Treatment with H2-Receptor Antagonists: When Is the Best Time to Dose?

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Abstract
Antisecretory drugs such as H2-receptor antagonists or H+K+-ATPase inhibitors heal acid-related lesions of the upper gastrointestinal tract, largely through their ability to reduce gastric acid secretion, and the clinical outcome with different compounds parallels the degree and duration of inhibition. The practice of administering H2-receptor antagonists at bedtime is empirical, and it has been suggested that a change in time of drug intake or increase in dose would optimize pharmacodynamic and clinical results. Whilst pharmacodynamic studies with the more potent drugs given after the evening meal yield superior intragastric pH control, this was less consistently reflected in the healing rates in duodenal ulcer trials. These results indicate that early evening dosing provides an effective alternative to the standard treatment regimens and further improvements may be obtainable by the use of increased doses of the available potent H2-receptor antagonists.