Peptic Ulcer Disease Drug Summary

Last updated: 18 February 2026
Reviewed by

Antacids*

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Drug Available Strength Dosage Remarks
Alexitol sodium
(Na polyhydroxy-aluminum monocarbonate hexitol complex)		 360 mg/tab 2-4 tab PO 1/2-1 hour after each meal and at bedtime
Max dose: 4 tab/day x 2 weeks		 Adverse Reactions
  • Rarely: nausea/vomiting, constipation
Special Instructions
  • Use with caution in patients with renal insufficiency
Aluminum hydroxide
[Al(OH)3]		 600 mg/tab 1-2 tab PO 6 hourly Adverse Reactions
  • Constipation; phosphate depletion may occur with prolonged use or in large doses
Special Instructions
  • Contraindicated in patients with hypophosphatemia
  • Use with caution in patients with renal and hepatic failure
320 mg/5 mL oral suspension 5-30 mL PO as required between meals and at bedtime
Calcium carbonate
(CaCO3)		 500 mg/tab 1-3 tab PO as required
Max dose: 16 tab/day		 Adverse Reactions
  • GI effects (constipation, flatulence);
    Metabolic effects (hypercalcemia, metabolic alkalosis)
Special Instructions
  • Contraindicated in patients with hypercalcemia, presence of or history of renal calculi, hypophosphatemia, suspected Digoxin toxicity
  • Use with caution in patients with renal impairment, hypercalcemia-associated diseases, hypoparathyroid disease
835 mg/cap, tab 1-2 cap/tab PO 4-6 hourly
1 g/tab 1 tab PO 4-6 hourly
1.25 g/tab
1.5 g/tab
Hydrotalcite 500 mg/tab 2 tab PO 6-8 hourly Adverse Reactions
  • GI effects (diarrhea, soft stools, dry mouth)
Special Instructions
  • Use with caution in patients with renal or cardiac disorder, diarrhea, hypermagnesemia
  • May interfere with absorption of tetracyclines
100 mg/mL oral suspension 10 mL PO 6-8 hourly
Magaldrate 400 mg/tab 1-2 tab PO 6-8 hourly Combination of Al and Mg(OH)2 and sulfate
Adverse Reactions
  • GI effects (nausea/vomiting, constipation, chalky taste, stomach cramps); Other effects (hypophosphatemia, hypermagnesemia, osteomalacia, encephalopathy)
Special Instructions
  • Avoid in patients with colostomy/ileostomy, ulcerative colitis, or diverticulitis
Magnesium hydroxide
[Mg(OH)2]		 311 mg/tab 2-4 tab PO 1 hour after meals Adverse Reactions
  • GI effects (diarrhea, abdominal cramps, nausea/vomiting); Other effects (hypermagnesemia in patients with renal impairment, muscle weakness, respiratory depression, hypotension)
Special Instructions
  • Contraindicated in patients with intestinal obstruction, fecal impaction, renal failure
  • Use with caution in patients with colostomy, ileostomy, electrolyte imbalance
  • Monitor for toxicity (hypermagnesemia) in patients with impaired renal function
400 mg/5 mL oral suspension 5-15 mL PO at bedtime or up to 6 hourly
Magnesium oxide (MgO) 84.5 mg/cap 3-4 cap PO 24 hourly or
400 mg PO 24 hourly		 Adverse Reactions
  • GI effects (cramps, diarrhea, vomiting, stomach upset, paralytic ileus); Other effects (rashes, hives, itching, hypermagnesemia)
Special Instructions
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal impairment, bowel obstruction
Magnesium trisilicate 500 mg/tab 1-4 tab PO as needed
Max dose: 8 tab/day		 Adverse Reactions
  • Diarrhea
Special Instructions
  • Contraindicated in patients with renal insufficiency
  • May cause CNS depression at high doses; siliceous calculus may develop on prolonged use
Sodium bicarbonate
(NaHCO3)		 325 mg/tab 3-6 tab PO 6 hourly Adverse Reactions
  • GI effects (cramps, belching, flatulence)
  • Excessive use of bicarbonate may lead to hypokalemia and metabolic alkalosis, especially in patients with impaired renal function
Special Instructions
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal and hepatic impairment, bowel obstruction
  • Usually given in combination with an Aluminum-containing antacid to decrease diarrhea
650 mg/tab 2-4 tab PO 8 hourly
*Various combinations of antacids are available. Al- and Mg-containing antacids are usually combined to decrease constipation/diarrhea. Please see the latest MIMS for specific formulations and prescribing information.

