What to Know About 6 Popular Proton Pump Inhibitors
Key takeaways:
Proton pump inhibitors, like omeprazole (Prilosec), treat heartburn, gastroesophageal reflux disease, and other health conditions caused by too much stomach acid.
There are many options when choosing a PPI. They work the same way and have similar side effects. But they differ on what formulations they come in and how they’re dosed.
There are ways to save on your PPI medications. Many options are available as lower-cost generics or have copay savings opportunities. GoodRx can help make your prescription more affordable.
Access savings on related medications
Table of contents
Many of us have eaten a spicy meal or drank a cup of coffee only for it to be followed by that dreaded burning sensation in the chest. This symptom of heartburn is a classic sign of acid reflux. And it can strike at any age. When acid reflux won’t go away or feels more severe, it’s called gastroesophageal reflux disease (GERD). Other symptoms of GERD include nausea, difficulty swallowing, or burping.
GERD is a common health condition that can be treated with lifestyle changes and medications. While antacids, like Tums, and H2 blockers, like famotidine (Pepcid AC), help treat infrequent symptoms, proton pump inhibitors (PPIs) are used for more serious or frequent episodes. PPIs reduce the amount of acid in your gut by blocking a specific enzyme (protein) in your stomach lining. They’re usually taken once daily and take 1 to 4 days to fully kick in.
There are several different types of PPIs. Their names sound similar, they work similarly, and have comparable side effects. But still, there are differences, too. Here, we’ll review the six available PPIs.
1. Omeprazole
Omeprazole (Prilosec) is one of the most common medications in the U.S. It’s available both as a prescription and over-the-counter (OTC) medication. It comes as delayed-release (DR) capsules, regular tablets, orally disintegrating tablets (ODT), and granule packets that are mixed with a liquid.
Omeprazole is FDA approved for the following medical conditions in adults:
Heartburn (OTC only)
GERD
Erosive esophagitis (inflammation of the esophagus)
Stomach and active duodenal (small intestine) ulcers
Prevention of ulcers caused by Helicobacter pylori (H. pylori)
Other conditions caused by extra stomach acid, such as Zollinger-Ellison syndrome
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Omeprazole can also treat GERD and erosive esophagitis (inflammation of the esophagus) that’s caused by GERD in children ages 2 years and older.
Omeprazole’s dosage for GERD is generally 20 mg once daily. It’s meant to be taken at least 30 minutes before the first meal of the day. It works best when you take it every day as opposed to taking it only when you feel symptoms. Your dosage may vary depending on the situation, but doses higher than 20 mg are only available with a prescription.
How to save: Omeprazole is available as both a brand-name and generic medication. Prescription omeprazole's price at certain pharmacies is as low as $5.88 with a free GoodRx discount.
OTC omeprazole's price at certain pharmacies is as low as $6.38 with a free GoodRx discount. Check out our article on how to use a GoodRx coupon for OTC products.
2. Esomeprazole
Esomeprazole (Nexium) is a cousin of omeprazole. It has a similar chemical makeup, and it’s also approved for the same uses. What’s more, it’s available both OTC and by prescription in a DR formulation. Esomeprazole’s dosage for GERD is generally 20 mg once daily taken at least 30 minutes before the first meal of the day.
Esomeprazole comes in capsules, tablets, and granule packets that are mixed with a liquid. Unlike omeprazole, it’s also available as an injection, which is used by healthcare providers in the hospital setting.
How to save: Esomeprazole is available as both a brand-name and generic medication. Prescription esomeprazole's price at certain pharmacies is as low as $10.20 with a free GoodRx discount. A manufacturer savings card is also available.
OTC Nexium’s price at certain pharmacies is as low as $28.93 with a free GoodRx discount.
3. Pantoprazole
Pantoprazole (Protonix) is a PPI that’s available by prescription only. It comes in DR tablets or granule packets that are mixed with a liquid. Similar to esomeprazole, an injectable form for hospital use is also available.
In adults, pantoprazole is approved to treat GERD, erosive esophagitis, and Zollinger-Ellison syndrome. It can also treat GERD in children ages 5 years and older. Unlike omeprazole and esomeprazole, it’s not approved to treat ulcers or prevent ulcers from H. pylori.
