Drugs in this Class
Esomeprazole Gastro-Resistant Capsules (Esomeprazole Magnesium Gastro-Resistant Capsules, Nexium Delayed-Release Capsules)
Rabeprazole (Aciphex)
Lansoprazole Delayed-Release Capsules (Lansoprazole Delayed-Release Capsule, Prevacid Delayed-Release Capsule)
Omeprazole Gastro-Resistant Capsules (Omeprazole Delayed-Release Capsules, Prilosec Delayed-Release Capsules)
Pantoprazole Gastro-Resistant Tablets (Pantoprazole Delayed-Release Tablets, Pantoprazole Sodium Gastro-Resistant Tablets, Protonix Delayed-Release Tablets)
Omeprazole Gastro-Resistant Tablets (Omeprazole Delayed-Release Tablets, Prilosec OTC Delayed-Release Tablets)

Summarizing the Evidence

• Although the Food and Drug Administration (FDA) has not approved Protonix for the treatment of duodenal and gastric ulcers, most healthcare providers feel that all PPIs are effective for healing ulcers because they all work in a similar manner.

• Most comparative clinical studies between the drugs in this class have shown that the PPIs are similar in their abilities to effectively heal ulcers. Since the PPIs are similarly effective, the choice of which PPI to use will depend on your doctor's preference, your prescription benefits formulary, and potential drug interactions.

• For treating ulcers that are caused by H. pylori (a bacteria responsible for causing nearly 90% of ulcers), clinical treatment guidelines do not specify which PPI should be used. Currently, only Aciphex, Nexium, Prevacid, and Prilosec are FDA-approved for inclusion into H. pylori treatment regimens. However, since all drugs in this class work similarly, most healthcare providers feel that all PPIs are effective for treating ulcers caused by H. pylori. You can learn more about how H. pylori. treatment regimens compare in our "Drug Comparisons" section.

• All of the PPIs appear to have similar side effect profiles.

Dosing and Administration

• All PPIs are typically taken once daily to treat duodenal and gastric ulcers. For treating duodenal or gastric ulcers that are caused by H. pylori, most PPIs are taken at least twice daily except for Nexium, which can be taken once daily as a part of certain H. pylori treatment regimens.

• 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.

Generic Availability

• Prilosec and Protonix are the only PPIs that are available generically at this time (generic names is omeprazole and pantoprazole resprectively). All other PPIs are only available as brand name products and by prescription. Generic medications are usually less expensive but equally effective. In addition to being available in generic formulations, Prilosec OTC is available over-the-counter without a prescription, although it is not indicated for the self-treatment of peptic ulcer disease.

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

References:

