Omeprazole or Esomeprazole: which is better, differences, rules for choosing a substitute. Comparative study of the clinical efficacy of omeprazole and lansoprazole in the treatment of diseases associated with Helicobacter pylori

Loss of appetite, pain and heaviness in the stomach, flatulence, nausea and heartburn after eating - these are not all dyspeptic symptoms that manifest themselves with inflammation of the inner surface of the digestive organ. Therefore, the choice of medicine for gastritis, in addition to the direct healing of mucosal defects, should be aimed at eliminating pain and normalizing acidity.

Destructive changes in the inner surface of the stomach are caused by a number of adverse factors. However, they have different symptoms and course (acute or chronic process). Therefore, a medicine that is prescribed to one patient may not have the proper effect on the body of another, and in the worst case, it can even cause significant harm. Only a gastroenterologist is able to determine which pills a patient needs.

Antibacterial agents

Sometimes the underlying cause of gastritis is a bacterial infection with H. pylori, for which antibiotic treatment is important.

In this case, tablets from gastritis of the stomach with an antibacterial effect are used:

• tinidazole,
• amoxicillin,
• erythromycin,
• tetracycline,
• Sulgin,
• Clarithromycin.

Treatment regimens for a disease caused by the H. pylori bacterium include the following combinations of drugs for gastritis:

• how to drink omeprazole with gastritis

• Omeprazole, Clarithromycin and Amoxicillin;
• Amoxicillin, Clarithromycin, Omeprazole, De-Nol, and sometimes additionally Tinidazole.

Bismuth preparations form a film on the inner surface of the stomach that reduces the corrosive effect of acid:

• De-Nol,
• Vikair,
• Novobismol,
• Vikalin.

These tablets for the treatment of gastritis have a bactericidal effect on the H. pylori bacterium, and also help the healing and epithelialization of mucosal ulcers.

To suppress the inflammatory process in gastritis of the stomach, effective combined preparations are used, which include several antimicrobial components.

Of these, the most popular are:

• Pilobakt NEO,
• Pylobakt AM,
• Ornistat.

At the same time, antibiotics can be used in different combinations, but PPI is present in the scheme in any case.

proton pump inhibitors

Means against gastritis, characterized by high acidity, should solve another problem - to slow down the production of hydrochloric acid. They have certain contraindications, so they should be prescribed only by gastroenterologists.

The drug, taken from hyperacid gastritis, has the following effect:

• inhibits the production of hydrochloric acid;
• stabilizes the level of acidity;
• reduces the production of enzymes.

This effective drug has shown good bioavailability and efficacy in hyperacid gastritis in adults and children. The tool improves the prognosis even in patients with gastrinoma, a malignant disease in which the tumor produces gastrin (a hormone that stimulates the production of hydrochloric acid).

Several generations of IPPs have been created, differing in their effectiveness. Therefore, today the most effective drugs for the treatment of gastritis are used:

• Lansoprazole,
• Omeprazole,
• Rabeprazole
• Promez,
• pantoprazole,
• Esomeprazole.

These remedies are the best medicines for gastritis with high acidity. Most of them are available by prescription.

Histamine H2 receptor blockers

For this purpose, drugs that have a different principle of action are used. Histamine blockers inhibit the production of pepsin, stimulate the synthesis of prostaglandins and microcirculation in the mucosa, increase the amount of gastric mucus, increase the production of bicarbonates, improve gastric and duodenal motility. Treatment involves taking the drug twice, since its effect lasts only 12 hours. To be more effective, they should be used in conjunction with PPIs. The best drugs in this group:

• cimetidine,
• famotidine,
• Nizatidine
• ranitidine,
• Levocyterizin.

Medicines are dispensed exclusively by prescription.

Antacids

A high level of acidity leads to ulceration and erosion of the gastric mucosa. To avoid such complications, the patient needs treatment with antacids.

In this case, a heartburn medicine with an enveloping effect, which has protective properties, is used. It protects the inner shell of the digestive organ from exposure to chemical, mechanical and thermal stimuli.

Symptoms of heartburn are relieved by antacids that neutralize hydrochloric acid. Drinking on an empty stomach, the medicines only work for a little over half an hour. Therefore, they should be taken after meals, in which case the duration of action of antacids is increased by 6 times.

Among the tablets from gastritis with antacid properties, the following are most often used:

• Maalox,
• Gastal,
• Rennie,
• Alumag,
• Gaviscon.

They can be combined with medicines containing omeprazole, but cannot be used in conjunction with gastroprotectors (De-Nol, Venter), Tetracycline, acetylsalicylic acid and digitalis products. If it is necessary to take the above drugs, it is necessary to make a two-hour interval between the use of these drugs and antacids.

You should also not use these funds uncontrollably for a long period of time. As a result of such treatment, the natural processes of acid secretion are inhibited and hyperacid gastritis can eventually transform into hypoacid gastritis, which is also not the norm.

Enzyme preparations

To improve the digestive processes in the gastrointestinal tract, enzymes are used. They help break down food ingredients. The most commonly used enzyme preparations are:

• Digestal,
• Pancreatin,
• Mezim-forte,
• Festal,
• acidin-pepsin,
• Panzinorm.

Such medicines must be taken with meals at the dosage prescribed by the attending physician.

Electrolyte preparations

These funds are not needed to treat gastritis of the stomach, but only to stop its symptoms and reduce the possibility of complications, replenishing the lack of fluid in the patient's body, lost during diarrhea or vomiting (typical symptoms in the acute form of the disease).

