Although licensed and frequently used for stress ulcer prophylaxis, overwhelming supportive evidence is scanty. Enteral nutrition has been shown to be as effective. No adequately powered study of proton pump inhibitors has yet been performed in ICU patients.

Some studies have shown efficacy in upper gastrointestinal haemorrhage secondary to stress ulceration or peptic ulceration.

Dosages should be modified in renal failure.

Cimetidine can affect metabolism of other drugs, in particular warfarin, phenytoin, theophylline and lidocaine (related to hepatic cytochrome P450-linked enzyme systems). This does not occur with ranitidine.

Omeprazole can delay elimination of diazepam, phenytoin and warfarin.

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