• Current guidance recommends that high-dose intravenous proton pump inhibitor (PPI) therapy (80mg bolus followed by 8mg/hour infusion for 72 hours) should be used in patients with major peptic ulcer bleeding following endoscopic haemostatic therapy.

• Omeprazole and pantoprazole are not licensed to be given by continuous intravenous infusion and use in this way is therefore the responsibility of the prescribing physician. Intravenous esomeprazole is licensed for the prevention of rebleeding following therapeutic endoscopy for acute bleeding gastric or duodenal ulcers.

• After administration of the initial 80mg dose, the continuous infusion can be prepared by reconstituting a 40mg vial of either omeprazole (Losec® infusion) or pantoprazole (Protium®) and further diluting in 100ml of sodium chloride 0.9%. This can be given at a rate of 8mg/hour (i.e. over 5 hours), and repeated with a fresh vial after that time. Depending on the host organisation’s attitude to microbiological stability, infusions could be made up and run over 24-48 hours if necessary since omeprazole (Losec®) and pantoprazole (Protium®) are chemically stable in sodium chloride 0.9% for this period. 

• After administration of the initial intravenous dose of 80mg esomeprazole, the contents of two 40mg vials of esomeprazole are dissolved in up to 100ml of 0.9% sodium chloride and given at a rate of 8mg/hour (i.e. over 10 hours). This is repeated with fresh vials after that time.

• No comparative studies of intravenous PPIs have been conducted in patients with peptic ulcer bleeding and therefore there is no efficacy data to recommend one PPI over another.