Document Detail

Prospective, randomized comparison of lansoprazole suspension, and intermittent intravenous famotidine on gastric pH and acid production in critically ill neurosurgical patients.
MedLine Citation:
PMID:  20596795     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is a paucity of studies comparing stress ulcer prophylaxis (SUP) agents in high-risk neurosurgical patients.
METHODS: In this prospective, randomized study, critically ill neurosurgical patients received lansoprazole 30 mg suspension via NG/NJ tube daily or famotidine 20 mg IV q12 h for SUP. Gastric pH and residual volumes were recorded for 3 days and adverse events for 7 days after admission.
RESULTS: There were 51 patients randomized to lansoprazole (n = 28) or famotidine (n = 23) who received SUP for ≥ 3 days. All patients had at least two risk factors for SRMD, and 75% had a baseline GCS < 9. On day 1 of therapy, more famotidine patients had a gastric pH ≥ 4 at least 80% of the time as compared to lansoprazole patients (74 vs. 36%, P = 0.01, respectively); however, there was no difference on days 2 and 3. Enteral feedings on day 1 predicted a pH ≥ 4 (P = 0.01). There were no significant differences in the percentages of time gastric residual volumes < 28 ml (P = NS). Heme-positive aspirates were present in 18-39% of patients (P = NS); one patient receiving famotidine met the criteria for overt bleeding. Thrombocytopenia occurred in 17% in the famotidine group and 4% in the lansoprazole group (P = NS).
CONCLUSIONS: Neurosurgery ICU patients receiving famotidine for SUP achieved a gastric pH ≥ 4 more often than lansoprazole-treated patients, but only on day 1 of the 3-day study period. Both agents were equally effective in reducing gastric acid production. There was no difference in the incidence of mucosal damage and thrombocytopenia.
Gretchen M Brophy; Marcia L Brackbill; Katherine L Bidwell; Donald F Brophy
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurocritical care     Volume:  13     ISSN:  1556-0961     ISO Abbreviation:  Neurocrit Care     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2011-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  176-81     Citation Subset:  IM    
Departments of Pharmacotherapy & Outcomes Sciences and Neurosurgery, Virginia Commonwealth University School of Pharmacy, P.O Box 980533, 410 N. 12th Street, Richmond, VA 23298, USA.
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MeSH Terms
2-Pyridinylmethylsulfinylbenzimidazoles / administration & dosage,  adverse effects,  therapeutic use*
Anti-Ulcer Agents / administration & dosage,  therapeutic use
Continental Population Groups
Critical Illness / therapy*
Famotidine / administration & dosage,  adverse effects,  therapeutic use*
Gastric Acidity Determination
Gastric Juice / drug effects,  physiology
Gastrointestinal Hemorrhage / chemically induced,  epidemiology
Hydrogen-Ion Concentration
Injections, Intravenous
Middle Aged
Neurosurgical Procedures
Prospective Studies
Young Adult
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Ulcer Agents; 0/Suspensions; 103577-45-3/lansoprazole; 76824-35-6/Famotidine

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