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