Injections from gastritis are needed, first of all, in case of a disease with atrophy, since in this case the absorption of the fluid taken is reduced. With severe intoxication, infusions of a glucose solution with vitamins B and C, as well as saline, are used. In severe cases, 0.85% saline is injected subcutaneously.

The list of drugs for rehydration is as follows:

• Dextrose solution (in ampoules),
• Saline solution (bottle),
• Regidron (in powder).

These medicines are sold in pharmacies without a prescription.

Ursodeoxycholic and chenodeoxycholic acids

These medicines for gastritis with high acidity stop attacks of heartburn, reflux. Such a remedy is the drug Ursodez for heartburn and gastritis.

This type of medicine also includes:

• Ursolite,
• Henofalk,
• Grinterol.

These drugs, used to treat atrophic, mixed and erosive forms of the disease, are sold by prescription.

Painkillers

With a strong pain syndrome, antispasmodics are used. An effective drug for pain and cramps in the stomach is No-shpa. This myotropic antispasmodic effectively helps with pain in the gastrointestinal tract. In addition to it, you can use Drotaverine, Papaverine and Spasmalgon. However, antispasmodics cannot cure the disease, but only relieve spasms and pain.

Painkillers for gastritis should not be taken before consulting a gastroenterologist. Only he can recommend how to treat gastritis with pain. The only exception to this are antispasmodics. In the future, the specialist can determine which drugs from other groups will not be harmful. Pain relievers such as NSAIDs can cause drug-induced gastritis.

Antihistamines

These drugs are mainly used in the treatment of erosive, autoimmune and atrophic types of gastritis. They are prescribed to drink in order to reduce the level of histamine, which destroys the inner lining of the stomach in these types of disease.

These funds include:

• Fenkarol,
• Tavegil,
• Rolinoz,
• Loratadine,
• Suprastin.

Such drugs belong to the group of over-the-counter drugs.

Adsorbents and binders

Adsorbent preparations are prescribed to bind and remove toxins and infectious agents that have caused the disease.

These include:

• Smecta,
• Polyphepan,
• Enterosgel,
• Activated carbon.

Adsorbents eliminate the negative symptoms of toxic and infectious gastritis, such as diarrhea, flatulence and bloating.

Other drugs

Some forms of gastritis can be treated with homeopathic medicines, such as Gastricumel. However, this type of therapy is controversial, and not all experts welcome such treatment. In addition, there are a large number of pharmacy gastric phytopreparations.

A group of drugs used to relieve nausea, flatulence and improve motor skills are prokinetics:

• metoclopramide,
• motilium,
• Domperidone.

Inflammation of the inner surface of the stomach is the leading pathology of the gastrointestinal tract, it often transforms into a chronic form, and sometimes leads to ulceration and perforation. Therefore, it is better to entrust the appointment of therapy to a doctor. Only a gastroenterologist can tell you how to treat gastritis and with what medicines. Timely treatment to a medical institution and adequately selected treatment will allow you to forget about this disease forever.

Consider the similarities and differences of medicines indicated in the instructions for medicines.

Comparative characteristics

Let's start the comparison of Rabeprazole and Omeprazole with a description of similar qualities:

• medicinal group. Relate to the IPP;
• Action on the body. Suppress the secretion of hydrochloric acid and help reduce gastric acidity;
• The duration of the therapeutic effect. They begin to act an hour after ingestion and the therapeutic effect of the active substance persists throughout the day;
• Indications for use. Medications are indicated for the treatment of peptic ulcer, esophagitis, heartburn and gastritis with high acidity.

Now consider the difference between Rabeprazole and Omeprazole:

• Active substance. Rabeprazole has Rabeprazole sodium and Omeprazole has Omeprazole;
• Efficiency. Rabeprazole has a higher acid range and helps to get rid of the symptoms that have arisen with hydrochloric acid up to ph 4.9;
• Therapeutic dose. In the treatment of diseases with the same severity of symptoms, the dose of Omeprazole will be twice as high;
• Side effects. Reactions to taking medications are the same, but after taking Omeprazole they occur in 15% of cases, and after Rabeprazole - in 2%;
• Release form. Both drugs are available in capsules, but omeprazole has only one adult dosage of 20mg;
• Relationship with food. Taken after a meal, Omeprazole loses some of its activity, and the bioavailability of Rabeprazole is not associated with gastric filling;
• development of the withdrawal syndrome. In a person who has stopped drinking Omeprazole, acidity is restored within 3 days and pain and heartburn may recur. After the abolition of Rabeprazole, acid secretion is restored more slowly (5-7 days) and there is almost no withdrawal syndrome;
• Price. Omeprazole costs almost 5 times cheaper and, if there are no special instructions, most patients prefer this medication during long-term therapy.

Despite the fact that the drugs are analogues, they differ in the active ingredient. Often, to increase the therapeutic effect, drugs are prescribed to drink together. Perhaps, in addition to the combined use of Rabeprazole (structural analogue - Pariet) and Omeprazole (similar drug - Omez), other PPIs will be additionally prescribed: Nolpaza, Lansoprazole, Pantoprazole or Esomeprazole.

What to choose

Omeprazole differs from Rabeprazole in composition and effect on the secretory function of the stomach. From the above comparison, it becomes clear that Rabeprazole is considered a more effective drug with fewer side effects, therefore, when choosing a drug, be guided by the following rules:

• The severity of the disease. With very high acidity, it is better to give preference to Rabeprazole;
• Portability. If side effects occur after taking Omeprazole, then Rabeprazole therapy can be continued;
• Financial opportunities. Omeprazole is cheaper and, with good tolerance, it is permissible to be treated with the drug for a long time.

