Comparison between proton pump inhibitors (PPIs).

PROTON PUMP INHIBITORS

Table 1: Doses and bioavailability of different PPIs ^[1]

Proton pump inhibitors (PPIs)	Doses recommended (mg)		Bioavailability (%)
	Gastroduodenal ulcers*	Gastroesophageal Reflux Disease (GERD)*
Dexlansoprazole	30 – 60	30  (OD – BD)	-
Esomeprazole	20 - 40	20 or 40 (OD)	64
Lansoprazole	15 – 30	30 (OD – BD)	85
Omeprazole	20 – 40	20 – 40 (OD – BD)	45
Pantoprazole	20 – 40	40  (OD – BD)	64
Rabeprazole	20	20 (OD – BD)	52

* TREAT GASTRODUODENAL ULCERS X 4/52; TREAT GASTRIC ULCERS X 8/52

Table 2: Studies comparing different PPIs

Authors (year)	Title	Conclusion(s)
Klok RM et al. (2003) [2]	Meta analysis: comparing the efficacy of PPIs in short term use	The significant difference may be dose-dependent and not PPI-specific.
Edwards SJ et al. (2008) [3]	Systematic review of PPIs for the acute treatment of reflux oesophagitis.	Esomeprazole has higher healing rates than Omeprazole at week 4 and 8.
Pantoflickova et al. (2003) [4]	Acid inhibition on the first day of dosing: comparison of 4 PPIs	Rabeprazole is the most potent acid inhibitor during the first day of dosing.
Li XQ et al. (2004) [5]	Comparison of inhibitory effects of the PPIs Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole and Rabeprazole on human CYP450 activity.	-Lansoprazole and Pantoprazole are the most potent in-vitro inhibitors of CYP450. -Esomeprazole has less inhibitory potency than Omeprazole. -Rabeprazole had lower inhibitory potency than other PPIs.
Stedman CAM et al. (2001) [6]	Review article: comparison of the pharmacokinetics, acid suppression and efficacy of PPIs	-Omeprazole increases in bioavailability with repeated administrations. -No significant interactions have been reported for Pantoprazole as it has minimum CYP450 inhibition. -Omeprazole and Lansoprazole showed more drug interactions. -Rabeprazole showed better acid suppression than Omeprazole. -Lansoprazole and Rabeprazole showed a more rapid onset of maximal acid suppression than other PPIs. -Lansoprazole showed earlier symptom relief from oesophagitis and more rapid healing of duodenal ulcers. -For peptic ulcer disease Rabeprazole was more superior to Omeprazole.

H. pylori eradication rates were found to be of similar trends when different proton pump inhibitors were used in triple therapy regimens. [6]

The studies in Table 2 show that most PPIs are similar in its end point effect. It’s up to the physicians and pharmacists’ discretion to choose based on their preferences with regards to which type of treatment they wish to target for which patient and at the same time to keep in mind cost benefit ratio when treating.

 References:

1. Adapted from: Wolfe MM, Sachs G. Acid suppression: Optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gasteroenterology 2000; 118: S9.

2. Klok RM, et al. Meta analysis: comparing the efficacy of PPIs in short term use. Aliment Pharmacol Ther. 2003; 17 (10): 1237-45.

3. Edwards SJ et al. Systematic review of PPIs for the acute treatment of reflux oesophagitis. Aliment Pharmacol Ther.  2008; 15(11): 1729-36.

4. Pantoflickova et al. Acid inhibition on the first day of dosing: comparison of 4 PPIs. Aliment Pharmacol Ther.  2003; 17 (12): 1507-14.

5. Li XQ et al. Comparison of inhibitory effects of the PPIs Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole and Rabeprazole on human CYP450 activity. Aliment Pharmacol Ther.   2004; 32(8): 821-7.

6. Stedman CAM et al. Review article: comparison of the pharmacokinetics, acid suppression and efficacy of PPIs. Aliment Pharmacol Ther.  2000; 14(8): 963-78.