ศึกษาเปรียบเทียบผลของยาโอเมปราโซล 80 มิลลิกรัมฉีดเข้าหลอดเลือดดำ ตามด้วย 40 มิลลิกรัม ฉีดทุก 12 ชั่วโมง ว่าสามารถเพิ่มค่าความเป็นกรด-ด่างในกระเพาะอาหารได้เทียบเท่ากับผลของยาโอเมปราโซล 80 มิลลิกรัม ฉีดเข้าหลอดเลือดดำ ตามด้วยให้ต่อเนื่อง 8 มิลลิกรัมต่อชั่วโมง ได้หรือไม่ในคนไทย / คณิตา ฉัตราโสภณ = Comparison between omeprazole 80 mg IV push then 40 mg IV every 12 hours that can rise intragastric pH as same as omeprazole 80 mg IV push then 8 mg drip per hour in Thai population / Kanita Chattrasophon
Background: Proton-pump inhibitor is more effective for gastric acid control in Asian than Western population possible because of high prevalence of poor metabolizing CYP2C19 genotype in Asian people. Objective: To evaluate the effect of low dose intravenous (IV) bolus VS. standard recommended dose continuous IV infusion of omeprazole in Thai healthy volunteers. Method: 8 healthy subjects were randomized to receive either omeprazole 80 mg IV bolus followed by 40 mg IV bolus every 12 hr or omeprazole 80 mg IV bolus followed by 8 mg/hr continuous infusion for 48 hr. The gastric pH was monitored by a pH catheter with a data logger (DIGITRAPPER pH 400, Medtronic A/S) for 2 days during the omeprazole treatment periods. The gastric pH sensor was positioned at 10 cm below the LES located by esophageal manometry. Results: The mean gastric pH for IV bolus was significantly lower than continuous infusion only on day 1 (6.2±1.0 VS 7.1±0.6(p<0.05). Percent time pH>6 for IV bolus was also significantly lower compared to continuous infusion on day 1 (66.2±22.7% VS. 84.7±17.3%)(p<0.05)and entire 48-hr study (69.9 ±12.6% VS83.0±13.8%,p<0.05). 2 subjects developed gastric acid break through during the IV bolus treatment, but none in continuous IV infusion of omeprazole. Conclusion: Continuous IV infusion of standard recommended dose of omeprazole provided better gastric acid control compared to lower dose IV bolus only during the first day but not on the second day. Although the continuous IV infusion was more effective ,both standard dose continuous IV infusion and low dose IV bolus omeprazole was effective for gastric pH control in Thai healthy volunteers with extensive metabolizing CYP2C19 genotypes. Comparing to Western population ,suggests the role of other factor(s) beside the CYP2C19 genotype, on gastric acid inhibition effect of IV omeprazole.