As to which drug would be best, you need to consult your doctor. You do not need to independently replace drugs with a cheaper or more effective one - they are different in composition and may not be combined with other drugs for the treatment of stomach diseases.

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IMPORTANT. The information on the site is provided for reference purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Omeprazole analogs. We combine economy and quality

The drug Omeprazole is prescribed in cases of ulcers of the gastric surfaces and duodenum, with gastritis and gastropathitis. The function of the drug is to reduce the amount of hydrochloric acid in the stomach in case of a negative reaction of the patient to its excess. The active component of omeprazole compensates for the lack of vitamins and, interacting with stomach acid, leads to the destruction of the beginnings of peptic ulcer. The drug inhibits the production of hydrochloric acid, affecting its activity.

A characteristic feature of the remedy is that it begins to show its medicinal qualities only when it enters an environment with an acidic reaction characteristic of the stomach. The drug is able to eliminate the action of the causative agent of ulcerative diseases and gastritis, a microorganism called Helicobacter pylori.

The drug is available in the form of tablets, capsules, powder, the active components of its analogues are similar in principle to the original and have the same active ingredient - omeprazole. However, taking the drug has contraindications, the main of which are chronic liver diseases, as well as periods of lactation and pregnancy.

Taking a medicine

The use of the drug is made before eating food for breakfast or before dinner. The dosage of the medicine is strictly individual, is prescribed in accordance with the disease card and depends on the severity of the disease. An overdose of the agent can cause a change in taste sensations, a feeling of dryness in the oral cavity and its inflammation, unstable stools, vomiting, impaired liver function, various skin diseases, and affect the qualitative and quantitative composition of human blood.

Types of medication

A natural remedy, a drug produced by branded companies, on the basis of a legal basis consisting in the presence of a patent.

Generics, characterized in that they do not have patent protection for the product. Otherwise, according to the manufacturer's statements, confirmed by doctors, the drug is completely identical to the original.

Omeprazole's analogs

Ultop is made in Portugal and differs from the original in the production process and release form. Ultop is characterized by release in the form of 40 mg injectable powders and capsules, what is its difference from Omeprazole, produced in 20 mg capsules. The ultop is also distinguished by additional substances to the main one, among which particles of sugars of complex composition and magnesium carbonate are contained, while the analogue contains titanium dioxide, glycerin and sodium lauryl sulfate. Despite the fact that the drugs are similar in indications for use, Ultop has an advantage over omeprazole, consisting in the fact that it can be prescribed to patients with impaired liver function. It is unacceptable to take Ultop, in addition to other contraindications, in case of a negative reaction of the body to sugar.

De-Nol acts on Helicobacter pylori, forming an astringent protective layer in connection with protein bodies in areas damaged by an ulcer. When taking De Nol, which has an antimicrobial effect, under the layer covering the surface of the mucosa, epithelial tissue is restored and scars are healed. De-Nol is able to penetrate deep into the mucous membrane, the habitat of bacteria of this species. The manufacturer of De-Nol is the Netherlands, the cost of a relatively cheap and affordable drug Omeprazole is high and ranges, depending on the number of tablets, from 5 to 10 US dollars for 56 and 120 pieces, respectively. The main difference between De-Nol and the original is its antibacterial effect, which is carried out by changing the conditions for the presence of microorganisms and through a direct bactericidal effect.

Ranitidine

Ranitidine counteracts the emergence of neurotransmitter chains for pain impulses, reduces the amount of hydrochloric acid in the body and has the effect of suppressing peptic ulcers. Indications for taking ranitidine are the critical stages of gastric ulcers, increased acidity in gastritis, surgical actions with the stomach. The difference between the original drug and Ranitidine is that Omeprazole performs the functions of blocking acid production and eliminating excess acid, which contributes to recovery processes. Another feature of Ranitidine is the addiction of the body to the doses of the drug, which provokes their increase, unlike the original.

Pantoprazole

Pantoprazole is characterized by a high activity of its biological components with a lower effect of suppressing acid production than that of Omeprazole. At the same time, the cost of Pantoprazole starts from US$ 3.5, while the price for Omeprazole is at the level of $ 0.5-3.5. Since the analogue of Omeprazole Pantoprozol has a longer disintegration time, it is better to practice a one-time administration of the drug during the day. The difference between the drugs and that Pantoprozol can be taken during the pregnancy period. A feature of the drug Pantoprozol is its inherent bactericidal properties.

Nolpaza

Despite the same purpose and rather high efficiency of Nolpaza in reducing the production of hydrochloric acid, it is not recommended to independently change the prescribed original drug to an analogue. Nolpaza, in comparison with Omeprazole, shows a greater bioavailability of the components of the agent, however, in the treatment of peptic ulcer, it is more preferable to take Omeprazole. Nolpaza shows good clinical results when used in complex treatment. The form of release of the Nolpaza analogue drug, which is produced in the form of oval-shaped tablets, and not capsules like Omeprazole, differs from the original one. It is not possible to identify, according to the patients' reviews, the answer to the question of which drug is better to take, since Nolpaza, like Omeprazole, show equally high efficiency depending on the indications for treatment.

Emanera

The drug Emanera is characterized by the suppression of various forms of hydrochloric acid production, through a directed action. Emaner's remedy is characterized by the rapid achievement of an antisecretory effect. Based on this, taking Emanera is recommended with strict adherence to the dosage prescribed in the prescription of the drug by the doctor. The price of the Slovenian drug Emanera is $7 for 28 capsules with a total weight of 20 mg of the active substance.

