Tx

• Some evidence benefits of SUP do not outweigh risks¹
• Treatment with PPIs, H2RAs, or Sucralafate is generally consider equivalent and is chosen based upon institutional preference and convenience, along with individual pt considerations¹
• ASHP recommends initiating with ≥ 1 major risk factor or ≥ 2 minor risk factors

Indications²

Major Risk Factors	Minor Risk Factors
Coagulopathy (INR > 1.5, Pmts < 50k, or aPTT > 2x ULN)	Sepsis
Expected Mechanical Ventilation ≥ 48hr	ICU > 7d
Hx of GI ulceration / bleeding w/i 1yr	Occult bleeding ≥ 6d
GCS ≤ 10	GCs > 250mg hydrocortisone equivalent
Burns > 35% BSA
Partial Hepatectomy
Multiple Trauma
Hepatic Failure
Spinal Cord Injuries

Initial Dosing²

Drug	Normal Renal Fx	Impaired Renal Fx
Cimetidine	300mg PO/IV QID 50mg/hr IV	< 30: 300mg BID or 25 mg/hr
Famotidine	20mg PO/IV BID 1.7mg/hr IV	< 30: 20mg QD or 0.85 mg/hr
Ranitidine	150mg PO BID 50mg IV Q4-6H 6.25mg/hr IV	< 50: 150mg PO QD-BID, 50mg IV Q12-24H, or 2-4mg/hr
Omeprazole	40mg load then 20-40mg QD	No adjustment
Sucralfate	1g QID	No adjustment

References