10 Best Gastric Injectables: Uses, Doses & Side Effects (English + Hindi)
Disclaimer: This article is for education. Doses vary with age, weight, renal/hepatic function, pregnancy, and indication. Use hospital protocols.
Why “Gastric” Injectables Matter / इंजेक्शन क्यों ज़रूरी होते हैं?
English: In emergency and inpatient care, injectable therapy for gastric and GI problems offers rapid symptom control, especially when patients cannot tolerate oral medicines due to severe vomiting, GI bleeding, obstruction, or pre-/post-operative status. Doctors commonly use PPIs for acid suppression, 5-HT3 antagonists and dopamine antagonists for nausea-vomiting, antispasmodics for crampy abdominal pain, somatostatin/vasopressin analogues in variceal bleeding, and short-term IV antibiotics or macrolides as prokinetics before endoscopy.
हिंदी: आपातकाल और इनडोर इलाज में गैस्ट्रिक/जीआई समस्याओं के लिए इंजेक्शन तेजी से राहत देते हैं—खासकर जब मरीज़ उल्टी के कारण दवा नहीं ले पा रहे हों, खून बह रहा हो, रुकावट हो, या ऑपरेशन के पहले/बाद की स्थिति में हों। डॉक्टर आमतौर पर एसिड कम करने के लिए PPI, उल्टी में 5-HT3 और डोपामीन एंटागोनिस्ट, पेट के मरोड़ों में एंटीस्पास्मोडिक, और वैरीसीज़ल ब्लीडिंग में सोमाटोस्टेटिन/वेसोप्रेसिन एनालॉग्स का उपयोग करते हैं।
1) Pantoprazole IV (Proton Pump Inhibitor)
Common physician uses (English): Upper GI bleeding (stress ulcers, peptic ulcer, erosive esophagitis), severe GERD when NPO, peri-operative acid suppression, prevention of stress-related mucosal disease in ICU when indicated.
उपयोग (हिंदी): ऊपरी जीआई ब्लीडिंग, गंभीर जीईआरडी (जब मुँह से दवा संभव न हो), ऑपरेशन के पहले/बाद एसिड नियंत्रण, आईसीयू में स्ट्रेस अल्सर प्रिवेंशन (इंडिकेशन अनुसार)।
Usual adult dose: 40 mg IV once daily for routine acid suppression. In acute upper GI bleed: 80 mg IV bolus, then 8 mg/hour continuous infusion for 72 hours (hospital protocol dependent), followed by 40 mg IV/PO daily.
Key side effects: Headache, diarrhea/constipation, hypomagnesemia with prolonged use, rare allergic reactions. With long infusions: phlebitis risk. Long-term PPI risks (fracture, C. difficile, B12 deficiency) apply mainly to chronic use.
Cautions: Adjust plan in severe hepatic impairment; review drug interactions (e.g., with some antiretrovirals).
2) Famotidine IV (H2-Receptor Antagonist)
Uses (English): Alternative to PPI for stress ulcer prophylaxis when indicated, mild-moderate GERD/ulcer when IV route needed, pre-op acid suppression.
उपयोग (हिंदी): PPI का विकल्प, स्ट्रेस अल्सर प्रोफाइलैक्सिस, हल्के-मध्यम जीईआरडी/अल्सर में जब IV आवश्यक हो, ऑपरेशन से पहले एसिड नियंत्रण।
Usual adult dose: 20 mg IV every 12 hours; reduce frequency in renal impairment (CrCl <50 mL/min).
Side effects: Headache, dizziness, constipation/diarrhea, rare confusion (elderly), very rare arrhythmias if pushed rapidly.
Pearl: Prefer slow IV push or short infusion; check renal function and adjust.
3) Ondansetron IV/IM (5-HT3 Antagonist)
Uses (English): Acute nausea and vomiting from gastritis, gastroenteritis, postoperative nausea-vomiting (PONV), chemotherapy-induced nausea-vomiting (CINV) as part of guideline regimens.
