I. Carafate Fact File
Carafate was introduced by Hoechst Marion Roussel.
Hoechst Marion Roussel is a long-standing chemical company - now part of the new Aventis.
In the year 2000, the Aventis Company created by the merger of Hoechst and Rhône-Poulenc is no longer a German chemical company with sites in many countries of the world. It is an internationally active group of companies with many of its roots in Germany and France and its headquarters is in the European city of Strasbourg.
II. Carafate Medication
Carafate is an Anti-Ulcer drug that is used in the short-term treatment of active duodenal ulcer. Carafate is also used in maintenance therapy for duodenal ulcer patients at a reduced dosage after healing acute ulcers.
Carafate works by forming a barrier or coating over the ulcer, protecting it from stomach acid and allowing it to heal.
Anti-Ulcer Drugs: Information
Anti-Ulcer drugs are medicines used to treat ulcers in the stomach and the upper part of the small intestine.
The Anti-Ulcer drugs described here are used as part of the treatment for ulcers. Ulcers are sores or raw areas that form in the lining of the stomach or the duodenum (the upper part of the intestine). Those that form in the stomach are called gastric ulcers; in the duodenum, they are called duodenal ulcers. Both types are referred to as peptic ulcers. For a long time, physicians thought that stress and certain foods caused ulcers. Now they know that most ulcers are caused either by infection with a bacterium called Helicobacter pylori or by long-term use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
In either case, something damages the barrier of mucus that normally protects the stomach and duodenum from the powerful acids and enzymes that the body produces to digest food. When that happens, the acids and enzymes begin to eat away at the unprotected tissue, causing ulcers.
The three basic types of Anti-Ulcer drugs are H2-blockers, acid pump inhibitors, and mucosal protective medications. H2-blockers block the production of histamine, a substance that stimulates acid secretion. By blocking histamine, these drugs reduce the amount of acid the stomach produces. Examples of H2-blockers are cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
These drugs usually provide relief within a few days to a few weeks, depending on the severity of the ulcer. H2-blockers usually are given for 6-8 weeks to encourage healing. If the ulcers were caused by Helicobacter pylori, and the infection is not treated, the ulcers will usually recur and must be treated again. However, ulcers usually do not come back when the underlying infection is treated. Ulcers caused by nonsteroidal anti-inflammatory drugs do not need treatment with antibiotics.
Acid pump inhibitors completely block the production of stomach acid by stopping the final step in acid secretion. Omeprazole (Prilosec) is an acid pump inhibitor.
Mucosal protective medications create a protective barrier that allows the ulcer to heal and prevents further damage to the stomach and duodenum. Sucralfate (Carafate) is such a drug.
Duodenal Ulcer: Information
Duodenal Ulcer is also known as Peptic ulcer disease, intestinal ulcer, just ulcer disease.
Diagram 1: Duodenal Ulcer
Diagram 2: Duodenal Ulcer
Peptic ulcers are areas of weakness or "depressions" that develop in the wall of the stomach or intestines, causing pain or discomfort. In a few cases they can bleed, tear open, or cause a blockage. Treatment is usually done with medicines, so surgery is very rarely needed.
Peptic Ulcer Disease is a broad description of any process that causes an ulcer to form in the stomach or intestines. If the ulcer is in the stomach, it is known as a gastric ulcer. If it is in the first part of the intestines, then it is called a duodenal ulcer.
Duodenal ulcers usually occur in younger people, while gastric ulcers occur in older age groups. It is still not clear what, if any, role stress plays in the development of ulcers. Alcohol and diet are not felt to play a very important role in the formation of ulcers. Some ulcers are caused by an organism called Helicobacter pylori, some are due to medications, and a few are caused by stomach or intestinal cancer. Therefore, treatment and long-term outcome depends on the cause of the ulcer.
Symptoms of Duodenal Ulcer
- Almost all people will have pain in the upper, central part of the abdomen (just under the breastbone). The pain can be a dull ache, throbbing, sharp, burning, "gas-like," cramping, etc. However, the pain can occur in almost any part of the abdomen.