Antispasmodics

Drug Dosage Remarks
Alverine citrate 60-120 mg PO 8 hourly Adverse Reactions
  • CNS effects (headache, dizziness); Other effects (allergic reactions, pruritus, rash, nausea)
Special Instructions
  • Contraindicated in patients with intestinal obstruction or paralytic ileus
Dicycloverine 20 mg PO 8 hourly

Adverse Reactions

  • GI effects (dry mouth, thirst, difficulty in swallowing and talking, constipation); CV effects (transient bradycardia, tachycardia, arrhythmias, palpitations); Other effects (dilatation of pupils, loss of accommodation and photophobia, flushing and dryness of the skin, dysuria)
Special Instructions
  • Use with caution in patients with closed-angle glaucoma or narrow-angle between iris or cornea
Homatropine methylbromide 5-10 mg PO 3-4 hourly Adverse Reactions
  • Dry mouth and skin, thirst, decreased bronchial secretions, mydriasis
Special Precautions
  • Avoid in patients with prostatic enlargement
  • Use with caution in patients with narrow-angle glaucoma
Hyoscine-N-butylbromide 10-20 mg PO 3-5 times daily
or
10-20 mg SC/IM/IV
May repeat dose after 30 minutes if needed		 Adverse Reactions
  • GI effects (dry mouth, thirst, difficulty in swallowing and talking, constipation); CNS effects (drowsiness, fatigue, occasionally CNS stimulation); CV effects (transient bradycardia followed by tachycardia, arrhythmias, palpitations); Other effects (decreased bronchial secretions, rash, dysuria, mydriasis with cycloplegia)
Special Instructions
  • Avoid in patients with tachycardia, glaucoma, prostatic hypertrophy, GIT mechanical stenosis, megacolon, myasthenia gravis
  • Use with caution in elderly patients, patients with heart failure (HF), thyrotoxicosis, hypertension, diarrhea
Methscopolamine Br 1-2 mg PO 8 hourly Adverse Reactions
  • Ophthalmologic effects (blurred vision, mydriasis, cycloplegia); Other effects (dry mouth, constipation)
Special Precautions
  • Avoid in patients with glaucoma
  • Use with caution in patients with pyloric obstruction, prostatic hypertrophy, history of bladder difficulty with anticholinergics
Oxyphencyclimine 5-10 mg PO 6-12 hourly Adverse Reactions
  • CNS effects (headache, nervousness, mental confusion); Ophthalmologic effects (blurred vision, cycloplegia, increased ocular tension); Other effects (xerostomia, decreased sweating, urinary hesitancy and retention, loss of taste, impotence, suppression of lactation, urticaria, constipation)
Special Instructions
  • Avoid in patients with closed-angle glaucoma, obstructive uropathy, GI obstruction, paralytic ileus, intestinal atony, ulcerative colitis, toxic megacolon; myasthenia gravis
  • Use with caution in elderly patients, patients with CHF, thyrotoxicosis, hypertension, autonomic neuropathy
Timepidium Br 30 mg PO 8 hourly Adverse Reactions
  • Photophobia, palpitations, hypersensitivity
Special Instructions
  • Avoid in patients with glaucoma, dysuria, severe cardiac disease, paralytic ileus
  • Use with caution in patients with prostatomegaly, hyperthyroidism, CHF, arrhythmias, idiopathic ulcerative colitis

