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Choosing Among Available PPIs against Heartburn

Proton-pump inhibitors (PPIs) represent a new and mighty weapon against stomach and duodenal ulcers, gastroesophageal reflux disease (heartburn), and other conditions, where it is an excess of stomach acid, which is the main culprit of illness. For the time being, there are five representatives of the PPI class of medications, approved and available on the U.S. market:

-         lansoprazole (brand name Prevacid)

-         omeprazole (brand name Prilosec, Zegerid)

-         pantoprazole (brand name Protonix)

-         esomeprazole (brand name Nexium)

-         rabeprazole (brand name Aciphex)

Besides, proton pump inhibitors can be found in some combination drugs, such as Prevpac and NapraPAC. Prevpac is the combination of lansoprazole and two antibiotics, amoxicillin and claritromycin; such combination works best in the treatment of gastrointestinal ulcers, caused by H. pilory bacteria. NapraPAC contains lansoprazole and naproxen, which is nonsteroidal anti-inflammatory drug. NapraPAC is usually prescribed for treating osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

Being the representative of one and the same class of medications, all the above mentioned drugs are very similar in the mode of action, effectiveness and safety profiles. That is why choosing a particular medication depends on the doctor’s preference or patient’s medical insurance. However, some differences still exist – and some of them may be of key importance when choosing proton pump inhibitor in every particular case.

The common features of all PPIs, as well as the distinguishing features of particular medications, are summarized in the following table, which is compiled exclusively for Pillwatch.com readers.

 
 
Year of  approval
2001
2000
1999
1995
1989
Manufacturer
Astrazeneca
Wyeth pharms
Eisai
Takeda Pharms
Astrazeneca
Mode of action

provide a long-lasting reduction of gastric acid production by “shutting down” acid-producing “proton pumps”, which are situated in the mucous lining of the stomach

Recommended daily dose
20-40 mg
40 mg
20 mg
15-30 mg
20-40 mg
Side Effects
Headache, diarrhea, abdominal pain
Headache (6%),

Diarrhea (4%), flatulence (2%), abdominal pain (1), hyperglycemia (1%), eructation (1%)

Pain (3%), pharyngitis (3%), flatulence (3%), infection (2 %), constipation (2 %)

Diarrhea (3.8%), abdominal pain (2.1%), nausea (1.3%), constipation (1.0%)

Headache (6.9%), abdominal pain (5.2%), nausea (4%), diarrhea (3.7%), vomiting (3.2%), flatulence (2.7%)

Clinically proved efficacy in relieving heartburn

After treatment 70.5 – 74.2% of patients experienced no heartburn for 7 consecutive days according to 4 clinical studies

Reduced number of heartburn episodes up to 5.1 (daytime) and 3.9 (nighttime) at month 1, and 2.9 (daytime) and 2.5 (nighttime) at month 12

69-92 % of patients without relapse of heartburn at week 52 according to 2 clinical studies

84% of days without heartburn at week 8

NA
Average cost per pill
5.3 $ (brand)
4.46 $ (brand)
3.63 $ (generic)
5.3 $ (brand)
5.3 $ (brand)
0.64 $ (OTC)
Known benefits

Rapid onset of action; works longer than other PPIs

Lowest cost among brand PPIs
Rapid onset of action
No headache
No prescription
 
Nick


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Protonix 90 Pills $32
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Prevacid 10 Pills $53
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Nexium 30 Pills $54
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Aciphex 60 Pills $43
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