Friday, May 1, 2020

Prostanoids and SUP

Q: What limits the use of prostanoids (prostaglandin analogs) as stress ulcer prophylaxis in ICU?

Answer:  Prostanoids exert their SUP effect via two mechanisms. First, they inhibit gastric acid secretion by selectively reducing the ability of the parietal cell to generate cyclic adenosine monophosphate (AMP) in response to histamine. Second, they exert a cytoprotective effect by enhancing mucosal defense mechanisms.

Misoprostol is the most well-known prostanoid. Despite its effectiveness, the prostanoids are the least used SUP in ICUs. There are three reasons for it

1. There are other equally or most effective SUPs available like H2-Blockers or Proton-Pump Inhibitors.

2. There is not much evidence/data generated for their use.

3. It has a high tendency to cause diarrhea.




1. Wilson DE. Antisecretory and mucosal protective actions of misoprostol. Potential role in the treatment of peptic ulcer disease. Am J Med 1987; 83:2. 

2. Dajani EZ. Overview of the mucosal protective effects of misoprostol in man. Prostaglandins 1987; 33 Suppl:117.

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