Drug Available Strength Dosage Remarks
Combination Products
Alverine citrate/
Simethicone		 Alverine citrate 60 mg/Simethicone 300 mg 1 cap PO 8-24 hourly Adverse Reactions
  • Nausea, headache, dizziness, hypotension, itching, rash and hypersensitivity reactions
Special Instructions
  • Avoid in patients with paralytic ileus
Chlordiazepoxide/
Alverine citrate		 Chlordiazepoxide 5 mg/Alverine citrate 30 mg 1-2 drag PO 8 hourly Adverse Reactions
  • Fatigue, drowsiness, muscle weakness
Special Instructions
  • Contraindicated in patients with acute narrow-angle glaucoma, myasthenia gravis, shock, severe psychoses
  • May produce drug dependence, amnesia and increase severity of grand mal seizures; organic brain disease, cardio-respiratory insufficiency, decreased hepatic or renal function; COPD or respiratory failure; avoid long-term use
Chlordiazepoxide/
Clidinium Br		 Chlordiazepoxide 5 mg/Clidinium Br 2.5 mg 1-2 tab PO up to 4x/day Adverse Reactions
  • GI effects (dry mouth, constipation); CNS effects (drowsiness, amnesia); Other effects (hypotension, urinary retention, blurring of vision, agranulocytosis, granulocytopenia)
Special Instructions
  • Contraindicated in patients with glaucoma and prostatic hypertrophy
  • Use with caution in patients with epilepsy, CV, hepatic, or renal disease, respiratory depression, first-trimester pregnancy

Cytoprotective Agents


Drug Dosage Remarks
Sucralfate Duodenal ulcer: 2 g PO 12 hourly or
1 g PO 6 hourly before meals and at bedtime x 4 weeks
Max duration: 8-12 weeks
Gastric ulcer: 2 g PO 12 hourly or
1 g PO 6 hourly before meals and at bedtime x 4-12 weeks
Prophylaxis of duodenal ulcer recurrence:
1 g PO 12 hourly for up to 1 year
Prophylaxis of stress ulcer:
1 g PO 4 hourly
Max dose: 8 g/day 		Adverse Reactions
  • GI effects (constipation; less frequently GI disturbances and dry mouth); Other effects (dizziness, skin rashes)
Special Instructions
  • Contraindicated in patients on dialysis
  • Use with caution in patients with renal impairment
  • Concomitant use with antacids should not be <30 min before or after sucralfate
Bismuth Preparations
Bismuth salicylate
(Bismuth subsalicylate)		 524 mg PO 1/2-1 hourly
Max dose: 8 doses/day
or
1,048 mg PO 12 hourly
May repeat every 1 hour to
Max dose: 4 doses/day 		Adverse Reactions
  • Not common if used for limited periods
  • CNS effect (reversible encephalopathy); GI effects (nausea/vomiting, stomatitis, darkening of stool and tongue); Other effects (bone and joint toxicity, skin reactions, renal failure, liver damage)
  • Bismuth salicylate may have similar side effects with Aspirin: GI effects (nausea/vomiting, GI ulceration), hematologic effects and hypersensitivity reactions
Special Instructions
  • Contraindicated in patients with moderate-severe renal impairment; Salicylate formulation should be avoided in patients with history of GI bleeding or coagulopathy
  • Bismuth salicylate should be used with caution in patients taking Aspirin
  • Monitor renal function regularly
Bismuth subcitrate
(Colloidal bismuth subcitrate)		 120 mg PO 6 hourly or
240 mg PO 12 hourly x 4-8 weeks
May also be repeated after 1 month of drug-free interval
Prostaglandin
Misoprostol Active duodenal ulcer, benign gastric ulcer, NSAID-associated ulcer: 800 mcg/day PO divided 6-12 hourly x 4-8 weeks
Prophylaxis for NSAID-associated ulcer: 100-200 mcg PO 6-12 hourly 		Adverse Reactions
  • GI effects (diarrhea, abdominal pain, dyspepsia, flatulence, nausea/vomiting); Gynecologic effects (increased uterine contractility, abnormal vaginal bleeding); Other effects (rash, headache, dizziness, rarely hypotension)
Special Instructions
  • Should not be used in women of childbearing potential unless able to comply with effective contraception
  • Use with caution in elderly, in patients with CV disease, renal impairment, inflammatory bowel disease
Other Cytoprotective Agents
Irsogladine maleate 4 mg/day PO in 1-2 divided doses Adverse Reactions
  • GI effects (constipation, diarrhea, nausea/vomiting); Other effects (rash, itching, chest pressure sensation, increased AST, ALT, alkaline phosphatase and LDH)
Special Instruction
  • Carefully administer in elderly patients starting at a low dose (eg 2 mg/day) while closely monitoring the patient's condition
Rebamipide 100 mg PO 8 hourly Adverse Reactions
  • GI effects (diarrhea, constipation, nausea); Dermatologic effects (rash, pruritus)
Special Instruction
  • Discontinue if markedly increased transaminase, fever, rash and hypersensitivity reactions develop
Teprenone 50 mg PO 8 hourly Adverse Reactions
  • GI effects (constipation, anorexia, nausea, dry mouth, diarrhea, abdominal pain); Metabolic effects (increase in serum cholesterol levels or LFT); Other effects (headache, rash, itching, thirst)
Special Instruction
  • Use with caution in patients with hepatic impairment

