Pantoprazole: worthy among the strongest. Comparative effectiveness of the antisecretory effects of rabeprazole and esomeprazole in individuals who rapidly metabolize proton pump inhibitors

20.01.2017

Gastroesophageal reflux disease (GERD) is the most common acid-related disease, and its incidence continues to increase worldwide (G. R. Lockeet al., 1997; S. Bor et al., 2005). The key goal of GERD management is to maintain intragastric pH >4. Proton pump inhibitors (PPIs) are most effective in the treatment of reflux esophagitis (J. Dent et al., 1999; P. O. Katzet al., 2013).

One of the most widely used and sensitive methods for assessing acid suppressive effects is 24-hour monitoring of intragastric pH (S. Shi, U. Klotz, 2008). At the same time, the main parameters characterizing the effectiveness of PPIs are considered to be the average pH value over 24 hours, the average time (in percentage terms) pH >4 and the rate of onset of an adequate acid-suppressive effect after taking the first dose (N. J. Bellet al., 1992 ).

Cytochrome P450 2C19 (CYP2C19) genotypes and Helicobacter pylori (H. pylori) infection may have a significant impact on the ability of PPIs to reduce gastric acidity. In patients with low activity of CYP2C19, the so-called slow metabolizers, the acid-lowering effect of PPIs is more pronounced compared with that in patients with high activity of this enzyme, that is, “rapid metabolizers” (E. J. Dickson, R. C. Stuart, 2003) . The frequency of the CYP2C19 genotype with high CYP2C19 activity in different populations can reach 20% (Z. Desta et al., 2002; A. Celebi et al., 2009).
Given the significance of the problem, in recent years a number of studies have been conducted on the comparative assessment of the effect of various PPIs on intragastric pH; however, most of these studies compared only two drugs.
The aim of this study was to evaluate the effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg and pantoprazole 40 mg on intragastric pH >4 and 24-hour pH in patients with GERD who are “extensive metabolizers” according to the CYP2C19 genotype and negative for H. pylori.

Materials and methods
The study included H. pylori-negative patients aged ≥18 years with GERD accompanied by heartburn and/or regurgitation observed at least once a week in the last 6 months. Exclusion criteria: gastric sphincter obstruction, hiatal hernia >2 cm, active peptic ulcer, cancer of the upper gastrointestinal tract, history of gastrointestinal surgery, motility disorders (systemic sclerosis, achalasia, etc.), atrophic gastritis, so-called alarm symptoms in regarding malignant neoplasms (hematemesis, dysphagia, odynophagia, melena), pregnancy or lactation.
Before starting treatment, all patients underwent a complete physical examination, esophagogastroduodenoscopy, a urea breath test to exclude H. pylori infection, and determination of the CYP2C19 mutation status. The study included patients with the “wild” (non-mutated) genotype of CYP2C19; patients with homo- or heterozygous CYP2C19 mutations were excluded from participation.
2 weeks before the start of the study, it was not allowed to take PPIs, histamine H2 receptor antagonists, prokinetics and antispasmodics. To control symptoms, patients could use antacids until the day before starting therapy.
Patients were randomized into 4 groups to receive esomeprazole 40 mg (enteric-coated tablet), rabeprazole 20 mg (enteric-coated tablet), lansoprazole 30 mg (micropellet capsule) or pantoprazole 40 mg (enteric-coated tablet) once daily. 30 minutes before standard breakfast.
24-hour pH measurements of the esophagus and stomach were performed using an Orion pH meter and two electrodes placed intranasally 5 cm above and 10 cm below the lower esophageal sphincter.
During the 6 days of the study, all meals were standardized; breakfast, lunch and dinner were served at 9:30, 13:00 and 19:00 respectively. Patients were not allowed to drink alcohol or acidic or alkaline drinks.

