bolus twice daily for up to 5 days. By contrast, bleeding stopped in only 3 out of 20 such patients given a continuous infusion of ranitidine, 400 mg daily for the same time period. Dose-finding studies in volunteers showed that an initial bolus of omeprazole, 80 mg, followed by continuous infusion for 48 hours (8 mg/hour for the first 24 hours and 4 mg/hour for the subsequent 24 hours) produced elevation of gastric pH to 6 or above. This high-dose regimen when combined with infusion of large amounts of fluid was accompanied by peripheral oedema in three females, but did not occur when the dose was reduced to 4 mg/hour. In patients with non-bleeding ulcers who were unable to take oral medication, treatment with an intravenous bolus of omeprazole, 40 mg twice daily, healed 91% of gastric ulcers and 88% of duodenal ulcers in 2 weeks. In patients with temporary impairment of gastric emptying, resulting from pyloric oedema secondary to an ulcer in this region, an intravenous bolus of omeprazole, 40 mg three times daily, led to resolution of pyloric stenosis in seven out of nine patients with pre- and intra-pyloric ulcers, and in three out of five patients with post-pyloric ulcers. Studies are ongoing to investigate the efficacy of intravenous omeprazole in the prophylaxis of stress ulcer and the prevention of aspiration pneumonitis. We conclude that intravenous omeprazole is superior to intravenous ranitidine in the treatment of bleeding ulcers, although the optimal dose remains to be established. It is also effective in the healing of non-bleeding ulcers in patients who are incapable of taking oral therapy, including those with pyloric ulcers.