Histamine2-Receptor Antagonists (H2RAs)

Drug Dosage Remarks
Cimetidine Active duodenal ulcer or benign gastric ulcer:
200 mg PO 8 hourly and 400 mg PO at bedtime or
300 mg PO 6 hourly or 400 mg PO 12 hourly or 600 mg PO 12 hourly or 800 mg PO at bedtime
Duration: Duodenal ulcer 4 weeks, gastric ulcer 6 weeks
NSAID-induced ulcer: 800 mg PO 24 hourly x 8 weeks
Maintenance/prevention: 300-400 mg PO 12 hourly or at bedtime
or
300 mg IM/slow IV 6 hourly or 200-400 mg intermittent IV infusion 6 hourly or 37.5 mg/hr continuous IV infusion
Max dose: 2.4 g/day 		Adverse Reactions
  • CNS effects (headache, dizziness, somnolence, insomnia, agitation); GI effects (diarrhea, nausea/vomiting); Other effects (rashes, myalgia, arthralgia)
  • Rarely reported effects: Hepatotoxicity, hypersensitivity reactions, CV effects (tachycardia, bradycardia, hypotension), hematologic effects (leukopenia, thrombocytopenia, agranulocytosis), acute pancreatitis, altered LFTs, reversible confusion in the elderly and those with renal failure
  • Cimetidine: Has weak anti-androgenic effects; impotence and gynecomastia have occurred and are usually reversible
Special Instructions
  • IV injection should be given slowly; IV infusion is preferred (especially for high doses and in patients with CV impairment)
  • Use with caution in patients with hepatic and renal impairment; dose adjustment recommended
  • Cimetidine: May reduce hepatic metabolism of some drugs through inhibition of cytochrome P450 isoenzymes; closely monitor those on oral anticoagulants, Lidocaine, Phenytoin or Theophylline; dose reduction may be necessary
Famotidine Active duodenal ulcer or benign gastric ulcer:
40 mg PO 24 hourly at bedtime or
20 mg PO 12 hourly x 4-8 weeks or
20 mg IV injection or infusion 12 hourly
Maintenance/prevention:
20 mg PO 24 hourly at bedtime
Lafutidine Duodenal ulcer or gastric ulcer:
10 mg PO 12 hourly
Nizatidine Active duodenal ulcer, benign gastric ulcer or NSAID-induced ulcer: 150 mg PO 12 hourly or
300 mg PO at bedtime x 4-8 weeks
Maintenance/prevention:
150 mg PO 24 hourly
Ranitidine Active duodenal ulcer or benign gastric ulcer:
150 mg PO 12 hourly or 300 mg PO at bedtime x 4-8 weeks
or
50 mg IM/slow IV 6-8 hourly or
50 mg slow IV then 0.125-0.25 mg/kg/hr continuous IV infusion
NSAID-induced ulcer:
150 mg PO 12 hourly or
300 mg PO at bedtime x 8-12 weeks
Maintenance/prevention:
150 mg PO at bedtime
Roxatidine Active duodenal ulcer or benign gastric ulcer:
75 mg PO 12 hourly or 150 mg PO at bedtime x 4-6 weeks
Maintenance dose: 75 mg PO at bedtime

