Drug Comparisons

Proton pump inhibitors (PPIs) decrease the amount of acid in the stomach. The stomach contains a pump, called the gastric acid pump, which produces stomach acid. PPIs bind to this pump and block the secretion of acid into the stomach. Decreasing stomach acid can help ulcers to heal and reflux, or heartburn symptoms to subside.

Drugs in this Class
Rabeprazole (Aciphex)
Omeprazole OTC (Prilosec OTC)
Esomeprazole injection (Nexium I.V.)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole capsules (Prilosec)
Pantoprazole (Protonix)

Summarizing the Evidence

• Currently, all of the PPIs, except for Protonix (pantoprazole), are FDA-approved for the management of heartburn or other symptoms of gastroesophageal reflux disease (GERD). While Protonix is not indicated for GERD treatment, it is indicated for the short-term treatment and maintenance healing of erosive esophagitis (erosion of the esophagus lining--a common complication of GERD) and has demonstrated efficacy for treating mild-to-moderate GERD in clinical studies. Most healthcare providers feel that all PPIs are effective for treating GERD because they all work in a similar manner.

• The American College of Gastroenterology published treatment guidelines for GERD in 2005. Those treatment guidelines note that PPIs eliminate GERD symptoms and heal esophagitis more frequently and more rapidly than other medications used to treat GERD (eg. H2 blockers).

• Most comparative clinical studies between the drugs in this class have shown that all PPIs are effective for treating acid-related gastrointestinal disorders, including moderate to severe GERD. Since all PPIs are similarly effective, the choice of which PPI to use will typically depend on your doctor's preference, your prescription benefits formulary and potential drug interactions.

• Taking PPIs long term (or chronically) is effective and appropriate to maintain control of GERD symptoms according to the American College of Gastroenterolgy treatment guidelines. Additionally, "on-demand" use of PPIs (meaning, taking the PPI only when GERD symptoms arise or when you anticipate circumstances which will lead to the development of GERD symptoms) has been shown to be an effective treatment strategy for some people. Although the "on-demand" treatment strategy has not been well studied, it may make economical sense to use this strategy for individuals who have mild-to-moderate GERD symptoms since PPI therapy can be very expensive.

Dosing and Administration

• All PPIs are typically taken once daily to treat GERD. For patients who have difficulty swallowing capsules, Prevacid is also available in an oral liquid suspension or the capsule can be easily opened and it contents mixed with applesauce or other food items. Prevacid is also available as an orally disintegrating tablet that is placed under the tongue and disintegrates within one minute. Nexium and Prilosec capsules can also be opened and mixed with certain foods. Nexium also is available in an oral suspension.

• When a PPI is taken once daily, it is best to take the PPI prior to the morning meal for most people. However, if you are experiencing an increase in nighttime GERD symptoms, it may be better to take the PPI dose prior to the evening meal.

Generic Availability

• Prilosec and Protonix are the only PPI's that are available generically at this time (generic names are omeprazole and pantoprazole, respectively). Generic medications are usually less expensive but equally effective. In addition to being available in generic formulations, Prilosec OTC is now available over-the-counter without a prescription for treating frequent heartburn, or heartburn that occurs 2 or more days per week. Prilosec OTC should not be taken for more than 14 consecutive days, or more often than every 4 months, unless directed by a physician. All other PPIs are only available by prescription.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

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Last Updated: March 2008
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.