Table 2.

Medications to treat gastrointestinal manifestations in systemic sclerosis

Proton pump inhibitors • Omeprazole 20-40 mg 1 to 2 times per day • Lansoprazole 15-30 mg 1 to 2 times per day • Pantorazole 40 mg 1 to 2 times per day • Esomeprazole 20-40 mg 1 to 2 times per day • Dexlansoprazole 30-60 mg once per day

Histamine-2 receptor blockers • Famotidine, Cimetidine, Ranitidine, Nizatidine at night (or twice daily) and as needed if on maximum doses of proton-pump inhibitors

Pro-motility agents • Metoclopramide 10 mg 3 to 4 times per day • Erythromycin 250 mg 3 to 4 times per day • Domperidone 10-20 mg 3 to 4 times per day • Octreotide 50 - 200 mcg, 1 to 2 times per day, subcutaneous injection

Antibiotics for small intestinal bacterial overgrowth • Amoxicillin 500 mg 3 times per day • Amoxicillin/ Clavulanate 500/125 or 875/125 mg 2 times per day • Ciprofloxacin 500 mg 2 times per day • Metronidazole 500 mg 3 times per day • Doxycycline 100 mg 2 times per day • Bactrim® Double Strength 1 tablet 2 times per day (trimethoprim-sulfamethoxazole) • Rifaximin 400 mg up to 3 times per day • Neomycin 500 mg 2 to 4 times per day

Laxatives • Docusate sodium 100 mg 1 to 2 times per day • Lactulose 15-30 ml 1 to 2 times per day (watch for increase in gas / distention) • Milk of magnesia 30-60 ml once per day or Magnesium tablets (magnesium oxide) • Sennosides 1 capsule 1 to 2 times per day • Polyethylene glycol 17 grams, 1 to 2 times daily • Linaclotide 145 – 290 micrograms once daily 30 minutes after breakfast • Lubiprostone 8 – 24 micrograms, 2 times daily