Potassium-Competitive Acid Blockers (PCABs)


Drug Dosage Remarks
Revaprazan 200 mg PO 24 hourly Adverse Reactions
  • GI effects (diarrhea, loose stools); Other effects (headaches, rhinorrhea)
Special Instructions
  • Use with caution in patients with hepatic impairment
Tegoprazan Gastric ulcer: 50 mg PO 24 hourly x 8 weeks Adverse Reactions
  • GI effects (nausea, diarrhea, dyspepsia); Other effects (nasopharyngitis, viral upper respiratory tract infection, chest discomfort)
Special Instructions
  • Avoid in patients taking Atazanavir, Nelfinavir or Rilpivirine-containing products
  • Use with caution in patients with renal and hepatic impairment
Vonoprazan Gastric ulcer: 20 mg PO 24 hourly
up to 8 weeks
Duodenal ulcer: 20 mg PO 24 hourly up to 6 weeks
Prevention of recurrence of gastric and duodenal ulcer during low-dose Aspirin and NSAID administration: 10 mg PO 24 hourly 		Adverse Reactions
  • GI effects (constipation, diarrhea, nausea, abdominal discomfort, taste disturbances, stomatitis); Hypersensitivity reactions (rash, urticaria, drug eruption, anaphylactic shock); Hepatic effects (hepatotoxicity, jaundice); Other effects (edema, eosinophilia)
Special Instructions
  • Avoid in patients receiving Atazanavir, Rilpivirine or Nelfinavir
  • Use with caution in patients with hepatic and renal disorders; may mask symptoms of gastric cancer
  • Increased risk for GI infection caused by C difficile and osteoporosis-related fractures of hip, wrist or spine

Proton Pump Inhibitors (PPIs)

Drug Dosage Remarks
Esomeprazole 20-40 mg PO 24 hourly
NSAID-associated ulcer:
20 mg PO 24 hourly x 4-8 weeks or
20 mg slow IV injection x up to 10 days
Prophylaxis for NSAID-associated ulcer: 20-40 mg PO 24 hourly x 6 months
or 20-40 mg IV 24 hourly
Maintenance of hemostasis and prevention of ulcer rebleeding:
80 mg IV infusion for 30 minutes, followed by 8 mg/hr continuous IV infusion given over 3 days, followed by 40 mg PO 24 hourly x 4 weeks		 Adverse Reactions
  • Generally well tolerated; most commonly reported: Headache, diarrhea, rash
  • GI effects (constipation, flatulence, abdominal pain, nausea/vomiting, dry mouth); Dermatologic effects (pruritus, urticaria); Musculoskeletal effects (arthralgia, myalgia, osteoporosis-related fracture); Hematologic effects (eosinophilia, leukopenia, thrombocytopenia); Other effects (dizziness, fatigue, insomnia, cough, upper respiratory tract infection)
  • Hypersensitivity reactions, elevated liver enzymes, and isolated cases of photosensitivity and hepatotoxicity have been reported
Special Instructions
  • Exclude possibility of gastric malignancy prior to treatment
  • Use with caution in patients with hepatic impairment (dose adjustment recommended); those at risk for osteoporosis
  • Concomitant use with Atazanavir or Nelfinavir is not recommended (PPIs reduce exposure to these drugs)
Lansoprazole Active duodenal ulcer: 30 mg PO 24 hourly x 4-8 weeks or 30 mg IV 12 hourly
Benign gastric ulcer: 30 mg PO 24 hourly x 8 weeks or 30 mg IV 12 hourly
Maintenance dose: 15 mg PO 24 hourly
NSAID-associated ulcer:
15-30 mg PO 24 hourly x 4-8 weeks
Prophylaxis for NSAID-associated ulcer: 15-30 mg PO 24 hourly
Omeprazole Active duodenal ulcer: 20 mg PO 24 hourly x 2-4 weeks
May be increased to 40 mg in severe cases
Benign gastric ulcer: 20 mg PO 24 hourly x 4-8 weeks
May be increased to 40 mg in severe cases
or
40 mg slow IV injection/infusion 24 hourly x 5-7 days
Maintenance/prevention: 10-20 mg PO 24 hourly
NSAID-associated ulcer: 20 mg PO 24 hourly x 4-8 weeks or
40 mg IV infusion 24 hourly
Prophylaxis for NSAID-associated ulcer: 20 mg PO 24 hourly
Pantoprazole Active duodenal ulcer: 40 mg PO 24 hourly x 2-4 weeks
Benign gastric ulcer: 40 mg PO 24 hourly x 4-8 weeks or
40 mg IV 24 hourly x 1 week
Max duration: 8 weeks
NSAID-associated ulcer:
20 mg PO 24 hourly
Prophylaxis for NSAID-associated ulcer: 20 mg PO 24 hourly
Rabeprazole
(Na rabeprazole, Sodium rabeprazole)		 Active duodenal ulcer:
10-20 mg PO 24 hourly in the morning x 4-8 weeks or
20 mg IV 24 hourly after breakfast x 4-8 weeks
Benign gastric ulcer: 10-20 mg PO 24 hourly in the morning x 6-12 weeks
Prevention of recurrence of gastric and duodenal ulcer during low-dose Aspirin administration:
5-10 mg PO 24 hourly

