Key takeaways:
Proton pump inhibitors (PPIs) are medications that decrease the amount of acid in your stomach. They’re available as over-the-counter (OTC) and prescription products. Omeprazole (Prilosec) is a common example.
There are slight differences between the various PPIs available. Examples include how long they work, when you should take them, and interactions.
If you’re treating heartburn, an OTC PPI can provide short-term relief. But if your symptoms are more frequent, you may need to take a prescription PPI for a longer period of time. Your healthcare provider can determine which PPI is right for you.
Acid reflux can be annoying and painful. Over-the-counter (OTC) products like calcium carbonate (Tums) or famotidine (Pepcid AC) can be convenient options for fast relief. But if they aren’t doing the trick, you may turn to a proton pump inhibitor (PPI).
Omeprazole (Prilosec) and esomeprazole (Nexium) are a couple PPIs you may have seen on pharmacy shelves. But there are several other PPIs available — including a few that require a prescription. So, what exactly is a proton pump inhibitor, and which one is best for you?
PPIs are a group of medications that work by lowering the amount of acid released in your stomach. Examples of PPIs are:
Omeprazole
Esomeprazole
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Dexlansoprazole (Dexilant)
Omeprazole, lansoprazole, and esomeprazole are available OTC in certain doses. Some dose amounts still require a prescription. Pantoprazole, rabeprazole, and dexlansoprazole require a prescription from your healthcare provider no matter the dose.
PPI medications aren’t all approved to treat the same health conditions. So, there might be slight differences between them. But generally speaking, PPIs can be used for:
Gastroesophageal reflux disease (GERD)
Peptic ulcer disease
Preventing ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs)
Conditions caused by excess stomach acid (e.g. Zollinger-Ellison syndrome)
Heartburn
Helicobacter pylori infection
Inflammation of the esophagus
Keep in mind: The OTC and prescription versions of a PPI might be used for different health conditions. For example, OTC omeprazole is only approved for the short-term treatment of frequent heartburn. Prescription omeprazole can be used to treat many of the conditions listed above.
Yes, you can take PPIs for GERD. But you shouldn’t take OTC versions of PPIs for GERD unless instructed by your healthcare provider.
As mentioned above, OTC PPIs should only be used for frequent heartburn. And you should only take them for up to 14 days at a time. If you’re needing to take a 14-day course more often than every 4 months, contact your healthcare provider. This is also the case if a PPI isn’t providing relief. Prescription PPIs are generally used for longer periods of time.
PPIs work by lowering the amount of acid released in your stomach. They do this by blocking enzymes (proteins) in the cells of the stomach lining. These enzymes are responsible for allowing acid to be secreted into the stomach. This results in lower stomach acid, which can help with acid reflux symptoms.
Some acid-blocking medications can be taken as needed for heartburn. But this isn’t the case for PPIs. Because of how they work, you’ll need to take one regularly for a few days to get the most benefit.
PPIs are usually well-tolerated, especially when taken for short-term relief. But you may experience some side effects during treatment. These can vary depending on which PPI you’re taking and for how long you’re taking it.
Examples of potential PPI side effects include:
Headache
Stomach pain
Nausea
Diarrhea
Constipation
Gas
Dizziness
Long-term PPI use has been linked to some serious side effects. Some of these include:
Increased risk of fractures (bone breaks)
Increased risk of gut and respiratory infections
Dementia
Kidney damage
Vitamin and mineral deficiencies (like magnesium and vitamin B12)
More research is needed to confirm potential risks of taking PPIs for longer periods of time. Talk to your healthcare provider to make sure you’re taking the lowest effective dose for the shortest period of time your condition.
All PPIs work the same way in your body to lower acid secretion into the stomach. But there are slight differences among them you may want to consider.
Is there a PPI that works best for acid reflux? Not really. Evidence suggests there aren’t huge differences between PPIs when it comes to symptom relief. However, there may be some differences in how long they suppress acid in your stomach (how long they work for).
An analysis of four studies looked at esomeprazole compared to several other PPIs. Researchers found that esomeprazole maintained a higher pH (lower amount of acid) in the stomach for the longest period of time.
Dexlansoprazole wasn’t included in the analysis mentioned above. But it’s the only PPI with a dual delayed-release design. In other words, the medication is released at two different points along your gut, several hours apart. This is thought to help it suppress acid release for a longer amount of time.
Some PPIs should be taken on an empty stomach. But others can be taken without regard to food. These differences are summarized in the table below. Keep in mind you should take your PPI as directed by your healthcare provider.
Medication | When to take it |
---|---|
Dexlansoprazole | Any time of day, without regard to meals |
Pantoprazole | Any time of day, without regard to meals (tablets) or 30 minutes before a meal (oral suspension) |
Omeprazole | First thing in the morning on an empty stomach |
Lansoprazole | First thing in the morning on an empty stomach |
Esomeprazole | 1 hour before a meal |
Rabeprazole | Depends on what you’re treating; follow your healthcare provider’s instructions |
Most PPIs come as tablets or capsules. But some are available in other dosage forms. These options can be helpful if you have trouble swallowing pills.
Liquid options: Omeprazole, esomeprazole, and pantoprazole are available as powder packets that are mixed with water.
Dissolvable tablets: Omeprazole and lansoprazole come as orally disintegrating tablets (ODTs). ODTs are tablets that dissolve on your tongue.
Sprinkle capsules: Some PPI capsules can be opened and their contents sprinkled onto a small spoonful of applesauce. Your pharmacist or healthcare provider can tell you if this is an option for your medication.
Drug interactions can vary across PPIs. So, it’s important to make sure your PPI won’t interact with other medications you’re taking.
Some medications require stomach acid to be present in order to be absorbed by your body. Examples include certain HIV and transplant medications. In this case, PPIs may interact and impact their effectiveness.
Certain PPIs can interfere with how other medications are broken down in your body. In this case, omeprazole tends to have more interactions than other PPIs. Pantoprazole is thought to have the least amount of interactions.
Share your current medication list with your healthcare provider and pharmacist before starting a PPI. They can identify and manage potential interactions ahead of time.
All of the PPIs discussed here are available as lower-cost generics. Omeprazole, lansoprazole, and esomeprazole are also available OTC.
There are many ways to save on your PPI medication. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find PPI medications as low as $7 with a free GoodRx discount.
PPIs are medications that decrease the amount of acid released into your stomach. Some PPIs are available as OTC and prescription products. But a few require a prescription from your healthcare provider.
PPIs are thought to work similarly well for acid reflux symptoms. So, the best PPI for you can depend on a few factors. What you’re treating, convenience, and drug interactions are a few things to consider. Depending on your needs, your healthcare provider will be able to help you decide on the best PPI for you.
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