Nizatidine

Nizatidine is an **H2-receptor antagonist** structurally and pharmacologically similar to ranitidine. While it possesses acid-suppressing capabilities like cimetidine and famotidine, its primary utility in veterinary medicine (particularly small animal practice) stems from its **prokinetic properties**. * Used to manage delayed gastric emptying, intestinal pseudo-obstruction, and feline constipation/megacolon. * May help prevent hemorrhagic necrosis in feline pancreatitis. > **Clinical Pearl:** Nizatidine is less commonly used today due to the availability of more potent acid suppressants (like proton pump inhibitors) and other prokinetics, but it remains a viable option, especially when dual acid-suppressing and prokinetic action is desired.

กลไกการออกฤทธิ์: * **Acid Suppression:** Competitively inhibits histamine at the **H2 receptors** on gastric parietal cells → reduces basal and stimulated gastric acid output → decreases pepsin secretion. * **Prokinetic Action:** Inhibits **acetylcholinesterase** → prevents breakdown of acetylcholine → increases acetylcholine concentrations at **muscarinic receptors** → stimulates GI motility. * May also exert direct agonist effects on **M3 muscarinic receptors**. * Increases lower esophageal sphincter (LES) pressure.

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