Esomeprazole

Esomeprazole is a separate substance at the molecular level that mimics omeprazole. Esomeprazole is the active ingredient of the previously discussed drug Emaner. Despite this, Esomeprazole has many side effects that occur after administration: constipation, depression, drowsiness, taste changes and various skin diseases. In general, it can be said that when exposed to Helicobacter pylori, no visible difference in action was found between Esomeprazole and Omeprazole, with the analogue being more effective in the treatment of GERD. However, the benefits of Esomeprazole are offset by contraindications and a fairly high price compared to the analogue.

Pariet

Means Pariet is characterized by a higher rate of exposure, elimination of the symptoms of the disease compared to Omeprazole. At the same time, Pariet causes fewer side effects that pass in a milder form than the original remedy. However, on the basis of this, one should not conclude that it is possible to replace the original with an analogue of Pariet, this decision is within the competence of the attending physician. Pariet also shows high efficiency in reducing acidity, compared with Omeprazole. The price of the drug Pariet is also high compared to Omeprazole and is about 10 US dollars for 7 pieces of the drug.

Lansoprazole

Lansoprazole is identical to Opeprazole, except for the higher speed of the first drug. In the issue of suppressing the production of hydrochloric acid, there was no particular difference between the effectiveness of Lansoprazole and the original drug. Lansoprazole, based on the action it has when it enters the small intestine, is available in capsules with fine granules. A distinctive feature of Lansoprazole is also the ability to quickly heal gastric ulcers. Possible side effects of the drug Lansoprazole include belching, heartburn, dysbacteriosis, constipation.

Losek

Losek is a form of the official analogue of Omeprazole produced by an Austrian company. The active substance of the drug Losek is a multitude of omeprazole magnesium granules encapsulated, acting locally to suppress acid secretion. The Losek preparation is activated, exclusively being in an environment with a certain acidic background, that is, exactly at the destination. Contraindications to taking Losek are hepatic and renal types of insufficiency, pregnancy and lactation. Losek is produced in the form of a powder or tablets and is taken in a fairly high dose prescribed by a doctor, depending on the severity of the disease.

Rabeprazole

According to the results of clinical studies, the effectiveness of Rabeprazole is higher than that of Omeprazole in suppressing the symptoms of the disease. Rabeprazole also has a higher rate of impact on the source of the symptoms of the disease. Among the side effects of Rabeprazole are: dizziness, back pain, the occurrence of allergic-type reactions, cough, rhinitis, drowsiness. Rabeprazole shows good results when used as monotherapy for duodenal and gastric ulcers. Another difference of Rabeprazole is the high bioavailability of the drug compared to Omeprazole at the first stages of treatment of gastrointestinal diseases.

Esomeprazole is an effective drug for gastrointestinal diseases

Esomeprazole is an effective drug whose action is aimed at getting rid of various diseases of the gastrointestinal tract. Produced in the form of tablets with a shell of substances that dissolve easily in the intestine. The main active ingredient is esomeprazole. Tablets are available in blisters of 7 pieces, the concentration can be 20 or 40 mg esomeprazole (active ingredient).

The drug belongs to proton pump inhibitors. This means that after taking it, the level of hydrochloric acid secretion will begin to decrease, which will allow more effective treatment of ailments, whose development is directly related to an increased amount of this acid.

Pharmacological properties

The active substance, esomeprazole, is the S-isomer. After entering the gastrointestinal tract, it is able to slow down the processes occurring in the proton pump, as a result of which the secretion of hydrochloric acid is significantly reduced. The S-isomer begins its vigorous activity when it enters the secretory tubules, in which an established acidic environment is formed.

Regardless of the dosage (20 or 40 mg), the effect after using the drug will come in about 1 hour. In those patients who use this medication for 5 days (in combination with Pentagastrin), there is a significant decrease in the level of secretion of hydrochloric acid - an average of 90%. In general, cure occurs after therapy lasting 28 days (in 79% of patients) and 56 days (in 94%).

Complete elimination of the gastrointestinal tract from Helicobacter pylori occurs in 89% of patients within 7 days. This is provided that antibacterial drugs were taken in combination with Esomeprazole. If patients have been diagnosed with a duodenal ulcer, and it is uncomplicated, then therapy with the above drugs is quite enough to have a beneficial effect on damaged tissues and promote their healing.

Esomeprazole is a drug that is well and rapidly absorbed when ingested. It binds to proteins almost 100%. Repeated use of the drug increases bioavailability from 64 to 89%. The components of the drug are converted into metabolites and excreted in the urine, a small part of them may be present in the feces.

When is Esomeprazole prescribed?

The instructions for Esomeprazole show that this drug is prescribed by a doctor to those patients who have been diagnosed with gastroesophageal reflux disease (GERD). Here the medicine helps as follows:

• relieves erosive reflux esophagitis;
• acts as a drug for the treatment of symptoms of GERD;
• serves to prevent possible consequences and relapses after treatment.

Along with this, esomeprazole can be prescribed as an adjuvant in combination with other medicines for:

• destruction of bacteria of the genus Helicobacter pylori;
• treatment of all diseases that are in one way or another associated / provoked by Helicobacter pylori.

Rules for taking the drug

Tablets are taken orally. It is undesirable to break, chew or grind them in any other way. It should be swallowed whole with plenty of liquid. If a person has impaired swallowing function, then the tablets should be dissolved in purified water at room temperature and administered through a special nasogastric tube.

The recommended daily dosage is calculated exclusively by the doctor, as well as the duration of the drug. After the examination, studying the clinical picture and making a diagnosis, the specialist will draw conclusions and prescribe exactly the amount of the drug that will be optimal.