उपयोग (हिंदी): तीव्र उल्टी/मतली—गैस्ट्राइटिस/गैस्ट्रोएंटेराइटिस, ऑपरेशन के बाद उल्टी, कीमोथेरेपी से होने वाली उल्टी के प्रोटोकॉल में।
Usual adult dose: 4 mg IV given slowly over ≥2–5 minutes; may repeat every 6–8 hours for symptomatic control. For PONV prophylaxis: 4 mg IV near end of surgery. For CINV: doses vary (commonly 8–16 mg IV per protocol).
Side effects: Headache, constipation, flushing, QT prolongation (dose-dependent), rare serotonin syndrome—caution with other serotonergic drugs.
Tip: Avoid rapid push in patients with cardiac risk; consider ECG if high doses or multiple QT-prolonging agents.
4) Palonosetron IV (Long-acting 5-HT3 Antagonist)
Uses (English): Longer control of nausea-vomiting, especially CINV, and sometimes for refractory PONV. Its longer half-life can cover delayed phases of CINV.
उपयोग (हिंदी): लम्बे समय तक उल्टी-मतली नियंत्रण—खासकर कीमोथेरेपी में; देर से होने वाली उल्टी को भी नियंत्रित करने में सहायक।
Usual adult dose: 0.25 mg IV as a single dose over ~30 seconds prior to emetogenic stimulus (e.g., 30 minutes before chemo).
Side effects: Headache, constipation, dizziness; relatively low QT effect compared with older agents but caution still advised.
Clinical pearl: Often combined with dexamethasone and NK1 antagonists per oncology protocols.
5) Metoclopramide IV/IM (Prokinetic & Antiemetic; D2 Antagonist, 5-HT4 Agonist)
Uses (English): Nausea/vomiting due to gastroparesis, migraine-associated nausea, functional dyspepsia flares, adjunct in GERD when gastric emptying is impaired; rescue antiemetic in ER.
उपयोग (हिंदी): गैस्ट्रोपेरेसिस, माइग्रेन से जुड़ी उल्टी, फंक्शनल डिस्पेप्सिया, जीईआरडी में जब पेट खाली होने में देरी हो; आपातकाल में रेस्क्यू एंटीइमेटिक।
Usual adult dose: 10 mg IV/IM every 6–8 hours as needed; give IV over ≥1–2 minutes to reduce akathisia risk. For diabetic gastroparesis in hospital, short courses under monitoring.
Side effects: Drowsiness, diarrhea, akathisia/restlessness, dystonia, Parkinsonism, and with prolonged/high-dose use—tardive dyskinesia (TD). QT prolongation risk is lower than some agents but exists.
Contraindications & cautions: Suspected GI obstruction/perforation, pheochromocytoma, seizure disorders; caution in elderly. Limit duration; use lowest effective dose.
6) Prochlorperazine IV/IM (Antiemetic; Dopamine Antagonist)
Uses (English): Rescue for severe nausea-vomiting unresponsive to 5-HT3 blockers; effective in migraine-associated nausea in emergency settings.
उपयोग (हिंदी): जब 5-HT3 दवाएँ काम न करें तब तेज उल्टी-मतली में; माइग्रेन से जुड़ी मतली में भी उपयोगी।
Usual adult dose: 5–10 mg IV given slowly (over several minutes) or 12.5 mg IM; may repeat per protocol (e.g., every 3–4 hours) with monitoring.
Side effects: Sedation, hypotension (especially with rapid IV), anticholinergic effects (dry mouth, blurred vision), extrapyramidal symptoms (dystonia, akathisia), rare neuroleptic malignant syndrome, QT prolongation.
Precautions: Avoid in Parkinson’s disease; caution with other QT-prolonging drugs; monitor blood pressure.
7) Hyoscine Butylbromide IV/IM (Antispasmodic; Anticholinergic)
Uses (English): Spasmodic abdominal pain/colic from GI cramping, biliary/renal colic adjunct, irritable bowel–type cramping (acute setting). Provides symptomatic relief rather than treating acid/ulcer itself.