Results
The study included 56 patients - 14 patients in each group. Seven subjects were excluded due to protocol deviation, leaving a total of 49 patients in the final analysis.
The groups did not differ statistically in baseline clinical and demographic characteristics (Table). Before treatment, the time of 24-hour intragastric pH >4 for esomeprazole, rabeprazole, lansoprazole and pantoprazole averaged 2.4% (95% confidence interval 0.3-14.3), 7.4% (0.9-11 ,3), 2.8% (0.4-15.5) and 6.4% (0.7-14.9), respectively, without significant differences between groups (p>0.05). On the 1st day of treatment, the corresponding figures were 56% (21-87), 58% (31-83), 57% (33-91) and 27% (5-77), on the 5th day – 68% ( 36-90), 63% (22-82), 65% (35-99) and 61% (35-98). Regarding the time indicator of intragastric pH >4, esomeprazole, rabeprazole and lansoprazole on day 1 were statistically significantly superior to pantoprazole, but on day 5 the difference between the groups was leveled out.
Mean 24-hour intragastric pH for esomeprazole, rabeprazole, lansoprazole and pantoprazole on day 1 was 4.2 (1.4-5.9), 4.4 (2.0-5.1), 4.1 ( 2.7-5.2) and 2.1 (1.0-6.0), on the 5th day – 4.5 (2.5-6.2), 4.6 (2.2-5 .5), 4.4 (2.8-6.0) and 4.4 (2.3-5.6), respectively. For this indicator, esomeprazole, rabeprazole and lansoprazole were significantly better than pantoprazole on day 1.
The time required to achieve intragastric pH >4 after the first dose was 3, 4 and 6 hours for esomeprazole, lansoprazole and rabeprazole, respectively. In the pantoprazole group, the pH reached 3 2 hours after administration, but then did not change until the 6th hour.
The mean intragastric pH for esomeprazole, rabeprazole, lansoprazole and pantoprazole 3 hours after the first dose was 4±0.5; 2.6±0.6; 3±0.5 and 2.9±0.7; after 4 hours – 4.1±0.6; 3.2±0.5; 4±0.5 and 2.9±0.6; after 6 hours – 4.8±0.6; 4±0.5; 4.3±0.7 and 3.2±0.7, respectively. Esomeprazole was statistically significantly superior to rabeprazole, lansoprazole and pantoprazole at 3 hours (p<0,05), а также пантопразол через 4 и 6 ч после приема (р<0,05).
Regarding the time required to reach pH >4 after the first dose, esomeprazole showed the fastest effect, followed in order of increasing time by lansoprazole, rabeprazole and pantoprazole. The hourly pH values ​​achieved in the 4 treatment groups are presented in the figure.

Discussion
The results of the study showed that in patients with GERD, not infected with H. pylori and belonging to the type of so-called rapid metabolizers, in terms of intragastric pH >4 on the 1st day of treatment, esomeprazole, rabeprazole and lansoprazole are significantly superior to pantoprazole, while esomeprazole turned out to be better than all other PPIs in terms of the rate of onset of adequate acid suppression. These data are generally consistent with observations obtained in other studies.
Thus, scientists from Sweden compared esomeprazole 40 mg with lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg and rabeprazole 20 mg. Esomeprazole was superior to all other PPIs in terms of mean time of intragastric pH >4 on days 1 and 5 of treatment (K. Rohss et al., 2004)
In a study by K. Miner et al. (2003) in H. pylori-negative patients with GERD, esomeprazole 40 mg/day on the 5th day of therapy for intragastric pH was statistically significantly better than lansoprazole 30 mg/day, pantoprazole 40 mg/day, rabeprazole 20 mg/day and omeprazole 20 mg/day
N. G. Hunfeld et al. (2012) found that esomeprazole 40 mg provides better efficacy and a faster acid suppressive effect compared to rabeprazole 20 mg.
Based on in vitro studies, the slower onset of action of pantoprazole compared to that of other PPIs may be due to two factors: the lower pKa1 and pKa2 values ​​of pantoprazole and its preferential metabolism by CYP2C19.

Conclusions
The present study demonstrated that in non-H. pylori-infected patients with GERD who are “rapid metabolizers,” pantoprazole is a less potent PPI than esomeprazole, lansoprazole, and rabeprazole on day 1 of treatment. On the 5th day of therapy, this difference disappears. In terms of the time required to increase intragastric pH >4 after the first dose, esomeprazole has the fastest effect, followed by lansoprazole and rabeprazole.
The results obtained may have practical significance when choosing PPIs prescribed on an “on demand” basis for the treatment of patients with GERD.

The article is published in abbreviation.
The list of references is in the editorial office.

Celebi A., Aydin D., Kocaman O. et al. Comparison of the effects
of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg,
and pantoprazole 40 mg on intragastric pH in extensive metabolizer patients with gastroesophageal reflux disease. Turk J Gastroenterol 2016; 27: 408-414.

Translated from English Alexey Tereshchenko

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Sometimes there is inaccurate information on this issue on the Internet, so let’s take a closer look.

Omeprazole And rabeprazole refer to proton pump inhibitors(IPP). Synonym - proton pump blockers. These are drugs that suppress the secretion of hydrochloric acid (HCl) in the stomach, so they are classified as antisecretory agents and are used to treat high acidity of the stomach. Proton pump inhibitors (proton pump blockers) reduce secretion hydrogen ions(H +, or proton) parietal cells of the stomach. The mechanism of secretion is the entry of extracellular potassium ion (K +) into the cell in exchange for the release of hydrogen ion (H +) to the outside.

Classification and characteristics

Currently applied 3 groups drugs that reduce stomach acidity:

1. proton pump inhibitors- are the most powerful antisecretory agents that suppress the formation of hydrochloric acid in the stomach. Taken 1-2 times a day;
2. H 2 blockers(read “ash-two”) - have low antisecretory effectiveness and therefore can be prescribed only in mild cases. Taken 2 times a day. Block histamine (H 2 -) receptors of parietal cells of the gastric mucosa. H2 blockers include ranitidine And famotidine.

