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- Gastrointestinal (upper)
- Clinical decisions
- Drug administration
- End of life care
- Symptoms and symptom management
Palliative care professionals often care for patients who would benefit from treatment to suppresses gastric acid secretions. Such patients include those with malignant bowel obstruction, gastrointestinal (GI) bleeding and dyspepsia. When faced with a patient population who commonly have swallowing difficulties, alternate routes to administer medications are frequently required, and many medications are given subcutaneously. Until recently, the H2 receptor antagonist ranitidine has been used as a subcutaneous option for many such indications. Due to recent concerns over its safety profile, however, ranitidine is not currently available in the UK. Consequently, there is increasing interest in the use of subcutaneous proton pump inhibitors (PPIs). This letter reviews the limited data published on this subject to date.
Use of subcutaneous PPIs for dyspeptic symptoms
Agar et al found subcutaneous omeprazole achieved symptom relief of epigastric and retrosternal burning chest pain in three separate patients with a variety of underlying diagnoses (linitis plastica and partial small bowel obstruction, metastatic oesophageal cancer and metastatic ovarian cancer).1 They were treated between 2 days and 4 days with no adverse effects.
Michelon et al successfully treated painful regurgitation in a patient with linitis plastica with subcutaneous pantoprazole.2 This study was limited, however, as scopolamine was started simultaneously, making it difficult …
Contributors SJ contributed to the design, searches and synthesis; led the manuscript writing; and was responsible for submission. JT provided oversight of the design, critical review and manuscript editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.