Prescribing information:
Omeprazole
- Ulcer healing, by mouth: 20 mg daily.
- Maintenance dose, by mouth: 10“20 mg daily (see notes above).
- Reflux oesophagitis, by mouth: 20“40 mg daily.
- Also available in an intravenous formulation.
Esomeprazole
- Reflux oesophagitis, by mouth: 40 mg daily.
Lansoprazole
- Ulcer healing, by mouth: 30 mg daily.
- Maintenance dose, by mouth: 15“30 mg daily (see notes above).
- Reflux oesophagitis, by mouth: 30 mg daily.
Pantoprazole
- Ulcer healing, by mouth: 40 mg daily.
- Maintenance dose, by mouth: 20“40 mg daily (see notes above).
- Reflux oesophagitis, by mouth: 20“40 mg daily.
Rabeprazole
- Ulcer healing, by mouth: 20 mg daily.
- Maintenance dose, by mouth: 10“20 mg daily (see notes above).
- Reflux oesophagitis, by mouth: 10“20 mg daily.
These drugs bind irreversibly to the H+/K+-ATPase, located in the secretory cannaliculae of parietal cells. The drug must be absorbed into the body to do this; it does not act directly from the stomach lumen. It also requires an acid environment to be activated; this provides a negative feedback mechanism”inhibition of acid production reduces the activation of the PPI. The H+/K+-ATPase is the final common pathway of gastric acid secretion, so these drugs are powerful antacids. See H2 antagonists section (p. 24) for details of acid secretion.
Drugs in this class
- Omeprazole
- Esomeprazole
- Rabeprazole
- Pantoprazole
- Lansoprazole
When suppression of gastric acid is required.
- Healing of gastric and duodenal ulcers.
- Reflux oesophagitis.
- Eradication of Helicobacter pylori infection, in combination with antibacterial drugs (see teaching point below).
- Treatment of Zollinger“Ellison syndrome.
- High-dose intravenous omeprazole has been used as adjunctive treatment in patients with high-risk bleeding duodenal ulcer (unlicensed indication).
Treatment:
- Some patients report that they cannot swallow tablets because they do not wish to take the drug, or because they are worried about adverse effects of the drug.
- Identify whether difficulty swallowing tablets is in fact a symptom of a more general swallowing problem. Causes include:
- Oesophageal strictures (benign and malignant)
- Stroke
- Muscle weakness (e.g. myasthenia gravis)
- Some patients may have problems because they do not take tablets with water; this is potentially hazardous. Tablets can stick to the oesophageal muscoa and cause ulceration; this has been a particular problem with bisphosphonate drugs, which should be taken with a full glass of water.
- Some patients find gelatin capsules more difficult to swallow than tablets; a change of formulation may solve the problem.
- A modified-release formulation may mean that the drug needs to be given less often.
- Some drugs (e.g. alendronate) are available in a formulation that can be given once weekly.
- There are several options for patients with persistent problems in swallowing tablets:
- Prescribe an elixir or melt formulation.
- Some capsules can be opened and the contents suspended in yoghurt or fruit juice (e.g. Lansoprazole, Zomorph®). Warn the patient not to chew the granules.
- Discuss with a pharmacist whether a specially prepared suspension or elixir can be produced.
- Parenteral administration is an option but is rarely ideal, although subcutaneous administration may be suitable.
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