   For reference: H 1-blockers are used against allergies ( loratadine, diphenhydramine, cetirizine etc.).

3. antacids(translated as " against acid") - products based on magnesium or aluminum compounds that quickly neutralize (bind) hydrochloric acid in the stomach. This includes almagel, phosphalugel, maalox etc. They act quickly, but for a short time (within 1 hour), so they have to be taken often - 1.5-2 hours after meals and before bedtime. Although antacids reduce acidity in the stomach, they simultaneously increase the secretion of hydrochloric acid by the mechanism negative feedback, because the body tries to return the pH (acidity level, can be from 0 to 14; below 7 is an acidic environment, above 7 is alkaline, exactly 7 is neutral) to its previous values ​​(normal pH in the stomach is 1.5-2).

TO proton pump inhibitors include:

• (trade names - Omez, Losek, Ultop);
• (trade names - Nexium, Emanera);
• lansoprazole(trade names - lancid, lanzoptol);
• pantoprazole(trade names - nolpaza, controlok, sanpraz);
• rabeprazole(trade names - Pariet, Noflux, Ontime, Zulbex, Khairabezol).

Price comparison

Omeprazole costs several times less than rabeprazole.

The price of generics (analogues) of 20 mg 30 capsules in Moscow as of February 14, 2015 ranges from 30 to 200 rubles. For a month of treatment you need 2 packs.

Price of the original drug Pariet (rabeprazole) 20 mg 28 tablets. - 3600 rub. For a month of treatment you need 1 package.
(analogues) of rabeprazole are much cheaper:

• Ontime 20 mg 20 tab. - 1100 rub.
• Zulbex 20 mg 28 tab. - 1200 rub.
• Khairabesol 20 mg 15 tab. - 550 rub.

Thus, cost of treatment per month is about 200 rubles (40 mg/day), rabeprazole when using chairabezola- about 1150 rub. (20 mg/day).

Differences between omeprazole and esomeprazole

Represents an S-stereoisomer (levorotatory optical isomer ), which differs from the dextrorotatory isomer in the same way that a left and right hand or a left and right shoe differ. It turned out that the R-form much more strongly (than the S-form) is destroyed when passing through the liver and therefore does not reach the parietal cells of the stomach. Omeprazole is a mixture of these two stereoisomers.

According to the literature, has serious advantages compared to , however it costs more. taken in the same dosage as .

Price trade names is:

• Nexium 40 mg 28 tab. - 3000 rub.
• Emanera 20 mg 28 tab. - 500 rub. (you need 2 packs per month).

Benefits of rabeprazole compared to other PPIs

1. Effect rabeprazole begins within 1 hour after administration and lasts 24 hours. The drug acts in a wider pH range (0.8-4.9).
2. Dosage rabeprazole is 2 times lower compared to omeprazole, which provides better tolerability of the drug and fewer side effects. For example, in one study side effects ( headache, dizziness, diarrhea, nausea, skin rashes) were noted in 2% during treatment rabeprazole and at 15% during treatment .
3. Admission rabeprazole into the blood from the intestines (bioavailability) does not depend on the time of food intake.
4. Rabeprazole more reliable suppresses the secretion of hydrochloric acid because its destruction in the liver does not depend on the genetic diversity of variants of the cytochrome P450 enzyme. This makes it possible to better predict the effect of the drug in different patients. Rabeprazole has less effect than other drugs on the metabolism (destruction) of other drugs.
5. After stopping treatment rabeprazole there is no rebound syndrome(cancellations), i.e. There is no compensatory sharp increase in the level of acidity in the stomach. The secretion of hydrochloric acid is restored slowly (within 5-7 days).

Indications for taking proton pump inhibitors

• gastroesophageal reflux disease (reflux of acidic stomach contents into the esophagus),
• pathological hypersecretion of hydrochloric acid (including Zollinger-Ellison syndrome),
• in complex treatment it is used to eradicate (eliminate) Helicobacter pylori infection, which causes ulcers and chronic gastritis.

Note. All proton pump inhibitors are destroyed in an acidic environment, therefore are available in the form of capsules or enteric tablets, which swallowed whole(cannot be chewed).

Conclusions

Briefly: rabeprazole ≅ esomeprazole > omeprazole, lansoprazole, pantoprazole.

Details: rabeprazole has a number of advantages compared to other proton pump inhibitors and is comparable in effectiveness only to , however treatment rabeprazole costs 5 times more than and slightly more expensive compared to .

According to the literature, the effectiveness of Helicobacter pylori eradication does not depend on the choice of a specific proton pump inhibitor (any one can be used), while in the treatment gastroesophageal reflux disease most authors recommend it rabeprazole.