- Often the pain associated with Peptic Ulcer Disease comes and goes. Some people notice that the pain gets worse after eating spicy foods. Also, many will notice that over the counter antacids help relieve their symptoms. Some people will feel better after eating, while, in others, the pain may increase after meals.
- Many will complain of stomach pain that wakes them up in the middle of the night -- usually between 2 and 4 am.
- Nausea and vomiting
- Because of the stomach pain, some lose their appetite and lose weight.
- In a few cases where the ulcers are more severe, the pain may radiate or move to the back.
- Not all people with these symptoms have a true ulcer. In fact, of all the people who have upper abdominal pain, only a minority has real ulcers. Most have a condition known as Gastritis or dyspepsia.
- Some will have chest pain or back pain
- If the ulcer causes a lot of inflammation, a blockage may develop.
- A few will have intestinal or stomach bleeding as their first symptom. There can be vomiting of blood or coffee-grounds like material. Others may complain of passing stools that are either red or black.
- In people with ulcers due to NSAIDs, up to half may not have any symptoms at all.
Causes of Duodenal Ulcer
The major causes of Peptic Ulcer Disease are:
- Helicobacter pylori -- this is a bacteria that is felt to cause many ulcers.
- NSAIDs: This is a group of medicines that includes things such as ibuprofen, naproxen, indomethacin, etc. These drugs are most often used to treat arthritis, headaches, back pain, and other conditions that cause pain and inflammation. It is felt that NSAIDs cause ulcers by decreasing the protective lining of the stomach and intestines.
- Zollinger-Ellison Syndrome is a condition that leads to excess acid production. This can overwhelm the protective layer in the stomach and intestines and lead to ulcers.
- In a few cases, the ulcer is actually due to a cancer in the stomach or intestine.
- Stress, diet, and alcohol are not felt to directly cause ulcers.
Treatment of Peptic Ulcer
- There are several different medicines available to treat ulcers. The type of treatment and the medicines used depend on the cause of the ulcer.
- There are three main types of medicines that can be used:
- medicines that reduce the amount of acid produced,
- medicines that protect the lining of the stomach and intestines, and
- medicines that destroy the bacterium, H. pylori.
- Medicines that reduce acid production are broken down into two categories. Generally, with these medicines, duodenal ulcers heal within 4-6 weeks and gastric ulcers heal within 6-8 weeks.
- Proton pump inhibitors -- Omeprazole and Lansoprazole are the most commonly used. Basically, they very effectively reduce acid production by the stomach. They are more potent than H2 receptor blockers but they are usually only used for short-term therapy. They can help cure up to 80-90% of ulcers. These medicines are usually taken 30 minutes before a meal. They help to relieve symptoms and allow healing to take place faster than H2 blockers, but the overall cure rate for ulcers is not much different between the two groups.
- H2 receptor blockers -- Cimetidine, Ranitidine, Famotidine, and Nizatidine are the 4 most commonly used medicines in this category. These medicines also reduce acid production and they can be used for longer periods of time. They are not as potent as the proton pump inhibitors, but they can be just as effective at curing ulcers. They also can cure about 80-90% of ulcers. Ulcer symptoms usually get better within about 2 weeks, but treatment is usually continued for 6-8 weeks.
- Certain medicines are available that basically protect and preserve the lining of the stomach and duodenum. These include:
i. Sucralfate -- this is a medicine that basically coats ulcers and forms a protective layer. It is very good at treating duodenal ulcers. It is not as good for treatment of gastric ulcers.
ii. Bismuth -- this is a medicine that causes increased production of the substances that normally protect the stomach and intestines. It also helps destroy H. pylori.
iii. Misoprostol -- this is a medicine that increases the production of the substances that normally protect the stomach and intestines. It is not as effective as the other medicines in treating an active ulcer. It is used mainly to help prevent the formation of ulcers in people who are on long-term treatment with NSAIDs.
iv. Antacids -- these are available over-the-counter. These medicines help protect the wall of the stomach and intestines. They do not reduce the formation of acid. They are no longer used as initial treatment for ulcers because more effective medicines are available. However, they do work very quickly and can be use to rapidly control symptoms.
