Mekanisme Sekresi H+

McQuaid, K.R. 2012. Drugs Used in the Treatment of Gastrointestinal Disease In: Basic and Clinical Pharmacology 12th edition. Katzung, B.G.,
Masters, S.B., and Trevor, A.J. (Eds). pp: 1081-1114
 Physiological and Pharmacological
Regulation of Gastric Secretion

Brunton, L.L., Chabner , B.A., Knollman, B.C. 2011. Pharmacotherapy of Gastric Acidity, Peptic Ulcers, and Gastroesophageal Reflux Disease
In: Goodman & Gilman’s The Pharmacological Basic of Therapeutics. 12th edition.
 PKPD RANITIDINE &
SUCRALFATE
Parameters Ranitidine Sucralfate
Absorption Oral: 50%; IM: Rapid Oral: Minimal
Onset:
Paste formation and ulcer adhesion: 1-2
Hours
Duration: Up to 6 hours
Distribution Vd : Normal renal function: ~1.4 L/kg; CrCl 25 to 35 Acts locally at ulcer sites; unbound in GI tract to
mL/minute: 1.76 L/kg aluminum and sucrose octasulfate
Protein Binding ~15%
Metabolism Hepatic (minor) to Noxide, Soxide, and Ndesmethyl None
Metabolites
Bioavaibility Oral tablets: ~50%; IM: 90% to 100%
Half-life Oral: Normal renal function: 2.5 to 3 hours
IV: Normal renal function: 2 to 2.5 hours; CrCl 25 to
35 mL/minute: 4.8 hours
Time to peak Oral: 2 to 3 hours; IM: ≤15 minutes
serum
concentration
Elimination Urine (as unchanged drug): Oral: 30%, IV: 70%; Urine (small amounts as unchanged compounds)
feces (as metabolites)
Lexicomp, 2015
 KRITERIA PEMBERIAN
PROPHYLAXIS STRESS ULCER
Berdasarkan RCT dan guideline, rekomendasi dari American Society of Health System
Pharmacist, Profilaksis Stres ulcer digunakan pada pasien dengan kondisi kritis yang
beresiko tinggi pendarahan saluran cerna. Berikut ini merupakan kondisi pasien yang
diindikasikan untuk menggunakan profilaksis stress ulcer :
 Koagulopati didefinisikan jumlah platelet < 50.000 per m3, INR > 1,5 dan PTT >2x nilai normal
 Pemasangan ventilator > 48 jam
 Riwayat GI ulcerasi atau bleeding selama setaun yang lalu
 Cedera otak, cedera tulang belakang, dan adanya luka bakar
 Dua atau lebih kriteria minor sebagai berikut :
• Sepsis;
• Pasien ICU > 1 minggu;
• GI bleeding > 6 hari;
• Mendapatkan terapi glukokortikoid (lebih dari 250 mg hidrokortison atau
ekuivalen).

Weinhouse, G.L. 2015. Stress Ulcer Prophylaxis in the Intensive Care Unit. Uptodate. 1-10.
 REKOMENDASI TERAPI

• Pada pasien kritis dengan faktor resiko stress ulcer

direkomendasikan menggunakan profilaksis (PPI, H2
blocker, antasida) lebih baik daripada nonprofilaksis
(grade 1B)
• Comparative Evidence: H2 blockers versus sucralfate
– A trial randomly assigned 1200 mechanically ventilated
patients to receive sucralfate suspension via nasogastric tube
plus an intravenous placebo, or a H2 blocker (intravenous
ranitidine) plus a placebo suspension via nasogastric tube.
The H2 blocker decreased overt GI bleeding compared to
sucralfate (1.7 versus 3.8 percent).

Weinhouse, G.L. 2015. Stress Ulcer Prophylaxis in the Intensive Care Unit. Uptodate. 1-10.
 DOSAGE RANITIDINE & SUCRALFATE
• Ranitidine:
– IV: Intermittent bolus: 50 mg every 6 to 8 hours (Lexicomp, 2015) or
50 mg every 12 to 24 hours (Lacy, 2013)
– Oral, nasogastric (NG) tube: 150 mg twice daily; may administer a
300 mg loading dose prior to maintenance dosing
• Sucralfate:
- 1 g 4 times/day
- In an acid environment (pH <4), sucralfate undergoes extensive
cross-linking to produce a viscous, sticky polymer that adheres to
epithelial cells and ulcer craters for up to 6 hours after a single
dose.
- Because it is activated by acid, sucralfate should be taken on an
empty stomach 1 hour before meals. The use of antacids within 30
minutes of a dose of sucralfate should be avoided