Drug Available Strength Dosage Remarks
Combination Products
Omeprazole/
Sodium bicarbonate		 Omeprazole 20 mg/Sodium bicarbonate 1,100-1,680 mg
Omeprazole 40 mg/Sodium bicarbonate 1,100-1,680 mg 		Active duodenal ulcer: 20 mg PO 24 hourly x 4 weeks
Some patients may require an additional 4 weeks of therapy
Benign gastric ulcer: 40 mg PO 24 hourly x 4-8 weeks		 Adverse Reactions
  • GI effects (pancreatitis [sometimes fatal], abdominal swelling, anorexia); Other effects (anaphylaxis, fever, pain, fatigue, malaise, chest pain, nervousness, myalgia, epistaxis)
Special Instructions
  • Use with caution in patients with atrophic gastritis, Na-restricted diet, hypokalemia, hypocalcemia and problems with acid-base balance, hepatic impairment, Bartter's syndrome
  • Symptomatic response to therapy with Omeprazole does not preclude the presence of gastric malignancy
Pantoprazole Na
sesquihydrate/
Domperidone		 Pantoprazole Na sesquihydrate 40 mg/Domperidone 30 mg 1 cap PO 24 hourly Adverse Reactions
  • Pantoprazole: CNS effects (headache, dizziness); Other effects (skin rash, pruritus, diarrhea)
  • Domperidone: CNS effects (headache, nervousness); Other effects (galactorrhea, gynecomastia, skin rashes, pruritus, thirst)
Special Instructions
  • Pantoprazole: Long-term therapy may lead to bacterial overgrowth in gastrointestinal tract
  • Use with caution in patients with hepatic or renal impairment
  • Contraindicated in pregnant and lactating women

Other Drugs Used in the Treatment of PUD

Drug Dosage Remarks
Muscarinic Receptor Antagonist
Pirenzepine 50 mg PO 8-12 hourly x 4-6 weeks Adverse Reactions
  • Antimuscarinic effects such as dry mouth or blurring of vision
Special Instructions
  • Use with caution in patients with renal impairment especially those with end-stage renal failure
Propulsive
Clebopride 0.5 mg PO 8 hourly Adverse Reactions
  • On large doses: Drowsiness, breast tension, dizziness
Special Instructions
  • Avoid in patients with proven tardive dyskinesia to neuroleptics and in whom stimulation of gastric motility may be harmful (hemorrhage, obstruction, perforation)

Supplements & Adjuvant Therapy

Drug Dosage Remarks
Fucoidan 50 mg PO 12 hourly or
100 mg PO 24 hourly		 Special Instructions
  • May be taken with or without food
  • Avoid in patients with hypersensitivity to Fucoidan

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs