Effective options for stress ulcer prophylaxis include PPIs, H 2 antagonists, antacids, and sucralfate (Carafate). No medication has been shown to be superior to another. Although the optimal duration of prophylaxis is not known, most experts suggest continuing therapy while the patient is in the ICU, when bleeding risk is highest. However, many patients continue to receive prophylaxis inappropriately when they are transferred to general medical units and continue therapy after discharge without clear medical indications. 31 To minimize adverse outcomes, physicians should discontinue PPIs in patients when they are discharged from the ICU if there are no other indications for therapy.
Ketoconazole and quinidine, strong inhibitors of CYP450 3A and 2D6, respectively, inhibit donepezil metabolism in vitro . Whether there is a clinical effect of quinidine is not known. Population pharmacokinetic analysis showed that in the presence of concomitant CYP2D6 inhibitors donepezil AUC was increased by approximately 17% to 20% in Alzheimer’s disease patients taking ARICEPT 10 and 23 mg. This represented an average effect of weak, moderate, and strong CYP2D6 inhibitors. In a 7- day crossover study in 18 healthy volunteers, ketoconazole (200 mg .) increased mean donepezil (5 mg .) concentrations (AUC0-24 and Cmax) by 36%. The clinical relevance of this increase in concentration is unknown.