उपयोग (हिंदी): पेट के मरोड़, कोलिकी दर्द (जैसे पित्त/किडनी कोलिक में सहायक), इरिटेबल बाउल के तीव्र मरोड़ों में लक्षणात्मक राहत।
Usual adult dose: 20 mg IV/IM; may repeat after 30–60 minutes if needed. Some protocols allow up to 100 mg/day in divided doses under monitoring.
Side effects: Dry mouth, tachycardia, blurred vision, urinary retention, constipation; rare angle-closure glaucoma precipitation.
Avoid/caution: Narrow-angle glaucoma, myasthenia gravis, severe ulcerative colitis with risk of toxic megacolon, prostatic hypertrophy causing retention.
8) Octreotide IV/SC (Somatostatin Analogue)
Uses (English): Acute variceal upper GI bleeding (reduces portal pressure and splanchnic flow), control of non-variceal upper GI bleeding as adjunct in some settings, refractory secretory diarrhea (e.g., carcinoid crisis), and pancreatic fistula output reduction. In gastric practice, its key role is upper GI bleed, especially variceal.
उपयोग (हिंदी): वैरीसीज़ल ऊपरी जीआई ब्लीडिंग में प्राथमिक दवा (पोर्टल प्रेशर घटाती है), कुछ मामलों में नॉन-वैरीसीज़ल ब्लीड में सहायक, सेक्रीटरी डायरिया में, तथा पैंक्रियाटिक फिस्टुला आउटपुट घटाने में।
Usual adult dose (variceal bleed): 50 micrograms IV bolus followed by continuous infusion at 50 micrograms/hour for 2–5 days (protocol dependent). Alternative: 100 micrograms SC every 8 hours if infusion unavailable.
Side effects: Abdominal cramps, nausea, hyperglycemia or hypoglycemia, bradycardia, gallstones with prolonged use, injection-site reactions.
Notes: Give alongside resuscitation, antibiotics when indicated, and urgent endoscopy; it is an adjunct, not a replacement for definitive therapy.
9) Terlipressin IV (Vasopressin Analogue)
Uses (English): First-line in many guidelines for acute variceal bleeding (improves hemostasis by vasoconstriction of splanchnic circulation). Also used in hepatorenal syndrome (HRS) with albumin—though that’s hepatic/renal, not “gastric”, it coexists with portal hypertension.
उपयोग (हिंदी): वैरीसीज़ल ब्लीडिंग में प्रमुख दवा—स्प्लैनच्निक वेसोकंस्ट्रिक्शन द्वारा रक्तस्राव रोके। एचआरएस में एल्ब्यूमिन के साथ भी प्रयुक्त (यह यकृत/किडनी संबंधित संकेत है)।
Usual adult dose (variceal bleed): 1–2 mg IV every 4–6 hours initially; once bleeding controlled, taper to 1 mg every 6 hours for up to 48–72 hours as per protocol.
Side effects: Hypertension, bradycardia, peripheral/mesenteric ischemia (chest/abdominal pain), hyponatremia, headache, pallor, diarrhea.
Contraindications/cautions: Ischemic heart disease, peripheral vascular disease; close cardiac monitoring recommended.
10) Erythromycin IV (Macrolide used as Prokinetic)
Uses (English): Short-term prokinetic to empty stomach before urgent upper endoscopy in acute GI bleeding (improves visualization by clearing clots/food), gastroparesis exacerbations when metoclopramide inadequate (brief use), and sometimes as rescue for severe dyspepsia with retained gastric contents.
उपयोग (हिंदी): आपात एंडोस्कोपी से पहले पेट खाली कराने हेतु अल्पकालिक प्रोकाइनेटिक; गैस्ट्रोपेरेसिस की तीव्रता में (कम समय के लिए), तथा पेट में सामग्री रुकी होने पर विज़ुअलाइज़ेशन सुधारने के लिए।
Usual adult dose: 250 mg IV infused over 20–30 minutes (commonly 30–90 minutes prior to endoscopy). Some centers use weight-based ~3 mg/kg. Repeat dosing generally avoided to reduce tachyphylaxis and QT concerns.
Side effects: GI cramps, transient diarrhea, QT prolongation/arrhythmia risk especially with other QT-prolonging drugs or electrolyte abnormalities, drug-drug interactions (CYP3A4).