Important: it should be borne in mind that if the patient has been diagnosed with liver failure, then the daily dose should be kept to a minimum.

Very often, esomeprazole can be prescribed in combination with antibacterial drugs. This helps to more effectively fight bacteria of the genus Helicobacter pylori, which can cause stomach ulcers, recurrences of peptic ulcers and affect the duodenum.

The negative feature of this drug is that it can neutralize many signs of the development of cancerous tumors, which in the end will greatly complicate the correct and timely diagnosis. If a patient has frequent vomiting (especially with an admixture of blood), rapid and inexplicable weight loss, the development of a stomach ulcer, then this is a reason to conduct all the necessary studies that will help exclude the development of malignant tumors.

Those patients who take Esomeprazole for a long period (more than a year) should be under the constant supervision of the attending physician. The fact is that proton pump inhibitors affect the amount of gastrin, leading to its increase. The control of the doctor will allow to identify this deviation in time and prevent the development of concomitant diseases. Also, in people who are forced to take this medication for a long time, glandular cysts may appear in the stomach. This happens because physiological transformations occur in the body associated with a change in the concentration of hydrochloric acid.

Tip: Don't worry, as these cysts are usually benign and disappear on their own without any medication or surgery.

Esomeprazole and other medicines

If you start taking Esomerazole and Citalopram, Clomipramine, Imipramine at the same time, then the concentration of the active substances of these drugs may increase, which will lead to an increase in their effect.

The opposite effect - a decrease in efficiency - can be observed if Esomeprazole and Itraconazole, Ketoconazole are taken simultaneously.

Possible side effects and contraindications

The list of side effects that occur most often includes:

• the appearance of pain in the abdominal region;
• headache;
• nausea and vomiting;
• stool disorders - diarrhea, flatulence or constipation.

Less often, patients may be concerned about the following:

• urticaria, pruritus or various kinds of dermatitis;
• dry mouth;
• dizziness and loss of orientation in space.

Very rarely there are such side effects:

• depression;
• angioedema;
• thrombocytopenia;
• anaphylactoid reactions;
• leukopenia;
• exudative erythema, which is malignant in nature.

If one of the above signs occurs, the drug should be stopped, and then contact your doctor for examination. He will prescribe the necessary procedures and either reduce the dosage, or prescribe a medication with a similar spectrum of action.

Contraindications include:

• individual intolerance to the components of the drug (along with hypersensitivity);
• simultaneous administration with Atazanavir due to the fact that esomeprazole reduces the concentration of the active substances of this drug, as a result of which its use ceases to be relevant;
• pregnancy and breastfeeding (components of the drug can be passed through breast milk to the newborn);
• young children (due to the lack of the necessary amount of data on how safe it is to take esomeprazole in childhood).

The drug does not have any effect on the psyche and the ability to concentrate, so it can be taken by those who work on vehicles.

Overdose of Esomeprazole

With an overdose of the drug, patients experience general weakness and increased side effects. In this case, it is necessary to temporarily stop taking the drug and eliminate the symptoms of an overdose by prescribing maintenance therapy. Effective antidotes have not been identified, hemodialysis (getting rid of the body of toxic products) does not have the desired effect.

special instructions

Although the drug is forbidden to be taken during pregnancy, a specialist can prescribe it. In this case, he will be guided by the fact that the intended benefit to the woman is higher than the potential risk to the fetus. At the first negative signs, you should refuse to take it, and then conduct examinations for the presence of its components in the blood. It is not known for certain how the components of the drug can affect the embryo and its development.

If the patient has abnormalities in the liver, then it is strictly forbidden for him to exceed the dose indicated by the specialist. This is dangerous to health and can lead to the most serious consequences.

Those patients who have sucrase-isomaltase deficiency and hereditary fructose intolerance are not allowed to take Esomeprazole.

Esomeprazole's analogs

There are many drugs that have a similar spectrum of action, among them the following stand out:

• Omeprazole - can be found under the names Ultop, Omez or Losek;
• Lansoprazole - Lanzoptol, Lancit;
• Pantoprazole - Controloc, Sanpraz, Nolpaza;
• Rabeprazole - Zulbex, Pariet, Ontime, Hairabezol, Noflux.

All of these medicines have the same effect, but belong to different price segments.

The most similar drug is Omeprazole, although there are still differences. The latter, for example, has many more side effects.

The article provides introductory information that cannot be considered a guide to action. The drug cannot be chosen for treatment on its own, all appointments should be made exclusively by a specialist based on examinations and a study of the clinical picture.

But perhaps it is more correct to treat not the consequence, but the cause?

for acquaintance, contraindications are possible, consultation with the doctor is MANDATORY! Do not engage in self-diagnosis and self-treatment!

• Diseases of the stomach
• • Gastritis
  • Gastroduodenitis
  • Gastroenteritis
  • Gastroenterocolitis
  • Stomach acidity
  • Erosion

• Diseases of the pancreas
• • Pancreatitis
  • Pancreas

• Gallbladder disease
• • Cholecystitis

• Diseases of the esophagus
• • Esophagitis

• Bowel disease
• • Appendicitis
  • Haemorrhoids
  • Dysbacteriosis
  • Constipation
  • Colitis
  • Diarrhea
  • Enterocolitis

• Other
• • Diagnostics
  • Other diseases
  • Vomit
  • Healthy foods
  • Preparations

• kidney disease
• • Analysis of urine
  • Kidney Anatomy
  • Other kidney diseases
  • kidney cyst
  • Urolithiasis disease
  • Nephritis
  • Nephrosis
  • Nephroptosis
  • Kidney cleansing
  • kidney failure

• Bladder diseases
• • Urination
  • Bladder
  • Ureters

• Katya 03/28/2018

The materials of the site are for informational purposes, for any questions related to health, consultation

with the attending physician is obligatory! Do not engage in self-diagnosis and self-treatment!