1. Prilosec (package insert). Wilmington, DE: AstraZeneca LP; September 2006.
2. Prevacid (package insert). Lake Forest, IL: TAP Pharmaceuticals, Inc; September 2006.
3. Protonix (package insert). Philadelphia, PA: Wyeth Laboratories; December 2005.
4. Aciphex (package insert). Teaneck, NJ: Eisai, Inc; August 2003.
5. Nexium (package insert). Willmington, DE: AstraZeneca LP; October 2006.
6. Omeprazole delayed-release capsules (package insert). Weston, FL: Apotex Corp.; February 2006.
7. Prilosec OTC (product label). Available at: http://www.prilosecotc.com/hcp/prilosec_label_image.pdf. Accessed on June 2007.
8. Vanderhoff BT, Tahboub RM. Proton pump inhibitors: an update. Am Fam Physician. 2002;66(2):273-280.
9. Andersson T. Pharmacokinetics, metabolism and interactions of acid pump inhibitors. Focus on omeprazole, lansoprazole and pantoprazole. Clin Pharmacokinet. 1996;31:9-28.
10. Howden CW, Hunt RH. Guidelines for the management of Helicobacter pylori infection. Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998;93(12):2330-2338.
11. Peterson WL, Fendrick AM, Cave DR, Peura DA, Garabedian-Ruffalo SM, Laine L. Helicobacter pylori-related disease. Guidelines for testing and treatment. Arch Intern Med. 2000;160:1285-1291.
12. Rehner M, Rohner HG, Schepp W. Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration ? a multicenter study. Aliment Pharmacol Ther. 1995;9:411-416.
13. Ando T, Kato H, Sugimoto N, et al. A comparative study on endoscopic ulcer healing of omeprazole versus rabeprazole with respect to CYP2C19 genotypic differences. Dig Dis Sci. 2005;50(9):1625-1631.
14. Lanza FL and the Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. A guideline for the treatment and prevention of NSAID-induced ulcers. Am J Gastroenterol. 1998;93(11):2037-2046.
15. Bianchi Porro G, Lazzaroni M, Imbesi V, Montrone F, Santagada T. Efficacy of pantoprazole in the prevention of peptic ulcers, induced by non-steroidal anti-inflammatory drugs: a prospective, placebo-controlled, double-blind, parallel-group study. Dig Liver Dis. 2000;32(3):201-208.
16. Pilotto A, Di Mario F, Franceschi M, et al. Pantoprazole versus one-week Helicobacter pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects. Aliment Pharmacol Ther. 2000;14(8):1077-1082.
17. Frevel M, Daake H, Janisch HD, et al. Eradication of Helicobacter pylori with pantoprazole and two antibiotics: a comparison of two short-term regimens. Aliment Pharmacol Ther. 2000;14(9):1151-1157.
18. Pilotto A, Franceschi M, Leandro G, et al. Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole. Aliment Pharmacol Ther. 2001;15(7):1031-1036.
19. Malfertheiner P, Kirchner T, Kist M, et al.; BYK Advanced Gastric Ulcer Study Group. Helicobacter pylori eradication and gastric ulcer healing?comparison of three pantoprazole-based triple therapies. Aliment Pharmacol Ther. 2003;17(9):1125-1135.
20. Bochenek WJ, Peters S, Fraga PD, et al.; Helicobacter pylori Pantoprazole Eradication (HELPPE) Study Group. Eradication of Helicobacter pylori by 7-day triple-therapy regimens combining pantoprazole with clarithromycin, metronidazole, or amoxicillin in patients with peptic ulcer disease: results of two double-blind, randomized studies. Helicobacter. 2003;8(6):626-642.
21. Sivri B, Simsek I, Hulagu S, et al. The efficacy, safety and tolerability of pantoprazole-based one-week triple therapy in H. pylori eradication and duodenal ulcer healing. Curr Med Res Opin. 2004;20(8):1301-1307.
22. Nakao M, Malfertheiner P. Growth inhibitory and bactericidal activities of lansoprazole compared with those of omeprazole and pantoprazole against Helicobacter pylori. Helicobacter. 1998;3(1):21-27.
23. Barradell LB, Faulds D & McTavish D: Lansoprazole: review of its pharmacodynamic and pharmacokinetic properties and its therapeutic efficacy in acid-related disorders. Drugs 1992; 44:225-250.
24. Capurso L, Di Pietro C, Koch M et al: Lansoprazole in the treatment of peptic ulcer disease. Gastroenterol Int 1995; 8:125-132.
25. Spencer CM and Faulds D. Esomeprazole. Drugs. 2000;60(2):321-329.
26. Hutchison TA & Shahan DR & Anderson ML (Eds): DRUGDEX System (electronic version). MICROMEDEX, Inc., Greenwood Village, Colorado, USA. Available at: http://csi.micromedex.com (06/12/2002).
27. Wilde MI, McTavish D. Omeprazole. An update of its pharmacology and therapeutic use in acid-related disorders. Drugs. 1994;48(1):91-132.
28. Zimmermann AE, Katona BG. Lansoprazole: a comprehensive review. Pharmacotherapy. 1997;17(2):308-326.
29. Blum RA. Lansoprazole and omeprazole in the treatment of acid peptic disorders. Am J Health-Syst Pharm. 1996;53(12):1401-1415.
30. Sachs G. Proton pump inhibitors and acid-related diseases. Pharmacotherapy. 1997;17(1):22-37.
31. Louw JA, van Rensburg C, Simjee AE, et al. Lansoprazole versus omeprazole in duodenal ulcer healing (abstract). S Afr Med J. 1993;83:777.
32. Petite JP, Slama JL, Licht H, et al. Comparison of lansoprazole 30 mg and omeprazole 20 mg in the treatment of duodenal ulcer. A multicenter double-blind comparative trial. Gastroenterol Clin Biol. 1993;17(5):334-340.
33. Rehner M, Rohner HG, Schepp W. Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration: a multicenter study. Aliment Pharmacol Ther. 1995;9:411-416.
34. Beker JA, Porro GB, Bigard M-A, et al. Double-blind comparison of pantoprazole and omeprazole for the treatment of acute duodenal ulcer. Eur J Gastroenterol Hepatol. 1995;7:407-410.
35. Dekkers CPM, Beker JA, Thjodleifsson B, et al. Comparison of rabeprazole 20 mg versus omeprazole 20 mg in the treatment of active duodenal ulcer: a European multicenter study. Aliment Pharmacol Ther. 1999;13:179-186.
36. Castell DO, Richter JE, Robinson M, et al. Large trial compares lansoprazole to omeprazole. Gastroenterology. 1995;108(suppl 4):A67.
37. Florent C, Forestier S, Joubert-Collin M. Lansoprazole versus omeprazole: efficacy and safety in acute gastric ulcer. Gastroenterology. 1993;104(Suppl):A80.
38. Dekkers CP, Beker JA, Thjodleifsson B, Gabryelewicz A, Bell NE, Humphries TJ. Comparison of rabeprazole 20 mg vs. omeprazole 20 mg in the treatment of active gastric ulcer: a European multicentre study. The European Rabeprazole Study Group. Aliment Pharmacol Ther. 1998;12(8):789-795.
39. Witzel L, Gutz H, Hutteman W, et al. Pantoprazole versus omeprazole in the treatment of acute gastric ulcers. Aliment Pharmacol Ther. 1995;9:19-24.
40. Prichard PJ, Rubinstein D, Jones DB, et al. Double blind comparative study of omeprazole 10 mg and 30 mg daily of healing duodenal ulcers. BMJ. 1985;290:601-603.

Last Updated: March 2008

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.

Back