logo

Drug comparisons - Proton Pump Inhibitors

Proton Pump Inhibitors - PPIs

  Drug Comparisons - Home Page  

Equivalent Dosages

Esomeprazole (Nexium ®):
20 - 40 mg
Lansoprazole (Prevacid ®): 
30 mg
Omeprazole (Prilosec ®):
20 mg
Pantoprazole (Protonix ®): 
40 mg
Rabeprazole (Aciphex ®):
20 mg
--
Estimates based on healing rates for a variety of conditions. 
Recommended reading: McDonagh MS et al. (See references).

Esomeprazole (Nexium ®)   

Supplied:  Capsule (delayed release): 20 mg, 40 mg.  Granules - for oral suspension: 20 mg, 40 mg. Injection (powder for reconstitution): 20 mg, 40 mg.
Dosing
Healing of erosive esophagitis: Oral: Initial: 20-40 mg once daily for 4-8 weeks. if incomplete healing, may continue for an additional 4-8 weeks. Maintenance: 20 mg once daily.
Symptomatic gastroesophageal reflux: Oral: 20 mg once daily for 4 weeks. 
Peptic ulcer disease: Eradication ofHelicobacter pylori: Oral: 40 mg once daily for 10 days -- requires combination therapy.
Pathological hypersecretory conditions (Zollinger-Ellison syndrome): 40 mg twice daily; adjust regimen to individual patient needs; doses up to 240 mg/day have been administered.

Lansoprazole (Prevacid ®)

Supplied:  Capsule (delayed release): 15 mg, 30 mg. Granules (for oral suspension): 15 mg and 30 mg packets.  Injection (powder for reconstitution): 30 mg.  Orally disintegrating tablet: 15 mg, 30 mg.
Dosing
Duodenal ulcer: Oral: Short-term treatment: 15 mg once daily for 4 weeks. Maintenance therapy: 15 mg once daily.  Gastric ulcer: Oral: Short-term treatment: 30 mg once daily for up to 8 weeks.
Symptomatic GERD
: Oral: Short-term treatment: 15 mg once daily for up to 8 weeks.
Erosive esophagitis:  Oral: Short-term treatment: 30 mg once daily for up to 8 weeks. Maintenance therapy: 15 mg once daily.     IV: 30 mg once daily for up to 7 days... patients should be switched to an oral formulation as soon as they can take oral medications.
Hypersecretory conditions: Oral: Initial: 60 mg once daily; adjust dose based upon patient response and to reduce acid secretion to <10 mEq/hour (5 mEq/hour in patients with prior gastric surgery). Doses of 90 mg twice daily have been used... administer doses >120 mg/day in divided doses.
Prevention of rebleeding in peptic ulcer bleed: 60 mg IV, followed by 6 mg/hour infusion for 72 hours.

Omeprazole (Prilosec ®)

Supplied:  Capsule: 10 mg, 20 mg, 40 mg.  Tablet (OTC): 20 mg
Dosing
Active duodenal ulcer: Oral: 20 mg/day for 4-8 weeks.
Erosive esophagitis: Oral: 20 mg/day for 4-8 weeks.  Maintenance of healing: 20 mg/day for up to 12 months total therapy.
Gastric ulcers: Oral: 40 mg/day for 4-8 weeks.
Symptomatic GERD: Oral: 20 mg/day for up to 4 weeks.
Pathological hypersecretory conditions: Oral: Initial: 60 mg once daily; doses up to 120 mg 3 times daily have been administered. Administer daily doses >80 mg in divided doses.

Pantoprazole (Protonix ®)

Supplied:  Tablet (delayed release):  20 mg, 40 mg.  Injection (powder for reconstitution): 40 mg.
Dosing
Erosive esophagitis associated with GERD:  Oral:  Treatment: 40 mg once daily for up to 8 weeks.  An additional 8 weeks may be used in patients who have not healed after an 8-week course.  Maintenance of healing: 40 mg once daily.   I.V.: 40 mg once daily for 7-10 days.
Hypersecretory disorders (including Zollinger-Ellison): Oral: Initial: 40 mg twice daily. Adjust dose based on patient needs.  Doses up to 240 mg/day have been administered.   IV: 80 mg twice daily. Adjust dose based on acid output measurements.
Prevention of rebleeding in peptic ulcer bleed : IV: 80 mg, followed by 8 mg/hour infusion for 72 hours.

Rabeprazole (Aciphex ®)

Supplied:  Tablet (delayed release):  20 mg
Dosing
Duodenal ulcer: Oral: 20 mg/day before breakfast for 4 weeks.
GERD: Oral: 20 mg once daily for 4-8 weeks; maintenance: 20 mg once daily.
Hypersecretory conditions: Oral: 60 mg once daily. Dose may need to be adjusted as necessary. Doses as high as 100 mg once daily and 60 mg twice daily have been used.
 
 

References

Aciphex - package insert. Teaneck, NJ: Eisai, Inc; August 2003.
Drug Facts & Comparisons. St. Louis, MO. Facts & Comparisons. 2005.
Gillessen A, Beil W, Modlin IM, Gatz G, Hole U. 40 mg pantoprazole and 40 mg esomeprazole are equivalent in the healing of esophageal lesions and relief from gastroesophageal reflux disease-related symptoms. J Clin Gastroenterol 2004; 38: 332-340.
McDonagh MS, Carson S. Drug Class Review on Proton Pump Inhibitors. 2006.
http://www.ohsu.edu/drugeffectiveness/reports/final.cfm  Accessed: Oct 2007.
Nexium - package insert. Willmington, DE: AstraZeneca LP; October 2006.
Prevacid - package insert. Lake Forest, IL: TAP Pharmaceuticals, Inc; September 2006.
Prilosec - package insert. Wilmington, DE: AstraZeneca LP; September 2006.
Protonix - package insert. Philadelphia, PA: Wyeth Laboratories; December 2005.
Wang WH, Huang JQ, Zheng GF, Xia HH, Wong WM, Lam
SK, Wong BC. Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis. World J Gastroenterol 2005; 11: 4067-4077
 
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer
more Career Center image description
Medical Calculators - A thru Z
Lab Values - A thru Z