Omeprazole or Esomeprazole?

For the treatment of conditions associated with high stomach acid, there is a group of drugs called proton pump (or pump) inhibitors, abbreviated as PPIs (or PPIs). They have been successfully used for several decades and have proven effective in changing and maintaining the pH of the gastric contents within the normal range.

Omeprazole is one of the very first PPI drugs that began to replace the less effective ranitidine in the treatment of gastric ulcer, GERD, gastritis and duodenitis. Later, it began to be used as part of the complex treatment of Helicobacter pylori. Over time, the list of PPIs began to be replenished with new substances.

Now the class of such derivatives includes the names of the following active substances:

• pantoprazole
• rabeprazole
• esomeprazole
• lansoprazole

They are produced under various trade names, and only one omeprazole has a dozen of them. Moreover, both consonant with the name of the original substance, for example, Indian Omez, and under more exotic ones, for example, Swedish Losek or Slovenian Ultop, which are essentially the same omeprazole.

Advantages and disadvantages of esomeprazole

Firstly, this is a separate independent substance, and not one of the names of omeprazole, although at the molecular level it is its mirror copy - an enantiomer. What is the difference in practice?

According to the site PubMed (a database of scientific articles on medicine and biology), an analysis was made of 1171 publications from around the world about the difference in action. Based on the results of the analysis, 14 studies were selected, on the basis of which it is possible to give a valid assessment of esomeprazole. It turned out that:

• when comparing the effectiveness of the treatment of gastritis caused by Helicobacter pylori, no significant difference was observed.
• in the treatment of GERD (gastroesophageal reflux disease), the efficacy in maintaining a normal pH level is slightly higher, however, given the cost factor, coupled with the average duration of therapy, the advantage is small.
• In the treatment of ulcers with control of the intragastric pH level 24 hours after taking esomeprazole and omeprazole, a difference that could be called any significant was also not detected.

Conclusion:

The drugs have differences in the mirror structure of the molecule and in price (not in favor of esomeprazole). With therapy at equivalent doses, the difference in efficacy is not significant.

Which is better - omeprazole or rabeprazole? Benefits of Rabeprazole

There is sometimes inaccurate information on the Internet on this issue, so let's take a closer look.

Omeprazole And rabeprazole are classified as proton pump inhibitors (PPIs). Synonymous with 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 stomach acid. Proton pump inhibitors (proton pump blockers) reduce the secretion of hydrogen ions (H + , or proton) by the lining (parietal) cells of the stomach. The secretion mechanism consists in the entry of an extracellular potassium ion (K +) into the cell in exchange for the removal of a hydrogen ion (H +) to the outside.

Classification and characteristics

Currently, 3 groups of drugs that reduce acidity in the stomach are used:

1. proton pump inhibitors - are the most powerful antisecretory agents that suppress the formation of hydrochloric acid in the stomach. Are 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. H 2 blockers include ranitidine And famotidine.

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

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

Proton pump inhibitors include:

• omeprazole(trade names - omez, losek, ultop);
• esomeprazole(trade names - nexium, emanera);
• lansoprazole(trade names - lancid, lanzoptol);
• pantoprazole(trade names - nolpaza, control, sanpraz);
• rabeprazole(trade names - Pariet, Noflux, Ontime, Zulbex, Hairabezol).

Price comparison

Omeprazole is several times cheaper than rabeprazole.

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

The price of the original drug Pariet(rabeprazole) 20 mg 28 tab. - 3600 rub. For a month of treatment, 1 pack is needed.

Generics (analogues) of rabeprazole are much cheaper:

• Ontime 20 mg 20 tab. - 1100 rubles.
• Zulbeks 20 mg 28 tab. - 1200 rub.
• Hairabezol 20 mg 15 tab. - 550 rubles.

Thus, the cost of treatment omeprazole per month is about 200 rubles (40 mg / day), rabeprazole using hairabezole- about 1150 rubles. (20 mg/day).

Differences between omeprazole and esomeprazole

Esomeprazole is the S-stereoisomer omeprazole(left-handed optical isomer omeprazole), which differs from the dextrorotatory isomer in the same way that a left hand and a right hand or a left and right shoe differ. It turned out that the R-shape omeprazole much stronger (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, esomeprazole has significant advantages over omeprazole, however, is more expensive. Esomeprazole taken at the same dosage as omeprazole.

The cost of trade names esomeprazole is:

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

Benefits of rabeprazole over other PPIs

1. Effect rabeprazole starts within 1 hour after ingestion and lasts 24 hours. The drug acts in a wider pH range (0.8-4.9).
2. The dosage of rabeprazole is 2 times lower compared to omeprazole, which gives better tolerability of the drug and fewer side effects. For example, in one study, side effects ( headache, dizziness, diarrhea, nausea, skin rash) were noted in 2% during treatment rabeprazole and 15% with treatment omeprazole.
3. Admission rabeprazole into the blood from the intestines (bioavailability) does not depend on the time of the meal.
4. Rabeprazole suppresses the secretion of hydrochloric acid more reliably, because its destruction in the liver does not depend on the genetic diversity of cytochrome P450 enzyme variants. Thus, it is possible to better predict the effect of the drug in different patients. Rabeprazole less than other drugs affects the metabolism (destruction) of other drugs.
5. After discontinuation rabeprazole there is no “rebound” (cancellation) syndrome, 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

• Ulcer of the stomach and duodenum,
• 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 (Helicobacter pylori), which causes ulcers and chronic gastritis.

