Carbenoxolone sodium has been shown to accelerate the rate of healing of both gastric and
duodenal ulcers, but its overall value in
duodenal ulcer is probably less because of the high rate of natural remission of
duodenal ulcers. Further studies are required to decide whether it should be used prophylactically to delay
ulcer recurrence.
Carbenoxolone may act by affecting both the proliferative activity of gastric epithelium and the differentiation of the epithelial cells to produce mucus (as well as favourably altering the physicochemical properties of mucus and by reducing peptic activity), factors which may be relevant ot the prevention of acute
gastric ulcers. Some studies suggest that
carbenoxolone adds to the effect of hospitalisation and
bed rest on
ulcer healing. Whether
bed rest confers additional benefit to the
drug's
ulcer healing effect in outpatients is also uncertain. There is no evidence that accelerated healing by
carbenoxolone is associated with improved overall prognosis.
Carbenoxolone is of greatest benefit in accelerating the healing of
gastric ulcers in patients for whom hospitalisation is not possible or desirable, but it should only be used in the ambulatory patient when careful and regular observation of serum
electrolytes (particularly
potassium), blood pressure and weight is possible and when it is known that the patient will attend regular follow-up. Patient must be educated in the proper use of the
drug. If severe
mineralocorticoid-like toxic effects such as
sodium and water retention and hypokalaemia appear, as they do in a variable proportion of patients but most frequently in those receiving excessive doses,
carbenoxolone should be stopped and the complication treated; they respond to
thiazide diuretics and
potassium supplements, and probably to
amiloride given in conjunction with a low dose of a
thiazide diuretic. Treatment with
carbenoxolone can continue with concurrent
diuretic therapy in patients with less severe side-effects. Optimum
therapeutic effect in
gastric ulcer with the least side-effects is achieved with a dosage of 100mg
carbenoxolone tablets 3 times daily for the first week followed by 50mg 3 times daily thereafter, best taken before meals. A lower dosage is desirable in the elderly and in those with liver, cardiac or renal disease.
Barium meal or preferably endoscopic examinations should be performed regularly and
therapy continued until the
ulcer is healed. Dosage for
duodenal ulcer is 50mg 4 times daily, in special positioned-release capsules. These are best taken about 20 minutes before meals.