- For ulcers caused by H. pylori, there are several treatment options.
- Metronidazole (500 mg twice a day) and clarithromycin (500 mg twice a day) and a proton pump inhibitor (such as omeprazole 20 mg twice a day) for 14 days.
- Amoxicillin (1 gram twice a day) and clarithromycin (500 mg twice a day) and a proton pump inhibitor (such as omeprazole 20 mg twice a day) for 14 days.
- Amoxicillin (1 gram twice a day) and metronidazole (500 mg twice a day) and a proton pump inhibitor (such as omeprazole 20 mg twice a day) for 14 days.
- Bismuth subsalicylate (2 tablets 4 times a day) and tetracycline (500 mg 4 times a day) and either metronidazole (250 mg 4 times a day) or clarithromycin (500 mg 3 times a day) for 14 days. Some are now recommending using ranitidine along with this regimen.
- After the person has completed one of the above regimens, they need to be continued on a proton pump inhibitor, an H2 antagonist, or sucralfate for an additional 4-6 weeks. This will help allow the ulcer to heal completely.
- This course of therapy should destroy the bacterium in more than 85% of people.
- For ulcers caused by NSAIDs, treatment is a little different.
- The first step is to stop using the NSAIDs.
- Proton pump inhibitors (such as omeprazole, lansoprazole) should be started as soon as possible. These are the most effective medicines.
- You can also use H2 receptor antagonists or sucralfate, but these are not as effective.
- If the person is on NSAIDs but tests also show the presence of H. pylori, then the best option is to stop the NSAIDs but also to go ahead and treat the H. pylori infection.
- In people with ulcers, NSAIDs can be continued along with one of the above medicines if there is absolutely no other alternative. However, healing of the ulcer will be delayed.
- Another cause is a missed cancer, especially with stomach ulcers that do not heal despite adequate therapy. Therefore, all gastric ulcers need to be followed by repeat endoscopy to confirm that they have healed. If they have not, then repeat biopsies should be done after 2-3 months of treatment. Repeat endoscopies should be done periodically until the ulcer has completely healed.
- A much more rare cause of non-healing or recurrent ulcers is Zollinger-Ellison Syndrome. Therefore, all people with continued ulcers should be checked for this condition.
- If all else fails and the person continues to have recurrent ulcers, then he or she may need surgery. This is the last treatment option that should only be considered after all other options are exhausted.
Side Effects of Anti-Ulcer Drugs
The most common side effects are dizziness, drowsiness, gas, headache, indigestion, nausea, vomiting, abdominal or stomach pain, and inflammation of the nose. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Less common side effects, such as blurred or dimmed vision, constipation, itching, rash, sleeplessness, abnormal dreams, breast swelling or tenderness, and backache also may occur and do not need medical attention unless they do not go away or they interfere with normal activities.
More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine as soon as possible:
- Confusion
- Fast, slow, pounding, or irregular heartbeat
- Sore throat
- Fever
- Tightness in chest
- Unusual bruising or bleeding
- Unusual tiredness or weakness
- Convulsions (seizures)
- Drowsiness.
Other rare side effects may occur. Anyone who has unusual symptoms after taking Anti-Ulcer drugs should get in touch with his or her physician.
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III. Useful links
Government http://www.cdc.gov/
http://www.fda.gov/
http://www.fda.gov/cder/ogd/
http://www.nih.gov/
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.health.gov.on.ca/
National Library of Medicine
World Health Organization
Health Sites
http://www.mayoclinic.com/index.cfm
MedicineNet.com
Drugdigest.org
Healthsquare.com
http://micro.magnet.fsu.edu/pharmaceuticals/pages/carafate.html
http://www.ecureme.com/emyhealth/data/Duodendal_Ulcer.asp
Pharmacy sites
http://www.roche.com/home/company/com_hist.htm
http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php
http://www.hsforum.com/stories/storyReader$1509
http://www.hsforum.com/stories/storyReader$1504
http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting
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