H2 Blockers or PPIs?

[docB]

Do you guys start your gastritis patients on H2 blockers or PPIs? The H2s work faster and are cheaper. The PPIs are stronger and have qd dosing.

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[southerndoc]

Both actually. It takes 3-5 days for PPI's to start working. I usually start them on a PPI and also write for a prescription-strength H2 blocker for 5 days until the PPI takes effect.

 

[kungfufishing]

H2s are accessible for our population and better than the nothing they are typically on.

 

[margaritaboy]

Usually just H2 blockers.

 

[NinerNiner999]

I start them on H2 blockers for an entirely different reason - most insurance companies will not approve PPI's until the patient has demonstrated failure to H2 blockers.

 

[kungfufishing]

what is this "insurance" you speak of?

a good point.

 

[ForbiddenComma]

Med school pharm is emphasizing PPIs over H2 blockers right now.

For what it's worth.

 

[bartleby]

Emphasizing as in putting it in italics during the powerpoint in lectures?

H2 blockers act faster, PPI's give more complete acid suppression. For gastritis in the ED, I typically give an IV H2 blocker if I'm looking for effect over 1-2 hours.

There is evidence that acute PPI administration decreases the need for endoscopic intervention and shortens hospital stay in acute upper GIB (Lau JY et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007 Apr 19; 356:1631-40.), but don't look for a head-to-head test of an H2 blocker and a PPI for this endpoint in this day and age. There was no change in the need for surgery, risk of rebleed or death.

Med school pharm is emphasizing PPIs over H2 blockers right now.

 

[southerndoc]

I always give IV PPI (Protonix) and IV H2 blockers for suspected upper GI bleeds. I do as posted previously for patients going home.

 

[GeneralVeers]

Both Wal-Mart and Target have Famotidine on their $4 list.

The $4 program is great, because you can give patients a 30-day supply of medications they can actually afford.

If you don't have the list of $4 medications in your ED, make sure you get it!

Hence I give the H2.

 

[docB]

Both Wal-Mart and Target have Famotidine on their $4 list.

The $4 program is great, because you can give patients a 30-day supply of medications they can actually afford.

If you don't have the list of $4 medications in your ED, make sure you get it!

Hence I give the H2.

I have been told that for the patient to be able to fill the $4 meds the script has to match their formulary exactly. For example the sheets I have of what's available at WallMart on their $4 program has Pepcid as:

famotidine 20mg tabs, QTY 60

So for the patient to fill it you'd have to write for 60.

Anyone else heard this?

 

[margaritaboy]

I came from a county program, so mostly I like the H2 blockers for outpatient treatment that is affordable for people without insurance.

One day when PPIs and H2 blockers have the same cost, maybe I switch to the PPI for outpatient use.

 

[GeneralVeers]

I have been told that for the patient to be able to fill the $4 meds the script has to match their formulary exactly. For example the sheets I have of what's available at WallMart on their $4 program has Pepcid as:

famotidine 20mg tabs, QTY 60

So for the patient to fill it you'd have to write for 60.

Anyone else heard this?

No, my understanding is that the $4 applies to up to a month supply, however any quantity below that will also cost $4.

 

[docB]

No, my understanding is that the $4 applies to up to a month supply, however any quantity below that will also cost $4.

Good to know. I'm going to post a new thread with a link to the WallMart site.

 

[southerndoc]

No, my understanding is that the $4 applies to up to a month supply, however any quantity below that will also cost $4.

There is a maximum number that can be filled at one time. For example, only 20 ciprofloxacin tablets can be obtained at one time. So if you wanted to send someone out on a 14-day course for some reason, you would need to write two scripts.

 

[GeneralVeers]

There is a maximum number that can be filled at one time. For example, only 20 ciprofloxacin tablets can be obtained at one time. So if you wanted to send someone out on a 14-day course for some reason, you would need to write two scripts.

We have a list (from the Wal-Mart site) of all the medications (approximately 200) under the program, and the number of pills that can be prescribed. It varies with the type of medication.

 

[southerndoc]

We have a list (from the Wal-Mart site) of all the medications (approximately 200) under the program, and the number of pills that can be prescribed. It varies with the type of medication.

Right, I was using ciprofloxacin as one of only many examples.