Analogy with antihypertensive drugs

Among proton pump inhibitors There are 3 drugs:

• (basic drug with side effects),
• (an improved drug based on the S-stereoisomer of omeprazole),
• rabeprazole(the safest).

Similar ratios exist among those used to treat arterial hypertension:

• amlodipine(with side effects)
• levamlodipine(an improved drug based on the S-stereoisomer with minimal side effects),
• lercanidipine(the most secure).

Read also:

7 comments to the article “Which is better - omeprazole or rabeprazole? Benefits of rabeprazole"

Benefits of Hairabezol:
Khairabezol is recommended for CHILDREN from 12 years old!!!
The shelf life of Khairabezol is 3 years.
Unique Braille packaging.
Taking Khairabezol does not depend on food intake

My story is this: the doctor prescribed Ultop to me. After a single use there were serious side effects: severe headache; blushed and began to see poorly in one eye; palpitations and fever. I told the doctor about this, but she doesn’t believe me - she says there can’t be such consequences from the ultop and prescribed Omez-insta. I come home and decide to read it, but it turns out to be the same Ultop, only under a different name!

In general, thanks to you, I have become enlightened and will look for a normal substitute without terrible side effects. I wish I could find a good gastroenterologist now...(((

1. 4 years ago I treated gastritis with Ultop, apparently it did not help, because gastric erosion was discovered this year. Zulbex was prescribed. with 2 tablets I almost went to the next world: an hour after taking the drug on the first day, my throat hurt and a cough began, I lost my appetite, in the morning on the second day there was a pain in the lower abdomen, like cystitis. I decided to take another pill. again, an hour after taking it, the temperature rose sharply to 38.5, my lower back ached, my head couldn’t think of anything at all, there was aches all over my body, everything was rumbling inside. I read in the side effects later that zulbex quite often causes influenza-like illnesses and infections of the genitourinary system. and this is still the safest drug, you want to say??? This didn’t happen with Ultop, the maximum was dry mouth and loss of appetite. By the way, perhaps the dosage of 20 mg is too high for me, because... my weight is 39 kg

   Unfortunately, Zulbex (rabeprazole), despite its advantages, is not as safe as it initially seemed. On the other hand, Ultop (omeprazole) is also capable of causing general fatigue, general weakness, weight gain, and fever. These effects are described in the instructions for the drug. As for the dosage, 10 or 20 mg of rabeprazole per day is usually used (no more than 20 mg). This means that rabeprazole is not suitable for you, you need to return to omeprazole or try esomeprazole.

2. Thanks for your comment. I read them, but the doctor prescribed them for me, and said that the drug was well tolerated and that it helped very well. Can you tell me how long it takes for it to be completely eliminated from the body? Today I didn’t take the pills anymore, but the temperature is still around 37.3, the lower back pain has gone, my throat hurts less, there is no such weakness anymore, my appetite has returned. I last took the drug a day ago. I remembered about the ultratop that it caused my hair to fall out a lot (this is also stated in the instructions).

   Rabeprazole itself is eliminated from the body quite quickly, after a day only traces remain, but the effect of the drug lasts about a day. Most likely, in 4-5 days the side effects will completely disappear. As a replacement, you can either try esomeprazole, or switch to H2 blockers, but they block the secretion of hydrochloric acid much weaker.

3. Hello! I read Zhanna’s review and was a little happy:) in the spring I had erosive gastritis, they prescribed pariet - it caused severe weakness, they replaced it with Nolpaza - I got very sick in the solar plexus area and blurred vision. Replaced the droppers with Nexium. At first there was a feeling of cold and shock, then a feeling that sand was coming from the kidneys, on the 2nd day my throat hurt and the temperature was 37, then for a couple of days it still rose, ulcers on the roof of my mouth. I found this in my notes - they asked me to bring such a diary.

   Gradually, the side effects went away, the drug was discontinued, but I followed the diet all summer, as a small error caused a burning sensation in the area of ​​​​the left shoulder blade. A week ago, a burning sensation began again, often in the shoulder blade, against the background of 1 night casting (apparently provoked by sports on an empty stomach). Then my right side hurt very badly and weakness began. I tried to help Seth with Iberogast and Chinese teas, but I had to resort to medications. I started taking Nexium yesterday - by the evening I felt body aches and weakness. Today I have no strength all day, terrible weakness, I can barely walk. My throat hurt again and my temperature rose to 37-37.5. At first I thought that I was sick, but there were no other signs of illness and rinsing did not help. In the spring, it seemed to me that there weren’t so many side effects, or at least there wasn’t such severe weakness. What drug can be replaced with? What can you say about famotidine? About its side effects?

