Overall, a new diagnosis of B12 deficiency was more common amongst patients with a 2 year supply or greater of PPIs and H2RAs
, compared with non-users.
Projected H2RA cost was based on ranitidine 150 mg twice daily (at $12 per month) for 9.
If H2RA treatment were then utilized instead of PPI, up to $358,488 in cost savings might be expected per year in our clinic.
Although PPIs are known to be more effective in the treatment of erosive esophagitis and severe GERD symptoms compared with H2RAs (86% compared with 52%), (29,30) uncomplicated less severe GERD/UGI disorders may be quite adequately managed with initial H2RA use.
The literature review identified seven randomised, controlled trials (RCT) comparing H2RA and PPI in the prevention of UGI bleeding associated with SRMD (10-16) and three individual meta-analyses (17-19).
Trials included in this analysis involved adult patient populations in the ICU setting, with any PPI vs any H2RA, regardless of drug, dosage or route of administration.
The PPI vs H2RA meta-analyses also failed to demonstrate a statistically significant difference in incidence of pneumonia in ICU patient populations (17-19).
Okano and Rascati (1995) evaluated a letter intervention targeted at physicians whose patients were taking two H2RA
drugs concurrently or an H2RA
with sucralfate in the Texas Medicaid program.
2) When coadministered with H2RAs
or proton-pump inhibitors, dose separation may be required.
1 percent (the concurrent use of an H2RA with misoprostol, omeprazole, or sucralfate) to 53.
Large numbers of individuals also failed the NSAID and H2RA dosage screens.
It incorporates updates and modifications of the UM/PCPS criteria and screens drug claims data for under- or overdosage, duration of therapy, drug-drug interactions, age-based contraindications, and duplicative therapy in eight drug categories: ACE inhibitors, antidepressants, antipsychotics, benzodiazepines, calcium channel blockers, digoxin, H2RAs
, and NSAIDs.