Note. All proton pump inhibitors are destroyed in an acidic environment, so they are available in the form of capsules or enteric tablets that are swallowed whole (can not be chewed).

conclusions

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

Detail: rabeprazole has a number of advantages over other proton pump inhibitors and is comparable in effectiveness only with esomeprazole, however, treatment rabeprazole cost 5 times more than omeprazole and slightly more expensive than esomeprazole.

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

Analogy with antihypertensive drugs

Among the proton pump inhibitors, 3 drugs stand out:

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

Similar ratios are found among calcium channel blockers, which are used to treat arterial hypertension:

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

For citation: Shulpekova Yu.O. Pantoprazole: worthy among the strongest // BC. 2011. No. 28. S. 1782

Modern medicine cannot be imagined without proton pump inhibitors (PPIs), which are widely used in gastroenterology, cardiology, pulmonology, and rheumatology. PPIs have undeniably proven effective in the treatment of acid-related diseases and their complications and superior to other classes of drugs.

The five main PPIs in a physician's practice are omeprazole, esomeprazole, rabeprazole, lansoprazole, and pantoprazole.
PPIs differ in the rate of onset and duration of antisecretory action, metabolic characteristics, release form (in capsules, enteric-coated tablets - MAPs (Multiple Unit Pellet System)), in the form of a solution for intravenous administration).
After oral administration, PPIs are released and absorbed in the small intestine. The active substance accumulates in areas with the lowest pH values; in the area of ​​secretory tubules of parietal cells, where pH=1÷2, the concentration of PPI is almost 1000 times higher than that in the blood. Under these conditions, PPIs are protonated and converted into their active form, sulfenamide. The latter irreversibly binds to the cysteine ​​residue of H+/K+-ATPase (proton pump) and blocks its function. This is accompanied by suppression of basal and stimulated secretion of hydrochloric acid (regardless of the nature of the stimulus). Acid production is restored as the newly synthesized H+/K+-ATPase molecules are incorporated into the parietal cell membrane.
The pH range at which PPI activation occurs is determined by the characteristics of their molecule. The rate of activation of pantoprazole with an increase in pH to 3 drops by half and practically stops at pH=4. Activation of other PPIs continues at a higher pH: thus, the rate of formation of isomeprazole sulfenamide, esomeprazole and lansoprazole decreases by 2 times at pH=4, rabeprazole - at pH=4.9. This feature allows us to consider pantoprazole as a drug that is selective for the parietal cells of the stomach, in the region of which the pH reaches the lowest values. Pharmacodynamics of pantoprazole does not imply the possibility of blockade of H+/K+-ATPase and H+/Na+-ATPase of other types of cells - biliary epithelium, blood-brain barrier, intestinal epithelium, renal tubules, corneal epithelium, muscles, immunocompetent cells, osteoclasts, and also influence on organelles with an acidic environment - lysosomes, neurosecretory granules and endosomes, where pH=4.5-5.0. The selectivity of action implies a lower likelihood of adverse events, especially with long-term use.
PPIs are metabolized in liver microsomes with the participation of cytochrome P450 subunits - CYP2C9, CYP2C19, CYP2D6 and CYP3A4. At the same time, they inhibit the oxidative activity of CYP enzymes to varying degrees. Of greatest importance is their interaction with CYP2C19 and CYP3A4.
Among the five most commonly used PPIs, pantoprazole has the least inhibition of CYP2C19 and the greatest inhibition of CYP3A4, according to in vitro studies. In terms of CYP2C19 inhibition, lansoprazole is followed by omeprazole, esomeprazole, rabeprazole, and pantoprazole; pantoprazole is followed by omeprazole, esomeprazole, rabeprazole, lansoprazole in terms of effect on CYP3A4.
The CYP2C19 gene is polymorphic, which affects the therapeutic effect of PPIs. CYP2C19 is involved in the metabolism of a significant number of drugs, therefore, the influence of PPIs on this cytochrome P450 subunit is of great practical importance. Pantoprazole has the least interaction potential with drugs detoxified by CYP2C19.
CYP3A4 also plays an important role in drug metabolism; its activity varies considerably. This cytochrome P450 subunit is also expressed on the apical membrane of the intestinal epithelium, which can significantly affect the bioavailability of drugs, contributing to the “first pass effect”.
In general, among the above PPIs, pantoprazole has the lowest affinity for the cytochrome P450 system, since immediately after the first phase of detoxification with the participation of CYP2C19 and CYP3A4, it enters the 2nd phase - the formation of sulfate, which occurs in the cytosol and sharply reduces the reactogenicity of the molecule.
In studies with the participation of healthy volunteers and patients with various pathologies, no significant interactions between pantoprazol and antacids, digoxin, diazepam, diclofenac, ethanol, phenytoine, glibenclamide, carbamazepine, caffeine, metoprolol, nipherapin, pyroxycam, theophyllin, and oiled, oral contrast, oral contraceptive were identified. , R -warfarin, clarithromycin, cyclosporine, tacrolimus, levothyroxine sodium. With the simultaneous administration of pantoprazole and coumarin anticoagulants, more careful monitoring of INR is necessary. The interaction of pantoprazole with methotrexate has not been studied enough.
Pantoprazole is presented on the Russian market by Nolpaza® (KRKA, Slovenia) in the form of enteric-coated tablets. They are small in size and easy to use.
