PPIs inhibit gastric acid secretion by irreversibly inhibiting the proton pump (H+/K+ -ATPase), thereby blocking gastric acid secretion (See reference 5).
There is currently insufficient published evidence to recommend one PPI over another.
Accordingly, this guidance suggests that any of the following PPIs would be a reasonable option.
Reduce doses in severe hepatic impairment.
40mg, diluted in 10mls 0.9% sodium chloride, administered as a SC bolus over 2
minutes as a single daily dose (See references 1, 10)
0.9% sodium chloride recommended
PPI injections/infusions are alkaline after reconstitution and should therefore not be
mixed with other medications(See references 1).
Esomeprazole may appear yellow after mixing (See references 1).
Local site irritation (See references 6, 7, 8).
Esomeprazole and omeprazole are weak-moderate inhibitors of CYP2C19. Important
Although SC Ranitidine is no longer in production, famotidine is widely available and, although unlicensed for SC administration, there are reports of safe use via this route though evidence is lacking. Famotidine injection is not available in the UK but can be imported as a special product – liaise with your pharmacy teams for further advice and costings.
Suggested administration guidance as per PCF8:
Famotidine 20mg can be given IV b.d. diluted to 5mL with sodium chloride 0.9% and given over 2min
Reduce doses in renal impairment
Refer to local formulary/guidance – may be specialist use only. Some items are classed as hospital only and therefore will affect community availability.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.