Other Ulcer Healing Drugs

Because of the effectiveness and safety of proton pump inhibitors and H₂ receptor antagonists, the other ulcer healing drugs are now seldom indicated. They are not recommended for non-ulcer dyspepsia because of unproven benefit and potential adverse effects.

• Promotes the healing of peptic ulcers by forming a bismuth/glycoprotein precipitate which forms a protective cover over the base of the ulcer.
• The effectiveness in treating peptic ulcers is similar to cimetidine and with a lower relapse rate. However its use is limited by side-effects and it should not be used for long term therapy.
• Indications:¹
  • Gastric and duodenal ulcers
  • As part of a Helicobacter pylori eradication regime in those who have not responded to first-line regimens²
• Interactions:
  • Tetracyclines: the absorption of tetracyclines is reduced
• Contra-indications:
  • Severe renal impairment
  • Patients on a low potassium diet
  • Pregnancy
• Side-effects:
  • May cause a dark tongue and black stools
  • Nausea and vomiting
  • There may be absorption of small quantities of bismuth but encephalopathy (which may occur with high-dose bismuth preparations) has not been reported

• Probably acts by protecting the mucosa from acid-pepsin attack in gastric and duodenal ulcers. It also stimulates production of mucus and prostaglandins.
• Sucralfate is a complex of aluminium hydroxide and sulphated sucrose but does not have any significant antacid properties.
• Sucralfate is as effective in the treatment of peptic ulcers as H₂ antagonists.³
• Indications:⁴
  • Benign gastric and duodenal ulceration
  • Chronic gastritis
  • Prophylaxis of stress ulceration
• Cautions:
  • Renal impairment (avoid if severe)
  • Pregnancy and breast-feeding
  • Not recommended in children
  • Administration of sucralfate and enteral feeds should be separated by 1 hour
  • Bezoar formation: following reports of bezoar formation associated with sucralfate, the Committee on Safety of Medicines has advised caution in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying.⁵ A bezoar is a ball of swallowed foreign material (e.g. hair) that collects in the stomach and fails to pass through the intestines.
• Interactions:
  • Sucralfate reduces the absorption of certain antibiotics (quinolones and tetracyclines), warfarin, phenytoin, antifungals, sulpiride and thyroxine. It may also reduce the absorption of digoxin.
• Side-effects:
  • Constipation, diarrhoea, nausea, indigestion, gastric discomfort
  • Dry mouth
  • Rash, hypersensitivity reactions
  • Back pain
  • Dizziness, headache, vertigo and drowsiness
  • Bezoar formation

Misoprostol is a synthetic prostaglandin E₁ analogue. It inhibits gastric acid secretion and stimulates the production of mucus and bicarbonate.

• It is effective in preventing NSAID-associated ulcers.
• Misoprostol is as effective as H₂ antagonists in healing duodenal ulcers but is less effective in the treatment of gastric ulcers and gastro-oesophageal reflux disease.
• Although effective, its use is mainly restricted because of potential side effects.
• Misoprostol is also used to induce abortion or labour.
• Indications:⁶
  • Gastric and duodenal ulceration; NSAID-associated ulceration
  • Prophylaxis of NSAID-induced gastric and duodenal ulcer.⁷ Misoprostol is more effective than H₂ receptor antagonists for preventing NSAID-associated ulceration but is associated with a greater cost and GI side-effects.⁸ Combination preparations with misoprostol are available for prophylaxis against NSAID-induced gastro-intestinal ulceration:
    • Diclofenac and misoprostol indicated for treatment of osteoarthritis and rheumatoid arthritis⁹
    • Naproxen and misoprostol indicated for treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis
• Contra-indications:
  • Pregnancy or planning pregnancy, breast-feeding. Use in women of childbearing age is restricted to NSAID induced ulceration (or risk of), and then only with effective contraception.
  • Not recommended in children.
• Side-effects:
  • Diarrhoea (may occasionally be severe and require withdrawal).
  • May also cause abdominal pain, dyspepsia, flatulence, nausea and vomiting, abnormal vaginal bleeding, rashes and dizziness.