   Pariet (rabeprazole), Nolpaza (pantoprazole), Nexium (esomeprazole) belong to the group of proton pump blockers and can cause similar side effects: fever and flu-like syndrome. H2 blockers (famotidine, ranitidine, roxatidine, nizatidine) are less likely to cause fever, so you should try them. They have other side effects, but there is a chance that you will not have any or only to a small extent. For specific side effects by drug, see the website. rlsnet.ru Try first those H2-blockers that suit your price. In general, H2 blockers are weaker than proton pump blockers. Just don’t use cimetidine, it is an outdated drug with a large number of adverse reactions.

4. Which analogue of rabeprozole (Pariet, Noflux, Ontime, Zulbex, Khairabezol) is the safest?

   In theory, all analogues should be equivalent. The branded drug (the reference drug, the first to enter the market) is Pariet. In general, it is believed that the best medicines are from European, American and Israeli manufacturers. But keep in mind that fakes are sometimes sold in Russia. Therefore, you can use any analogue (generic) if it helps you and does not cause side effects.

5. I have been sick since 1994. I have a fixed catarrhal hernia of the esophageal opening of the diaphragm, catarrhal reflux esophagitis, erosion of the antrum of the stomach, superficial gastroduodenitis. Previously, there was a stomach ulcer and a scar was found in the duodenum. Regularly received treatment at the place of residence. In particular, I constantly (almost every day) took Omeprazole, which helped only slightly and for a short time (sometimes I had to take several tablets at a time to relieve severe heartburn). Heartburn almost never stops. Around the same time, I developed vasomotor rhinitis. It became impossible to breathe. I spray hormonal sprays as prescribed. Almost no help. Over the past 4-5 years I have gained a lot of weight (from size 46 to size 56-58). Soon there will be nothing left of the hair. Over the past two years, she began to feel short of breath. I had an attack of suffocation such that I was blue-violet. For some reason, the therapist prescribed a penicillin-containing antibiotic, to which I always have a terrible allergic reaction like angioedema (I warned you). For a long time I treated my allergies with tablets and droppers with hormonal drugs (in a hospital). Over the past year, I began to feel more and more out of breath. Hemoglobin dropped to 88, protein to 72-73. Now I am being treated by a hematologist: moderate anemia, anemic heart. (I am forced to take sorbifer. The hematologist categorically forbade Maltofer, it does not cure). The gastroenterologist has now prescribed Pariet. I really doubted the need to take such an expensive drug. But I read the information on your website about the effectiveness of the drugs and the complications from them, and I realized that perhaps only he could help me. And all the complications in the form of severe shortness of breath, bronchospasms, weight gain, hair loss, blurred vision (I began to see poorly both with and without glasses), I became very weak and much more, you can’t describe everything, from Omeprazole. I didn’t even imagine that Omeprazole could do more harm than good and be simply dangerous to health; it seemed so reliable to me and, importantly, cheap.

   Will I ever be able to breathe normally now, will my vision be restored, will my weight return to normal,...? (Allergy tests are negative, I can’t get a referral to a pulmonologist). Can anyone give me a professional answer or advice on how to deal with this?

   Rabeprazole and omeprazole are from the same group, so their side effects are similar. Don't expect radical improvement.

   Asthma and vasomotor rhinitis are most likely associated with the reflux of acid from the esophagus into the bronchi. This is a typical complication.

   It is not entirely clear why omeprazole does not help. To check, you should do a daily pH measurement.

   However, I am sure that omeprazole works, and the real cause of your problems is a hiatal hernia. The only option to eliminate it (and then life will most likely begin to improve) is surgery. Your situation is somewhat advanced, so you will need preparation before the operation (increase hemoglobin, etc.). However, it is necessary to have surgery, because it will get even worse.

Nowadays, it is not often possible to meet a completely healthy person. Most often, due to poor nutrition, stress and a sedentary lifestyle, the gastrointestinal tract suffers. , gastritis, stomach ulcer - this is not a complete list of diagnoses that each of us has heard at least once in our lives.

To treat inflammatory processes in the stomach, drugs belonging to the group “proton pump inhibitors” are used. These drugs contain various active ingredients, for example omeprazole or esomeprazole. What is the difference between them? Let's look at the example of drugs of the same name.

Before comparing two drugs, you need to familiarize yourself with each of them.

Omeprazole is an active substance that blocks the cells responsible for the production of hydrochloric acid in the stomach. Based on it, both the drug of the same name and .

The mechanism of action of omeprazole is quite simple: once it enters the human body, it acts on parietal cells, inhibiting acid production. Due to the accumulation of the substance in these cells, the effect of taking Omeprazole persists for approximately five to seven days after the end of administration.

In addition, omeprazole has a neutralizing effect, reducing the acidity of existing gastric juice. All together, this creates a favorable environment for the restoration of damaged mucosa, scarring of ulcers, and healing of erosions.

The main indications for taking omeprazole are the following diseases:

1. Stomach and duodenal ulcers, including those provoked by stress, taking medications;
2. Reflux esophagitis;
3. Tumor of the islet apparatus of the pancreas.

The effect of the drug begins after the patient drinks an Omeprazole capsule; the effect will last for about a day.

