Friday, August 5, 2016

PPI: Comparison

  • Generally according to FDA-approved indications of PPIs, it is used for the prevention and treatment of gastric acid related conditions.
  • PPIs differ in their routes of excretion, peak plasma levels, and half lives as shown in the table below. 1
Comparison: General
  • Generally all PPIs have equal potency and effectiveness but some PPIs have advantages over one another in certain diseases.
  • Esomeprazole is more superior than omeprazole in healing erosive esophagitis.
  • If in short term effect, esomperazole is more effective in healing esophagitis compared to pantoprazole.
  • Generally for the long term effect, esomeprazole, pantoprazole, lansoprazole are equally effective in treating mild to moderate esophagitis.
 Comparison: Pantoprazole
  • Pantoprazole and omeprazole are safe and effective but pantoprazole is more effective than omeprazole in healing acute and benign gastric ulcer.
  • Pantoprazole has less interaction with clopidogrel compared to omeprazole.
  • Pantoprazole also is more safe in pregnancy since it is in category B while omeprazole is in category C.
  • The table below shows the indication and regimen of drugs in PPIs group
Evidences: General
Evidences: Pantoprazole
  • Pantoprazole, 40 mg once daily in the morning, is a highly effective, well tolerated treatment for acute, benign gastric ulcer compared to Omeprazole 20mg but pantoprazole and omeprazole were equally safe in the therapy of gastric ulcer.6
  • Pantoprazole 40 mg and omeprazole MUPS 40 mg were equivalent with respect to healing after 4 and 8 weeks of treatment in patients with reflux esophagitis grade II/III. Both drugs were well tolerated and safe.7
  • There is one study shows that patients receiving pantoprazole had a significantly better platelet response to clopidogrel as assessed with the PRI VASP compared to patients receiving omeprazole. The present findings suggest the preferential use of pantoprazole compared with omeprazole in patients receiving clopidogrel to avoid any potential negative interaction with CYP2C19. 8
Reference
  1. http://www.nps.org.au/medicines/digestive-system/indigestion-reflux-and-stomach-ulcer-medicines/heartburn-and-reflux-medicines/for-health-professionals/indications
  2. http://sma.org/wp-content/uploads/2012/11/November_Article.pdf
  3. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0008767/#results.s4
  4. http://consumerhealthchoices.org/wp-content/uploads/2012/01/BBD-PPIs-Full.pdf
  5. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-dosingchart.pdf  (table differences)
  6. http://www.ncbi.nlm.nih.gov/pubmed/7766739
  7. http://www.ncbi.nlm.nih.gov/pubmed/12743434
  8. http://www.sciencedirect.com/science/article/pii/S0735109709021962

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.