Pearl: Limit to short courses; check for interacting agents (e.g., certain antipsychotics, fluoroquinolones, azoles).
Fast Comparison Table / त्वरित तुलना तालिका
| Drug | Core Role | Typical Adult Dose | Key Cautions |
|---|---|---|---|
| Pantoprazole IV | Acid suppression; upper GI bleed adjunct | 40 mg IV OD; bleed: 80 mg bolus → 8 mg/h infusion | Long-term PPI risks; hepatic caution |
| Famotidine IV | Acid suppression (alt. to PPI) | 20 mg IV q12h (renal adjust) | Confusion in elderly; renal dosing |
| Ondansetron IV/IM | Antiemetic (PONV, CINV, gastritis) | 4 mg IV slow; repeat q6–8h; CINV per protocol | QT prolongation; serotonin syndrome risk |
| Palonosetron IV | Long-acting antiemetic | 0.25 mg IV once (pre-chemo) | Headache/constipation; QT caution |
| Metoclopramide IV/IM | Prokinetic + antiemetic | 10 mg IV/IM q6–8h | EPS/TD risk; avoid in obstruction |
| Prochlorperazine IV/IM | Rescue antiemetic, migraine nausea | 5–10 mg IV slow or 12.5 mg IM | Hypotension, EPS, QT prolongation |
| Hyoscine butylbromide IV/IM | Antispasmodic for colic/cramps | 20 mg IV/IM; repeat if needed | Glaucoma, retention, tachycardia |
| Octreotide IV/SC | Variceal bleed; adjunct for UGI bleed | 50 mcg bolus → 50 mcg/h infusion | Glucose swings; bradycardia; gallstones |
| Terlipressin IV | Variceal bleed control | 1–2 mg IV q4–6h then taper | Ischemia risk; hyponatremia |
| Erythromycin IV | Prokinetic before endoscopy | 250 mg IV over 20–30 min | QT prolongation; CYP3A4 interactions |
Practical ER/ICU Scenarios / व्यावहारिक परिदृश्य
Scenario A: Acute Upper GI Bleed
English: Start resuscitation and early endoscopy pathway. Give pantoprazole 80 mg IV bolus then 8 mg/h infusion. In suspected variceal bleed (cirrhosis, portal hypertension), add octreotide infusion (50 mcg bolus → 50 mcg/h) or terlipressin 2 mg IV then 1–2 mg every 4–6 h. Consider erythromycin IV 250 mg before endoscopy to improve visualization. Use antibiotics when indicated (e.g., variceal bleeding prophylaxis as per local protocol). Avoid unnecessary nasogastric tube if high variceal risk.
हिंदी: प्राथमिक उपचार और जल्द एंडोस्कोपी की व्यवस्था करें। पैंटोप्राजोल 80 mg बोलस के बाद 8 mg/घंटा इन्फ्यूज़न दें। वैरीसीज़ल ब्लीड की आशंका में ऑक्ट्रीटाइड इन्फ्यूजन (50 mcg बोलस → 50 mcg/घंटा) या टर्लीप्रेसिन 2 mg फिर 1–2 mg हर 4–6 घंटे पर दें। एंडोस्कोपी से पहले दृश्य स्पष्टता हेतु एरिथ्रोमाइसिन IV 250 mg दें। आवश्यक होने पर एंटीबायोटिक भी स्थानीय प्रोटोकॉल अनुसार।
Scenario B: Intractable Vomiting with Dehydration
English: Start fluids and electrolytes. Use ondansetron 4 mg IV slowly; if inadequate, add metoclopramide 10 mg IV (watch for akathisia) or prochlorperazine 5–10 mg IV slow. Evaluate for obstruction; if suspected, avoid prokinetics until imaging confirms patency.