When prescribing a medication, it should be taken into account that the removal of omeprazole from the body creates an extra burden on the liver, so it should be used with caution in people suffering from liver failure.

Contraindications to taking the drug are intolerance to the components, patient age under 18 years, pregnancy, breastfeeding.

"Esomeprazole": brief information about the drug

This drug belongs to the same group of antiulcer drugs as Omeprazole, however, the basis here is another active ingredient - esomeprazole. Due to its properties to block the secretion of hydrochloric acid, it is used to treat diseases such as:

• stomach and duodenal ulcers, including: caused by Helicobacter pylori or associated with taking NSAIDs;
• peptic ulcers (prevention of relapses caused by Helicobacter pylori), prevention of relapses of repeated bleeding;
• Zollinger-Ellison syndrome and other conditions characterized by increased gastric secretion, incl. idiopathic hypersecretion.

Contraindications to taking Esomeprazole are:

• Hypersensitivity to esomeprazole or other substances in the drug;
• Simultaneous administration with the drugs “atazanavir” and “nelfinavir”;
• Glucose-galactose malabsorption;
• Children under the age of 12 are strictly prohibited; in the period from 12 to 18 - in some cases, on the recommendation of a doctor;
• During pregnancy and breastfeeding, use is not recommended, since there is no official data on the safety of the drug for a child.

Comparison of Esomeprazole and Omeprazole

Both of these drugs have similar indications for use, but they still differ in some ways. To understand the difference, let's look at them in more detail:

Manufacturer and price

Omeprazole from manufacturers from various countries (Russia, Serbia, Israel) is represented on the domestic market. The cost of one pack depends on the dosage and is about 30-150 rubles. Esomeprazole is also produced in Russia, but its cost is higher - 250-350 rubles per package.

Active ingredient

Esomeprazole is an isotope of omeprazole (S form). These two substances differ in the structure of their molecules - omeprazole and esomeprazole mirror each other.

Release form

"Omeprazole" is produced in the form of hard gelatin capsules, and "Esomeprazole" is produced in the form of tablets. The dosage for both drugs varies 20 and 40 mg.

Contraindications

Omeprazole is highly versatile; its popularity is due to the fact that there are quite a few contraindications to its use. It is prohibited for use by young children, persons intolerant to omeprazole and other components of the drug, as well as pregnant and lactating women.

In exceptional cases, if we are talking about serious medical indications, Omeprazole can be prescribed to children aged four years and over, as well as expectant mothers, however, this is rather an exception to the rule.

Neither Omeprazole nor Esomeprazole should be used thoughtlessly for renal and liver failure, since the removal of these compounds from the body places additional stress on these organs, which can lead to side effects (including severe ones).

Side effects

In any instructions for Omeprazole you can read a fairly impressive list of side effects, after reading which you will be scared to take such a dangerous drug. At the same time, you can hear the opinion that Omeprazole is well tolerated by most patients. How is such a contradiction possible?

The thing is that the manufacturer is obliged to indicate all possible reactions, even if isolated cases of their occurrence have been recorded. As a rule, all severe reactions to taking Omeprazole developed in seriously ill patients against the background of other diseases of the liver, nervous system, etc.

Most often, treatment with Omeprazole occurs without any negative reactions. Those that occur go away quickly, without any special treatment.

So, most often, while taking Omeprazole, headaches, upset stools, nausea, and abdominal pain may occur. Even less frequently, less than 1% In cases of ingestion, sleep disturbances, itching and rashes on the skin, and swelling of the extremities are observed.

The list of possible side effects from taking Esomeprazole also includes the following:

• blood and lymphatic system;
• immune system;
• metabolism and nutrition;
• nervous system;
• organs of hearing, breathing, skin;
• hepatobiliary disorders;
• muscular and osteoarticular changes;
• renal disorders;
• reproductive and sexual sphere;

But still, most often, less often than every tenth patient, gastrointestinal disorders are observed, which disappear immediately after discontinuation of the drug.

Interaction with other drugs

Observations of patients who took Omeprazole showed that when taking a dose of the drug in the amount of 20 mg/day, there was no effect on the concentration in the blood plasma of most other drugs.

The only group of drugs with which it is undesirable to take Omeprazole at the same time are those whose absorption depends on the pH value, since if taken together their effectiveness decreases. Esomeprazole works similarly.

Summarizing the above, it is impossible to unambiguously answer the question of which drug is better. Based on the practice of use, we can say that the use of Esomeprazole in the treatment of reflux disease is more effective.

However, in the case of treating peptic ulcers, the results of using both drugs are approximately the same. The main difference is the price of the drug, as well as (if we talk about Omeprazole of Israeli and Serbian production) the country of production.

In addition, the individual characteristics of the patient’s body are a significant factor. That is why the decision on choosing a drug should be made by the attending physician, taking into account the financial capabilities of the patient.

