CIMIRAX

*Benign Duodenal Ulceration, benign Gastric Ulceration and NSAID associated Ulceration:* ORAL OR BY IM OR IV INJ: Adult: 400 mg twice daily in the morning and at night for at least 4 wks (at least 6 wks in case of Gastric Ulceration 8 weeks in case of NSAID associated Ulceration), alternatively 800 mg once daily at night for at least 4 weeks, increased if necessary up to 400 mg 4 times a day. Maintenance: 400 mg once daily, at night, alternatively, 400 mg twice daily, in the morning and at night. Children above 1 yr: 20-40 mg/kg daily in divided doses *Reflux oesophagitis:* ORAL OR BY IM OR IV INJ: Adult: 400 mg 4 times a day for 4-8 weeks Children above 1 yr: 25-30 mg/kg daily in divided doses Prophylaxis of stress ulceration: ORAL OR BY IM OR IV INJ: Adult: 200-400 mg every 4-6 hours *Gastric acid reduction in obstetrics:* ORAL OR BY IM OR IV INJ: Adult: 400 mg, at start of labour, then increased if necessary up to 400 mg every 4 hours, do not use syrup in prophylaxis of acid aspiration; max. 2.4 g per day. *Zollinger-Ellison syndrome and other cases of high gastric secretion, and haemorrhage from ulceration or erosion of upper GI tract:* ORAL OR BY IM OR IV INJ: Adult: 200 mg 3 times a day with meals and 400 mg at bedtime. Children above 1 yr: 20-40 mg/kg daily in divided doses *Gastric acid reduction during surgical procedures:* ORAL OR BY IM OR IV INJ: Adult: 400 mg, 90-120 minutes before induction of general anaesthesia. *Short-bowel syndrome:* ORAL OR BY IM OR IV INJ: Adult: 400 mg twice daily, adjusted according to response, with breakfast and at bedtime *To reduce degradation of pancreatic enzyme supplements:* ORAL OR BY IM OR IV INJ: Adult: 0.8-1.6 g daily in 4 divided doses, 1 hours before meals.Acid related dyspepsia and non-ulcer acidic ORAL OR BY IM OR IV INJ: Adult: 400 mg twice daily in the morning and at night for at least 4 wks (at least 6 wks in case of Gastric Ulceration 8 weeks in case of NSAID associated Ulceration), alternatively 800 mg once daily at night for at least 4 weeks, increased if necessary up to 400 mg 4 times a day. Maintenance: 400 mg once daily, at night, alternatively, 400 mg twice daily, in the morning and at night. Children above 1 yr: 20-40 mg/kg daily in divided doses.

Diluted 200 mg in 0.9% NaCI total volume of 20 ml to be given slow IV over a period of 2 min, to be repeated 4-6 hourly. For intermittent infusion diluted400 mg in 100 ml dextrose 5% injection, infusion time not less than 30 min. Total dosage in 24 hr should not exceed 6 infusions or 2400 mg.

Exclude malignant disease before and during treatment. Monitor patients on long term therapy. Renal impairment; reduce dose to 200mg 4 times daily if eGFR 30-50 ml/minute/1.73m2, reduce dose to 200mg 3 times daily if eGFR 15-30 ml/minute/1.73m2, reduce dose to 200mg twice daily if eGFR less than 15 ml/minute/1.73m2. Occasional risk of confusion

Oral anticoagulants, phenytoin, theophylline, IV lignocaine.

Diarrhoea, dizziness, rash, tiredness, gynaecomastia, occasional reversible liver damage, confusion, fever, headache, myalgia, arthralgia, sinus bradycardia, tachycardia, heart block, anaphylaxis, hallucinations, depression. Rare: interstitial nephritis, acute pancreatitis, thrombocytopenia, leucopenia, pancytopenia, aplastic anaemia, alopecia, galactorrhoea, pancreatitis, vasculitis.