हिंदी: द्रव और इलेक्ट्रोलाइट सुधारें। ऑन्डैनसेट्रॉन 4 mg IV धीरे दें; असर न हो तो मेटोक्लोप्रामाइड 10 mg IV या प्रोक्लोर्पेराज़ीन 5–10 mg IV धीमे दें। रुकावट होने की आशंका में प्रोकाइनेटिक से बचें जब तक इमेजिंग स्पष्ट न हो।
Scenario C: Crampy Abdominal Pain (No Peritonitis)
English: Provide analgesia and consider hyoscine butylbromide 20 mg IV/IM for spasmodic pain. Exclude red flags: peritoneal signs, GI bleed, persistent vomiting, fever, jaundice, weight loss.
हिंदी: दर्द निवारण दें और मरोड़ों के लिए हायोसीन ब्यूटाइलब्रोमाइड 20 mg IV/IM दें। रेड-फ्लैग लक्षण अवश्य देखें।
Scenario D: Chemotherapy-Related Nausea
English: For highly emetogenic regimens, combine palonosetron 0.25 mg IV + steroid + NK1 antagonist (per oncology protocols). For moderate emetogenic risk, ondansetron may suffice with dexamethasone.
हिंदी: अधिक उल्टी कराने वाली कीमोथेरेपी में पैलोनोसेट्रॉन 0.25 mg IV + स्टेरॉयड + NK1 एंटागोनिस्ट का संयोजन (ऑन्कोलॉजी प्रोटोकॉल अनुसार)। मध्यम जोखिम में ऑन्डैनसेट्रॉन + डेक्सामेथासोन पर्याप्त।
Safety Checklist / सेफ्टी चेकलिस्ट
- Check ECG/QT: With ondansetron, palonosetron (less), prochlorperazine, erythromycin—especially if low K/Mg, elderly, or on other QT-prolonging agents.
- Avoid prokinetics if obstruction suspected (severe colicky pain, distension, no flatus, tinkling bowel sounds)—get imaging first.
- Renal function: Adjust famotidine; watch electrolytes for QT risks.
- Hepatic disease: Octreotide/terlipressin used frequently, but monitor hemodynamics and sodium; be cautious with sedatives and anticoagulants around endoscopy.
- Elderly/frail: Greater risk of delirium (H2 blockers), hypotension (prochlorperazine), EPS (metoclopramide). Use lowest effective dose.
- Pregnancy: Ondansetron is widely used but remains debated in early pregnancy; weigh risks/benefits and follow obstetric guidance. Metoclopramide often preferred first-line in some settings.
- Drug interactions: Erythromycin (CYP3A4) and PPIs/H2 blockers (pH-dependent absorption for orals once restarted). Always review the chart.
Hindi Quick Summary / हिंदी सार
एसीड कंट्रोल: Pantoprazole IV (गंभीर/ब्लीड में), Famotidine IV (विकल्प, रीनल एडजस्ट्मेंट)।
उल्टी-मतली: Ondansetron 4 mg IV धीमे; लम्बे असर के लिए Palonosetron. रेस्क्यू में Metoclopramide या Prochlorperazine (EPS/हाइपोटेंशन का ध्यान)।
मरोड़/कॉलिक: Hyoscine butylbromide 20 mg IV/IM।
GI ब्लीड: Pantoprazole इन्फ्यूज़न + Octreotide या Terlipressin (वैरीसीज़ल में) + जल्द एंडोस्कोपी; आवश्यकता पर Erythromycin IV पहले।
FAQs
Q1. Can PPIs and H2 blockers be combined intravenously?
Answer: Routine combination is not recommended; choose one based on indication. Switching may be considered if inadequate response or for step-down once oral route is possible.
Q2. Which antiemetic first in the ER?
Answer: Many clinicians start with ondansetron 4 mg IV for broad effectiveness and tolerability; escalate/rotate to metoclopramide or prochlorperazine if needed, watching for EPS and QT.
Q3. When to choose octreotide vs terlipressin?
Answer: Both are effective in variceal bleeding. Choice depends on availability, contraindications, and local protocols. Terlipressin has ischemia/hyponatremia risks; octreotide may affect glucose and cause bradycardia.
Q4. Is erythromycin IV an antibiotic here?
Answer: Mechanistically it’s an antibiotic, but in this context it’s used short-term as a prokinetic to improve endoscopic visualization or gastric emptying.