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Diseases associated with the digestive system plague a huge number of people of all age and social groups. This is facilitated by poor nutrition, poor environment and bad habits that modern society is prone to. The pharmaceutical industry does not stand still and is actively developing new means to combat diseases of the digestive system.

Proton pump inhibitors (for example, Omeprazole or Pantoprazole) are a fairly large class of drugs used in the treatment of peptic ulcers. Is there a difference between these analogues and how significant is it? First, let’s take a closer look at these tools to answer this question.

Before comparing the two medications, let's understand a little about what each of them is.

Omeprazole is an active ingredient; on its basis, both the drug of the same name and . Omeprazole acts in two directions: firstly, it reduces the acidity of gastric juice due to its neutralizing effect, and secondly, it suppresses the secretion of hydrochloric acid at the cellular level.

All this creates a favorable environment for the healing of erosions and damage to the mucous membrane of the stomach walls.

Indications for taking the drug are:

• stomach and duodenal ulcers;
• reflux esophagitis;
• symptomatic gastroesophageal reflux disease;
• dyspepsia, against the background of increased acidity;
• Zollinger-Ellison syndrome.

The drug begins to act half an hour or an hour after administration, the effect lasts throughout the day. After the course of treatment is completed, acid production returns to its previous level within a few (up to five) days.

The process of removing the drug from the body creates additional stress on the liver, so it is not recommended to take Omeprazole for people suffering from liver disease.

Contraindications to use are intolerance to the components of the drug, such as lactose or fructose; children under four years of age (children under eighteen only in particularly severe cases, as decided by the attending physician). Use during pregnancy should be justified and weighed, since the safety of the medicine for the unborn child has not been clinically proven.

Brief information about Pantoprazole

Although this drug belongs to the same group as Omeprazole, the active ingredient here is different - pantoprazole. The principle of action is absolutely identical to the work of Omeprazole; the drug blocks the secretion of acid and lowers the level of acidity in the stomach. It is used in the treatment of gastric and duodenal ulcers, reflux esophagitis and Zollinger-Ellison syndrome.

The dosage, of course, is calculated individually, but on average it is 40 mg per day (depending on the form of release, this is one or two capsules). The maximum safe dose, which health organizations prohibit exceeding, is 80 mg per day.

Difference between drugs

In order to understand where these two drugs are similar and where they differ, let’s look at them in terms of their main characteristics.

Price and manufacturer

Pantoprazole is produced by the Russian pharmaceutical company Kanonpharma and its cost is 200-300 rubles per package (depending on the dosage). "Omeprazole" is represented on the market by several manufacturers (Russia, Serbia, Israel), and its cost ranges from 30-150 rubles.

Active ingredient

It has been proven that the comparative intensity of the antisecretory effect of the proton pump inhibitor of omeprazole is higher than that of pantoprazole. At the same time, the time required for the substance to block secretion for pantoprazole is almost three times longer than for omeprazole.

Release form

Omeprazole is available in the form of hard gelatin capsules. Pantoprazole is produced in the form of film-coated tablets.

Time required for the drug to achieve effect

Omeprazole begins to act approximately half an hour to an hour after ingestion (the time may vary slightly in each individual case). Pantoprazole takes approximately two to two and a half hours to reach its highest concentration in the blood plasma.

Contraindications

The list of contraindications for Omeprazole is quite short and includes intolerance to the components of the drug, pregnancy and lactation, childhood, and concomitant use with certain drugs. “Contraindications to taking Pantoprazole are:

• intolerance to the components of the drug;
• age less than 18 years;
• dyspepsia (neurotic genesis);
• malignant formations in the gastrointestinal tract;
• simultaneous administration with the drug "Atazanavir".

Taking during treatment with other drugs. Observation of patients taking Omeprazole showed that long-term use of a dose of 20 mg per day did not affect the concentration in the blood of substances such as caffeine, theophylline, diclofenac, naproxen, propranolol, ethanol, lidocaine and some others. It is undesirable to use the drug in parallel with drugs whose absorption depends on the pH value, since Omeprazole reduces their effectiveness.

Pantoprazole works similarly. However, it can be taken by the following groups of patients without any risk:

• For diseases of the cardiovascular system. Example of drugs: Digoxin, Nifedipine, Metoprolol;
• For diseases of the gastrointestinal tract. Example of antibiotics: Amoxicillin, clarithromycin;
• Taking oral contraceptives;
• Taking non-steroidal anti-inflammatory drugs;
• For diseases of the endocrine system, example drugs: Glibenclamide, Levothyroxine sodium;
• If you have anxiety and sleep disorders, take Diazepam;
• For epilepsy, take Carbamazepine and Phenytoin;
• After transplantation, take Cyclosporine and Tacrolimus.

