Regarding (Ranitidine with Omeprazole) it shouldn't be used together as rantidine make partial block of acid secrection and omeprazole make complete block of acid secretion , therefore there is no benefit from the use both together.

Antacid with Ranitidine: sometimes physician require to give rapid neutralization of the gastric acid and in the same time need long time inhibition of acid secretion so they give them both but it shoul be at different time to avoid drug interaction.

Sucralfate with Omeprazole: sucalfate will help people who suffer from gastric ulcer as it make a protective coat on the stomach surface so it will be helpful when it used with omeprazole, in addition to the long protective time of omeprazole, but it should be used in different timesto avoid drug interaction.

Regarding (Ranitidine with Omeprazole) it shouldn't be used together as rantidine make partial block of acid secrection and omeprazole make complete block of acid secretion , therefore there is no benefit from the use both together.

Antacid with Ranitidine: sometimes physician require to give rapid neutralization of the gastric acid and in the same time need long time inhibition of acid secretion so they give them both but it shoul be at different time to avoid drug interaction.

Sucralfate with Omeprazole: sucalfate will help people who suffer from gastric ulcer as it make a protective coat on the stomach surface so it will be helpful when it used with omeprazole, in addition to the long protective time of omeprazole, but it should be used in different timesto avoid drug interaction.

Poly phramcy. this trend was recently strated with pantoprazole and domperidone.magine wht could happen when a lay man uses this medication along with bowel stopper.

there must be some strong reason if two drugs of the same category are added.

triple drug Anti diabetics have laimed more lives.

waht if an heart patient ahs to use cardiac drugs with PPI.

Since antiacids are used most often without prescriptions it wuld be best not to combine two drugs.

I am not sure that there is any evidence that these combinations will have any greater effect, in terms of preventing gastroduodenal ulceration, than a PPI alone. If the ulceration you refer to is associated with the use of nonsteroidal anti-inflammatory drugs, then you should also be concerned, even more concerned, about the ulceration occurring beyond the duodenum. NSAID-enteropathy is as common as the upper GI damage with these drugs. It is more difficult to detect, and there are no proven-effective prevention or treatment options. Moreover, there is recent evidence that anti-secretory drugs (PPIs, H2RAs) actually exacerbate the small intestinal damage caused by NSAIDs.

While using the combinations, go thru the mechanisms of action and its specific purpose

1. Antacids act very quickly, but there are possibilities of rebound acidity (that is, when the acidity in the pyloric region is reduced, compensatory mechanisms will start up, increasing the acid production and secretion.

2. Ranitidine (or H2 blockers) are quick acting than comapared to Proton pump inhibitors (PPI) , but have less sustained action than PPI.

3. PPI are the best drug, since all the pathways (H2, Gastrin/ CCK, Muscarinic ) pathways converge at Proton pump to increase acidity. So it is more radical treatment than all others. But two drawbacks of PPI are a) They are active only in presence of acid ie, if the acidity of stomach is less or pH is more than 4-4.5, due to the use of antacids or H2 blockers, the omeprazole WILLNOT be converted to its active metabolite which irreversibly bind K+H+ATPase, and hence no action will be seen. So they should not be combined with any other quick acting antacid.

Hence the following will be the most rational treatment

1. In acute hyperacidity crisis, initiate the therapy with oral antacids, which will help to tide over the situation in less than one minute ( due to direct acid neutralisation). If there is no acute phase, this is not mandatory

2. Continue the treatment with Ranitidine, preferably as inj, for quick and sustained action and to prevent the possibility of rebound acidity.

3. On the next day start with the proton pump inhibitor. Remember that PPI are slow in action so effect may take 12- 48 hours to initiate its action. And remember not to give anything that will reduce the gastric pH. ( Give as pre prandial, without mixing with antacids, or preferably after 8 hours of administration of H2 blockers)

4. Sucralfate is to be given when there is already formed ulcer. In other cases of hyperacidity it is not much beneficial. If there is ulcerations, it is always preferabe to use and helicobactor antibiotics, than sucralfate alone

The best way to treat gastritis (not ulcer) is to use antacids along with PPIs, the best PPI is rabiprazole till now.

The American Gastro. Association guidelines recommend the use of a PPI and an H2 receptor blocker in some situations. 

In my experience, combined use of a PPI and an H2 receptor is effect in treating peptic ulcer. 

Dear Dr Huynh & Russak

Will the combination of PPI & H2 blocker be a pharmacologically sound combination ?

As one increases the pH, the other drug may not be even be able to act, going by the pharmacodynamics.

ranitidine belongs to a group of drugs called histamine-2 blockers. it works by reducing the amount of acid your stomach produces.

on the other hand Antacids work by counteracting (neutralising) the acid in your stomach that is used to aid digestion. This can reduce the symptoms of heartburn and relieve pain.

Some antacids also coat the surface of the oesophagus (gullet) with a protective barrier against stomach acid or produce a gel on the stomach’s surface which helps stop acid leaking into the oesophagus so it is better to use this combination .. though i dont know it is rational or irrational therapy