Omeprazole vs Lansoprazole vs Pantoprazole vs Esomeprazole in the treatment of reflux esophagitis
One comparative study was conducted in order to clarify whether there is any difference in the symptom relief in patients with reflux esophagitis after administration of four Proton pump inhibitors (PPIs): Omeprazole, Lansoprazole, Pantoprazole and Esomeprazole. Study compared their symptom relief in the first 7 days of reflux esophagitis treatment. It has been showed that esomeprazole was most effective for symptom relief within 2 days compared to omeprazole, pantoprazole and lansoprazole administration; however this difference disappeared 5 days after beginning of drug administration. Study also confirmed that esomeprazole use of 40 mg daily was more effective than omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg daily in the relief of heartburn symptoms during the first day and the first 5 days after the begining of administration. A consequence of such results is because esomeprazole has been shown to have a faster onset of antisecretory activity comapraed to omeprazole, lansoprazole and pantoprazole. The healing rate of reflux esophagitis after 8 weeks of treatment tended to be higher in patients administered esomeprazole than in patients who administered omeprazole, lansoprazole or pantoprazole, although these differences did not reach a statistically significant level.
Omeprazole Vs Lansoprazole
There have been many debates into the similarities differences between omeprazole and lansoprazole. Both drugs belong to the same class of drugs called PPIs and can be used as an effective acid reflux treatment. Although they are from the same family of drugs and have the same mechanism of action, there are slight differences that may need to be considered when taking these drugs.
Studies showed that lansoprazole can be more potent and thus effective in acid lowering for acid reflux treatment and in some cases, it is considered as faster acting than omeprazole. However antacids such as Gaviscon are able to reduce the absorption of this drug from the gastrointestinal tract and may also decrease its efficiency. Antacids can also lower the effects of the same time administered omeprazole but not in rates as they do to lansoprazole. Therefore Lansoprazole should not be taken within an hour of taking antacids. It has been also showed that lansoprazole is more likely to cause anemia or iron deficiency than omeprazole. On the other hand, omeprazole may enhance anti-clotting effects of the anticoagulants such as warfarin or thrombocyte antiaggregation drugs such as clopidogrel. You should monitor your INR levels before taking this medication and upon stopping it. Both medications are suggested by recent studies that increase the risk of bone fractures when they are taken on a long term basis. This can be managed by taking enough calcium and vitamin D to reduce this risk.
Studies also showed that both drugs begin to work within 24 hours, but it may take up to 4 days pass before their effects become noticeable. After long-term use, it has been showed that lansoprazole is more effective than omeprazole.
Both drugs have almost the same structured indications; however omeprazole is label indicated for initially treatment of Zollinger-Ellison Syndrome while lansoprazole is not.
Omeprazole has a higher potential to cause allergic reactions compared to lansoprazole. For either drug, patients should warn their doctors if they have a history of liver disease. Potential lansoprazole users need to tell their healthcare providers of any previous medical history that includes sweating, lightheadedness or dizziness along with the heartburn; chest pain or shoulder pain; pain that spreads to the arms, neck, or shoulders; shortness of breath or wheezing; unexplained weight loss; nausea or vomiting. Also both drugs may cause withdrawal symptoms if they are taken for a long time. Patients who stop taking either omeprazole or lansoprazole may experience the return of regular heartburn but also the other symptoms of the original illness. Ending use of either of these drugs may cause acid reflux.
Lansoprazole is classified in the category B by the FDA pregnancy list of drugs while pantoprazole is in category C. This means that, omeprazole is not safe during pregnancy, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Lansoprazole should only be used during pregnancy if benefits outweigh risks.
30-count package of 15mg Prevacid capsules cost about $38 at most pharmacies, while a similar supply of 20 mg Prilosec capsules cost about $10. Both are one-month supplies. The drugs may be found more cheaply online in some cases.
Omeprazole vs Esomeprazole
Both drugs belong to the same class of medications known as proton pump inhibitors and have similar mechanism of action, however there are some differences. Omeprazole is a pro-drug which is converted in the gastric parietal cells to the active drug compared to Esomeprazole which is the active drug. Studies showed that esomeprazole is more potent than Omeprazole because omeprazole is a racemic mixture and esomeprazole may give the same degree of acid suppression with lower doses in comparison to omeprazole. Esomeprazole has higher bioavailability of Omeprazole ranging from 30-76% while Esomeprazole ranges from 50 – 90 %. Approximately 95% of Omeprazole is bound to blood plasma compared to 97% in case of Esomeprazole. Both medications are prescribed for same indications, but omeprazole can be used for both adults and children, while esomeprazole is only prescribed for adult patients.
One study conducted by NIH showed that esomeprazole was more beneficial and safer for patients with gastroesophageal reflux disease (GERD). Esomeprazole was also superior to omeprazole for all secondary measures and had a similar safety profile. Esomeprazole in doses of 40 mg was more effective in controlling acid production in GERD patients than twice the dose of omeprazole.
Both esomeprazole and omeprazole have similar side effects profiles. Common side effects include diarrhea, nausea, gas, headache and abdominal pain. In addition, esomeprazole can also cause dry mouth, constipation and drowsiness. Omeprazole can cause vomiting in higher rates. In children, esomeprazole can cause headache, diarrhea, abdominal pain, nausea. Omeprazole, in addition may also cause respiratory problems and fever.
Esomeprazole (Nexium) is a prescription drug and has no generic equivalent available. Prilosec costs much less, and it can be bought as OTC in generic form.