Part 2: Proto pump Inhibitors

Proton pump inhibitors (PPIs) are among the most commonly used drugs in the world. People take PPI drugs to treat gastrointestinal symptoms such as heartburn and oesophageal inflammation. PPIs are highly effective, but it is important to realise this is not the only option in treating acid reflux or oesophagitis. Other pharmacological agents such as H2 blockers (Ranitidine) are also very effective as are well non-medical treatments such as radical lifestyle alteration. Lifestyle changes such as modifying one’s diet, increased daily exercise activities and a dedicated weight reduction programme (if appropriate) have all shown tremendous benefits in treating acid-reflux, oesophagitis and GORD.

What Is a Proton Pump Inhibitor and How Does It Work?

Proton pump inhibitors are powerful acid-reducing drugs. PPI drugs target proton pumps in the stomach (parietal cells). The blockage of these pumps reduces the amount of acid these pumps produce. This in-effect reduces the amount of acid in the stomach.

List of PPI available

There are eight brand name proton pump inhibitors available, they are also available in generic form. All PPI drugs are available in prescription strength.

Nexium is the biggest selling PPI. Nexium is also one of the best-selling drugs of all time. AstraZeneca reported a staggering $72.5 billion in sales for Nexium between 1992 and 2017.

List of PPIs

• Omeprazole (Losec)
• Esomeprazole (Nexium)
• Lansoprazole
• Pantoprazole
• Rabeprazole

What Are PPIs Used to Treat?

• Gastroesophageal reflux disease (GORD) A chronic digestive disorder caused when stomach acid flows back into the oesophagus
• Helicobacter pylori (H. pylori) A bacteria found in the gut lining/flora.
• Zollinger-Ellison syndrome A rare condition that causes the stomach to produce too much acid
• Erosive esophagitis (EE) A condition characterized by inflammation of the lining of the oesophagus
• Gastric and duodenal ulcers A raw place or sore in the lining of the stomach or intestine

Dosage Information on Proton Pump Inhibitors

Dosage varies with each PPI and the condition it is being used to treat. A doctor will advise a patient on the dose needed and how often a patient should take a PPI drug.

When Should I Take a PPI?

Patients should ask their doctor when to take a PPI. Generally, doctors tell patients to take PPIs on an empty stomach — about 30 minutes before a meal. Often this will be first thing in the morning. Some patients take a second dose before dinner when a doctor deems it necessary. Always take it with a large glass of water.

PPI Side Effects

Proton pump Inhibitor side effects. The most common side effects include constipation, headache, diarrhoea and vomiting. For information on serious side-effects read the manufacturers list.

PPI Interactions

Proton pump inhibitors may cause drug interactions with other medicines. Some of these may be minor. But some PPI interaction can be serious. Always tell their doctor about all other drugs they are taking before using PPIs.

What Are the Differences Among PPIs?

• Studies tend to show that all PPIs are about the same in most cases. But their costs can vary widely.
• Some PPIs may be more effective than others at treating certain conditions. And some may present a greater risk for certain side effects.
• A 2010 study reviewed research comparing several PPIs.

How Does Nexium Compare to Other PPIs?

Nexium (esomeprazole) is as effective as other PPIs in most treatments. Studies have found it may be better than other PPIs at healing oesophagitis symptoms at four to eight weeks. This applied only to moderate to severe cases.

How Do Omeprazole and Rabeprazole Compare to Other PPIs?

A study found Omeprazole and Rabeprazole performed better than other PPI drugs at controlling GORD. They both worked better than other PPIs in high doses. Another study found older patients responded better to the Omeprazole and Rabeprazole than they did to other PPIs.