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Does an increased dosage of an H2RA have an obvious effect on healing of esophagitis and relief of symptoms?
J.G. Mills (London), R.H. Murdoch (Glaxo Research Triangle Park, North Carolina)
Ranitidine given 150 mg twice daily, or even as a single 300 mg dose at bedtime is an effective treatment for most patients with reflux esophagitis [1,2]. Nevertheless, a proportion of patients fail to respond. There is some evidence to suggest that patients whose esophagitis does not heal show little or no reduction in acid reflux time [3,4],
Reduction in esophageal acid contact time - a dose response
Ranitidine 150 mg b.d. is associated with a significant reduction in total reflux time. However, this dosage regimen is less effective in controlling daytime than nocturnal acid reflux and does not normalize acid contact time (ACT) in all patients (i.e., reduction of acid contact time (ACT) to <4.0%).
Increasing the dose of ranitidine, but more importantly the frequency of dosing, is associated with a further reduction in acid contact time (ACT) [5-7]. A dose-response relationship is most clearly demonstrated by the study of Jansen et al. [5]. The patients studied all had severe erosive esophagitis which had not responded to treatment with 150 mg b.d. However, larger and more frequent doses (up to 4 and 6 times 300 mg) reduced acid contact time (ACT) to within the normal range. A dose-response relationship has been confirmed in studies with other H2-receptor antagonists. A comparison of famotidine 40 mg nocte, 40 mg b.d. or 20 mg b.d. showed that twice daily administration was significantly more effective than the once daily regimen [8].
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