advice

Re: advice

Mark Rowland — Thu, 16 May 2013 07:55:01 GMT

[quote user="Christopher Saul"]

[quote user="Mark Rowland"]cisapride is available as a liquid oral formulation[/quote]

is it? From where ? I thought you could only get it as tablets.

[quote user="Mark Rowland"]Ranitidine causes a reduction in Hcl secretion of over 70%[/quote]

Forgive my stupidity here.... is that a rabbit thing? Ranitidine is considered a less potent antacid than, say, omeprazole in humans and dogs at least....

[/quote]

Sorry just under 70%

Effects of eight weeks' continuous treatment

with oral

ranitidine

and cimetidine on gastric acid

secretion,pepsin secretion, and fasting serum

gastrin

MOHAMMED, R J HOLDEN, J B HEARNS, B M

McKIBBEN,K D BUCHANAN, and G P CREAN

From

the Gastro-Intestinal Centre, Southern General Hospital, Glasgow, and University Department ofMedicine, Queen's University, Belfast

SUMMARY

Gastric acid secretion, pepsin secretion, and fasting serum gastrin levels were

measured in 23

patients with duodenal ulcer disease, divided into three groups which

received either cimetidine 800 mg daily, cimetidine 1600 mg daily, or ranitidine hydrochloride 300

mg daily for eight weeks. Pentagastrin tests were carried out at intervals both before and after treatment.

Each dose of cimetidine reduced acid secretion to 42% of control one week after starting therapy. Ranitidine reduced acid secretion to 33% of the pretreatment value. Acid

secretion

remained suppressed to these levels throughout treatment with each drug. Acid secretion

returned to pretreatment levels in all patients one week after treatment

and remained normal until the end of the

study. Both drugs reduced pepsin, which fell to 64% and 61%(p<O-Ol) after 800 mg and 1600 mg cimetidine respectively and to

65% (p<0-005) with ranitidine

after

one week's treatment. Pepsin secretion remained at this reduced level in

both cimetidine groups

till the end of treatment. Pepsin levels fell to 50% at two

weeks of therapy with ranitidine but stabilised

at this level till the end of therapy. Cimetidine withdrawal was followed by a return

towards

pretreatment levels of pepsin secretion; but secretion remained significantly depressed(p<0.05)

to the end of the study period. In the ranitidine-treated patients pepsin output returned to normal after drug withdrawal. Fasting gastrin levels rose during treatment with

both drugs but failed to reach significant levels. After withdrawal of treatment fasting serum

gastrin levels returned to normal in all three groups of patients.

The

gastric acid inhibitory properties of cimetidine are well known.1 2 Ranitidine hydrochloride is a

new

histamine H2-receptor antagonist which is structurally different from cimetidine and is

reported

to be several times more potent on a molar basis.3

4 Although the half life of these drugs is short,5 6 each is capable of reducing gastric pH to low levels for

long periods over 24 hours during treatment with usual

therapeutic doses.Substantial suppression of acid secretion could

theoretically

result in sustained hypergastrinaemia and

subsequent acid hypersecretion.Gastrin induces

parietal cell hyperplasia in experimental animals9

and very large doses of metiamide,Received for

Re: advice

CatherineThomas — Thu, 16 May 2013 06:59:57 GMT

You can get liquid cisapride from Summit. The only problem I've found with it is that it seems to have quite a short shelf life. Sometimes it's only a couple of months and we might not use it all up in time. Plus you have to pay for delivery each time.

Re: advice

Christopher Saul — Wed, 15 May 2013 23:53:23 GMT

[quote user="Mark Rowland"]cisapride is available as a liquid oral formulation[/quote]

is it? From where ? I thought you could only get it as tablets.

[quote user="Mark Rowland"]Ranitidine causes a reduction in Hcl secretion of over 70%[/quote]

Forgive my stupidity here.... is that a rabbit thing? Ranitidine is considered a less potent antacid than, say, omeprazole in humans and dogs at least....