Side effects

The list of possible negative reactions of the body to taking Omeprazole is quite wide, however, most of them occurred in isolated cases. Among the relatively common ones (less than 10% of prescriptions) are: lethargy, headache and digestive problems such as stool disorders, nausea, vomiting, increased gas formation, abdominal pain.

Much less frequently, in less than 1% of cases, insomnia, dizziness, hearing loss, allergic skin reactions, weakness, swelling of the limbs, brittle bones, and increased levels of liver enzymes in the blood may occur.

As for Pantoprazole, in less than ten percent of cases headaches, abdominal pain, problems with stool, and gas formation are observed. Less commonly, in less than 1% of prescriptions, sleep problems, dizziness, blurred vision, allergic skin manifestations (redness, itching, rash), general weakness and malaise, and nausea occur.

Overdose

Cases of reactions to an excess of Omeprazole were observed with the following symptoms: a state of confusion, decreased clarity of vision, drowsiness, a feeling of dry mouth, headache, nausea, heart rhythm disturbances. An overdose of Pantoprazole has not been observed. But the manufacturer recommends using symptomatic treatment in any case. Hemodialysis in both cases shows low efficiency.

To summarize, we can say that the difference between Omeprazole and Pantoprazole is not too significant. The drugs vary in price, as well as in the active ingredient. Moreover, the mechanism of their effect on the stomach is absolutely identical. Omeprazole has been used in pharmacology for much longer; how it affects the body has been better studied.

In this case, there have been no cases of Pantoprazole overdose; side effects when taking it occur less frequently. In any case, it is worth discussing with your doctor which medicine is preferable in this particular case and not making any decisions on your own.

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Proton pump inhibitors (PPIs), of which Rabeprazole is a representative, are widely used in gastroenterology as part of complex therapy for acid-dependent pathologies of the digestive tract. Many drugs based on the described active component are significantly more expensive than PPIs used before, but their effectiveness is not always higher, which gives rise to the use of Rabeprazole analogues.

Rabeprazole

Rabeprazole is a drug that suppresses the secretion of acid in the stomach, reducing. It is produced by different manufacturers in the form of enteric-coated tablets or capsules containing rabeprazole 10 or 20 mg.

Pantoprazole

Important! It is necessary to select an analogue only together with a doctor, since the patient is not able to take into account the course of the disease. There is no better or worse drug, but only one that is suitable and unsuitable for the treatment of a particular acid-related disease in a particular patient.

Comparison of drugs

Drugs that can replace Rabeprazole differ significantly in price. It is this factor that often becomes decisive for patients when choosing a treatment, especially if the doctor recommends long-term use. The table below shows approximate prices of analogues from the IPP group.

Name	Dosage/quantity per package	Price, rub.
Complete analogues
Rabeprazole-SZ	20 mg/28 capsules	440
Pariet	20 mg/28 tablets	3860
Zulbex	20 mg/28 capsules	1470
Khairabesol	20 mg/30 capsules	850
Rabelok	20 mg/14 tablets	530
Rabiet	20 mg/28 capsules	680
Ontime	20 mg/20 tablets	1170
Beret	20 mg/14 tablets	500
Razo	20 mg/30 tablets	475
Analogues from the PPI group
Omez	40 mg/28 capsules	280
Gastrozol	20 mg/14 capsules	100
Omeprazole	20 mg/30 capsules	40
Omegast	20 mg/14 capsules	130
Esomeprazole	20 mg/28 tablets	430
Pantoprazole	20 mg/28 tablets	280
Epicurus	30 mg/14 capsules	380
Panum	40 mg/20 tablets	290
Crosacid	20 mg/28 tablets	220
Sanpraz	40 mg/30 tablets	550
Lancid	30 mg/30 tablets	390
Losek	20 mg/28 tablets	650
Emanera	40 mg/28 capsules	670
Nexium	40 mg/28 tablets	480
Orthanol	40 mg/28 capsules	400
Ultop	40 mg/28 capsules	480
Nolpaza	40 mg/28 tablets	450
Kotrolok	40 mg/28 tablets	630

Instructions for use

The tablet should be swallowed whole and should not be crushed or chewed. The preferred time of administration is the morning. Studies have found that food intake and time of day do not affect the activity of the drug.

How is an antisecretory agent prescribed:

• For peptic ulcers, Rabeprazole is recommended to be taken one tablet (20 mg) once a day. The optimal duration of treatment is 4-6 weeks. If necessary, the course of therapy can be extended by the doctor for another 4-6 weeks.
• In the case of gastroesophageal reflux disease, the drug is prescribed 1 tablet once a day, regardless of meals. The average treatment period is 4-8 weeks.
• If the patient has been diagnosed with H. Pylori, Rabeprazole, which is part of the eradication regimen, is taken twice a day, 20 mg (1 tablet). The duration of such therapy is 7-14 days.

For children, the drug is allowed only from 12 years of age, the dosage is the same. Raueprazole-C3 has similar instructions for use.