Lacy. 2013. Drug Information Handbook; Lexicomp, 2015; Brunton, L.L., Chabner , B.A., Knollman, B.C. 2011.
Pharmacotherapy of Gastric Acidity, Peptic Ulcers, and Gastroesophageal Reflux Disease In: Goodman & Gilman’s The
Pharmacological Basic of Therapeutics. 12th edition.
 RANITIDINE & SUCRALFAT
Regimen
Obat 24/11 25/11 26/11 27/11 28/11 29/11 30/11
Dosis
Ranitidine 2 x 1 amp iv √ √ √ √ √ √ √
Sucralfat 3xIC
√
Syr

Data Klinik 24/11 25/11 26/11 27/11 28/11 29/11 30/11

Mual/Muntah -/- mual mual

• Dosis pemberian ranitidine dan sucralfate sudah sesuai

pada pasien yaitu 2x50mg dan 3x1C(15ml) per hari.
Sebaiknya sucralfate diberikan 1 jam sebelum ranitidine,
karena sucralfate akan bekerja pada suasana asam (pH<4).
 Hyoscine Butylbromide

• Hyoscine HBr merupakan antikolinergik yang berikatan dengan reseptor

muskarinik pada sel otot polos saluran cerna, sehingga digunakan untuk
mengatasi nyeri perut.
Tygat, G.N. 2007. Hyoscine Butylbromide: A Review of its Use in the Treatment of Abdominal Cramping and Pain.
Drugs. 67 (9). 1343-1357.
 Hyoscine Butylbromide (2)

• Beberapa meta analisa dan sistematik review menunjukkan bahwa

Hioscyine HBr efektif dalam mengobati kramp perut dengan level
evidence intermediate.
Tygat, G.N. 2007. Hyoscine Butylbromide: A Review of its Use in the Treatment of Abdominal Cramping and Pain.
Drugs. 67 (9). 1343-1357; Poynard, T., Regimbeau, C., Benhamou, Y. 2000. Meta-analysis of Smooth Muscle Relaxants
in the Treatment of Irritable Bowel Syndrome. Aliment Pharmacol Ther. 15. 355-361.
 BUSCOPAN
Regimen
Obat 24/11 25/11 26/11 27/11 28/11 29/11 30/11
Dosis
Hyoscine 3 x 1 amp
√ √ //
HBr

Data
24/11 25/11 26/11 27/11 28/11 29/11 30/11
Klinik
Nyeri
+8 +3 +3 +2 - - - -
Perut

• Rekomendasi Dosis Hyoscine HBr untuk mengatasi nyeri perut

karena kramp yaitu 10-20 mg 3-4 kali sehari. Dosis maksimal
100 mg/hari per oral (Tygat, 2007) .
• Dosis Hyoscine HBr yang diberikan pada pasien sudah
sesuai.
Tygat, G.N. 2007. Hyoscine Butylbromide: A Review of its Use in the Treatment of Abdominal Cramping and Pain.
Drugs. 67 (9). 1343-1357
 DAFTAR PUSTAKA
• Brunton, L.L., Chabner , B.A., Knollman, B.C. 2011. Pharmacotherapy of Gastric
Acidity, Peptic Ulcers, and Gastroesophageal Reflux Disease In: Goodman &
Gilman’s The Pharmacological Basic of Therapeutics. 12th edition.
• Lacy. 2013. Drug Information Handbook.
• Lexicomp, 2015.
• McQuaid, K.R. 2012. Drugs Used in the Treatment of Gastrointestinal Disease In:
Basic and Clinical Pharmacology 12th edition. Katzung, B.G., Masters, S.B.,
and Trevor, A.J. (Eds). pp: 1081-1114.
• Poynard, T., Regimbeau, C., Benhamou, Y. 2000. Meta-analysis of Smooth Muscle
Relaxants in the Treatment of Irritable Bowel Syndrome. Aliment Pharmacol Ther.
15. 355-361.
• Tygat, G.N. 2007. Hyoscine Butylbromide: A Review of its Use in the Treatment of
Abdominal Cramping and Pain. Drugs. 67 (9). 1343-1357.
• Weinhouse, G.L. 2015. Stress Ulcer Prophylaxis in the Intensive Care Unit.
Uptodate. 1-10.