Re: advice

Mark Rowland — Wed, 15 May 2013 23:07:25 GMT

[quote user="patrick murphy"]

any thoughts re. ranitidine re. metaclop or anything else. I used to always use metaclop, but with ranitidine readily available as an oral follow up and injectable I have been treading that path recently

[/quote] I don't use ranitidine much, cisapride is available as a liquid oral formulation, metoclopramide works best Iv as an infusion IMO . My theoretical concern with ranitidine lies with the potential for lower intestinal dysbiosis and diarrhoea caused by raising gastric pH. Ranitidine causes a reduction in Hcl secretion of over 70%. Hope that helps some

Re: advice

Julie Innes — Wed, 15 May 2013 22:42:57 GMT

Sorry to hear about your rabbit- sometimes they do seem to go downhill very quickly (and frustratingly!), doubt there was much you could have done in the time frame.

Re metoclop/ ranitidine- I always give metoclop for its pro-kinetic effect, occasionally give an injection of ranitidine if rabbit looks sore (and always give pain relief ++ to these guys- rabbit +pain = death in my experience!) But I don't ever give oral ranitidine, as the zantac syrup has something in it (? sorbitol?- can't recall exactly!) which can cause diarrhoea in bunnies.

Re: advice

patrick murphy — Wed, 15 May 2013 22:14:31 GMT

Re: advice

patrick murphy — Wed, 15 May 2013 22:12:10 GMT

from radiographs. it was in fact trying for a very short while to take blodds (mistake? day 2 ) that he really went down. so frustrating

Re: advice

patrick murphy — Wed, 15 May 2013 22:10:15 GMT

but when to intervene?my guy was almost unable to be caught on the table after we re fixed his iv after 12 hours of treatment, but sucumbed (?sp) in 3 hours

Re: advice

Marie Kubiak — Wed, 15 May 2013 20:36:38 GMT

Rat guts are worse!

Seriously though, we do a fair bit bit of rabbit intestinal surgery (obstruction relief and resections with anastamoses mostly) and if you can get them stable first and analgese well they are not horrendous patients. Time consuming post-op with syringe feeding, bolus fluids and nursing but don't write them off!

Marie

Re: advice

Mark Rowland — Wed, 15 May 2013 17:13:38 GMT

[quote user="patrick murphy"]

some gas more left and dorsal, with lots of solid injesta, but nothing else anywhere in guts.

[/quote] Was this from a pm? Did you run any bloods ante Mortem? Mark

Re: advice

Stephen Courtney — Wed, 15 May 2013 16:42:57 GMT

Rabbits are fragile. If your usual protocol, which bears great similarities to ours, didn't work, then I doubt anything could have changed the outcome. rabbits are fragile and usually sicker than they look. I sometimes suspect my 'successes' are simply those bunnies that weren't poorly in the first place....

Re: advice

Martin Atkinson — Wed, 15 May 2013 16:16:51 GMT

[quote user="patrick murphy"] I did not open up, which I now regret[/quote] I think you would have regretted opening it up! nothing lends itself less to successful surgery than rabbit gut.

Re: advice

patrick murphy — Wed, 15 May 2013 15:30:15 GMT

like horses and my top button after a great meal?

Re: advice

patrick murphy — Wed, 15 May 2013 15:29:25 GMT

some gas more left and dorsal, with lots of solid injesta, but nothing else anywhere in guts.

Re: advice

patrick murphy — Wed, 15 May 2013 15:28:31 GMT

trying to syringe feed recovery? cause? just happened, I think I got it 1 day too early, or one day too late. I did not open up, which I now regret

Re: advice

Gillian Mostyn — Wed, 15 May 2013 14:39:36 GMT

sometimes they feel better when the gut perforates.......but only for a little while.......

Re: advice

James Laidlaw — Wed, 15 May 2013 14:30:54 GMT

Radiographs? Not likely to make any difference though, but might give a clearer picture of what's going on internally. Some rabbits seem destined to just want to die...

Re: advice

CatherineThomas — Wed, 15 May 2013 14:23:54 GMT

I like cisapride for these kind of cases. Were you syringe feeding too? Did you work out what caused the ileus in the first place?