The dose for pantoprazole is generally 40 mg once daily at least 30 minutes before the first meal. However, dosages vary for children who weigh less than 40 kg (88 lbs).
How to save: Protonix is available as both a brand-name and generic medication. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Protonix at an exclusive cash price of $200.10. You may also pay as little as $8.38 for a 30-day supply of generic pantoprazole with a free GoodRx coupon.
4. Lansoprazole
Lansoprazole (Prevacid) is approved to treat the same medical conditions as omeprazole and esomeprazole, plus a few others. It can prevent and treat nonsteroidal anti-inflammatory drug (NSAID)-associated stomach ulcers in adults. It can also treat GERD and erosive esophagitis in kids ages 1 year and older.
Lansoprazole comes in a DR formulation as a capsule or ODT. It’s available by prescription and OTC. The lansoprazole dosage for GERD is generally 15 mg once daily taken at least 30 minutes before your first meal.
How to save: Lansoprazole is available as both a brand-name and generic medication. Prescription lansoprazole's price at certain pharmacies is as low as $11.60 with a free GoodRx discount. A manufacturer savings card is also available.
OTC lansoprazole's price at certain pharmacies is as low as $12.00 with a free GoodRx discount.
5. Dexlansoprazole
Dexlansoprazole (Dexilant) is only available by prescription, like pantoprazole. It’s a cousin of lansoprazole with a related chemical structure. It’s available as a DR capsule and is approved for adults and adolescents 12 years and older for GERD and erosive esophagitis.
Dexlansoprazole’s dosage is generally 30 mg once daily when treating GERD. A benefit to taking dexlansoprazole is that it can be taken any time of the day without regard to food.
How to save: Dexlansoprazole is available as both a brand-name and generic medication. Dexlansoprazole's price at certain pharmacies is as low as $88.71 with a free GoodRx discount. A patient assistance program is also available.
6. Rabeprazole
Rabeprazole (AcipHex) is another PPI that’s available with a prescription. However, only one formulation is available. It comes as a 20 mg DR tablet that’s taken once daily.
Rabeprazole is approved for the same conditions as omeprazole, but younger kids shouldn’t take it. The minimum age for GERD treatment is 12 years old.
Another difference is that the first dose of rabeprazole could potentially have a bigger effect compared to the first dose of omeprazole. This is because rabeprazole is thought to work slightly faster than omeprazole at blocking acid production.
How to save: Rabeprazole is available as both a brand-name and generic medication. Rabeprazole's price at certain pharmacies is as low as $14.40 with a free GoodRx discount. A manufacturer copay card is also available.
What are the common side effects of PPIs?
PPIs typically don’t usually have noticeable day-to-day side effects. Some mild effects with short-term use are possible, but they generally improve over time. They include:
Headache
Nausea
Stomach pain
Diarrhea
Constipation
More serious PPI side effects could also happen. These are more likely to happen with long-term use, but they’re rare. These include:
Higher risk of infection, like pneumonia or Clostridium difficile (C. diff)
Keep in mind: The direct link between these long-term side effects and PPI use is a debated topic. It’s important to be cautious and discuss how long you should take a PPI with your healthcare provider. You should always use PPIs for the shortest amount of time possible.
How do I know which PPI is right for me?
It depends. Experts don’t recommend one PPI over another for GERD. Research has shown there isn’t much difference among the PPIs in terms of how well they work. Some research has found esomeprazole 40 mg to be more effective for treating GERD as a short-term treatment, but this is not a strong recommendation. Using the right dose of whichever PPI you’re taking may be a more important factor. It’s also important to consider cost and insurance coverage as well as your health background.
Drug interactions can also play a role. For example, omeprazole and esomeprazole may be most likely to interact with clopidogrel (Plavix). This is a commonly used blood thinner. And in general, omeprazole, esomeprazole, and lansoprazole have more drug-drug interactions than pantoprazole and rabeprazole do.
The bottom line
Common PPIs include omeprazole, esomeprazole, and pantoprazole. Three others are also available. They treat GERD and other stomach-acid related medical conditions. All PPIs work similarly to one other, but they differ on how they’re formulated and what’s available OTC or by prescription.
Regardless of which PPI you take, it’s important to use it for the shortest amount of time possible. Talk to your healthcare provider about the best PPI for you.
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References
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