The pharmacokinetics of pantoprazole is characterized by rapid absorption from the gastrointestinal tract; oral bioavailability is 77% and does not depend on food intake. The time to reach the maximum concentration of the drug in plasma (Cmax) when taken orally is 2-2.5 hours. With regular intake of pantoprazole, the Cmax value remains constant. The area under the concentration-time pharmacokinetic curve (AUC) and Cmax also does not depend on food intake. AUC reflects the amount of the drug that has reached the target of action - proton pump molecules, and correlates with the severity of the antisecretory effect. For pantoprazole, the AUC is 9.93 mmol/l.h, which is comparable to the AUC for 40 mg esomeprazole. There is a form for intravenous administration of pantoprazole.
Pantoprazole is 98% bound to plasma proteins. The half-life (T1 / 2) is 1 hour. 80% of metabolites are excreted by the kidneys, 20% - with bile. In chronic renal failure (including in patients on hemodialysis), no change in doses of the drug is required. In severe liver diseases, T1 / 2 increases to 3-6 hours, AUC increases 3-5 times, Cmax - 1.3 times compared with healthy individuals, and therefore a daily dose of pantoprazole is recommended, not exceeding 20 mg. In elderly patients, there is a slight increase in AUC and Cmax, which has no clinical significance.
In addition to the narrow pH range at which drug activation is observed, pantoprazole differs from other PPIs in its longer binding to the proton pump due to the formation of a covalent bond with an additional cysteine ​​residue (Cis 822). As a result, the half-life of the drug does not correlate with the duration of the antisecretory effect, and after stopping pantoprazole, gastric secretion is restored after 46 hours.
We believe it is necessary to provide data on the efficacy and safety of pantoprazole based on studies and reviews of the most recent years.
Efficacy of pantoprazole in GERD. PPIs have established themselves as first-line drugs in the treatment of moderate to severe GERD. These drugs reduce the volume of gastric secretion, increase the pH of gastric contents, preventing damage to the esophagus by hydrochloric acid, bile components and digestive enzymes.
The recommended dose of pantoprazole for reflux disease, depending on the severity of esophagitis and sensitivity to treatment, is 20-80 mg per day (in one or two divided doses). The 20 mg dose is more commonly prescribed for milder forms of GERD. A dose of 40 mg in the treatment of moderate and severe reflux esophagitis is comparable in effectiveness to omeprazole, lansoprazole, esomeprazole.
Supportive treatment with pantoprazole at a dose of 20-40 mg per day for up to two years prevents relapse of reflux esophagitis in the vast majority of patients.
You can also recommend taking 20-40 mg of pantoprazole "on demand" - in the event of heartburn and regurgitation. In the work of Scholten et al. on-demand pantoprazole 20 mg or esomeprazole 20 mg has been shown to be equally effective as long-term maintenance treatment for non-erosive GERD and LA esophagitis stages A-B. Against the background of taking pantoprazole, the severity of heartburn was less.
Pantoprazole 40 mg provides adequate control of nocturnal reflux symptoms and is comparable to esomeprazole in this respect.
In the review of Lehmann FS. and Beglinger C. and other works of recent years present data on the high efficiency of pantoprazole in the treatment of various forms of GERD and good tolerability of the drug. Against the background of treatment with this drug, the frequency of complications decreases and the quality of life of patients with reflux disease improves.
The effectiveness of pantoprazole depends on the genetically determined activity of CYP2C19 - S-mephenytoin 4'-hydroxylase. In Sheu B.S. et al. 240 patients with reflux esophagitis stages C and D according to the Los Angeles classification received pantoprazole at a dose of 40 mg per day for six months. Those patients who managed to achieve complete healing of erosions and resolution of reflux symptoms (n=200) were recommended to continue treatment with pantoprazole 40 mg “on demand” for a year. Based on the CYP2C19 genotype, "fast", "intermediate" and "slow metabolizers" were isolated. The effectiveness of on-demand therapy was higher in “slow metabolizers”: they took an average of 11.5 tablets per month (versus 16.3 in “intermediate” and 18.6 in “fast metabolizers”,<0,05) .
In overweight patients, the appointment of pantoprazole in a "double dose" - 40 mg 2 times a day improves the results of treatment of reflux esophagitis and allows you to quickly switch to the "on demand" regimen. The effectiveness of dose escalation is especially noticeable in "rapid metabolizers".
Two randomized, double-blind studies assessed the rate of onset of a clinical effect - relief of symptoms of non-erosive reflux disease and Savary-Miller stage 1 reflux esophagitis - during treatment with low-dose pantoprazole (20 mg per day) or second-generation histamine receptor blockers type 2 ( nizatidine 150 mg twice daily and ranitidine 150 mg twice daily). The studies were conducted in parallel groups, the severity of symptoms was assessed on a 4-point scale. During treatment with pantoprazole, a significantly higher proportion of patients noted the disappearance of heartburn already on the second day of treatment (39% vs. 14.5% in the group treated with nizatidine, p<0,01). Достоверная разница в пропорции пациентов, которых изжога перестала беспокоить, сохранялась в течение первой недели, а затем препараты показали равную эффективность .
GERD is often accompanied by sleep disorders. A cohort study examined the effect of pantoprazole on the well-being of patients with symptoms of reflux disease and obstructive sleep apnea. Patients received 40 mg of pantoprazole per day for 3 months. During therapy, a significant improvement was noted: a decrease in daytime sleepiness (p = 0.002), episodes of awakening from reflux symptoms (p<0,0001), выраженности храпа (р=0,03) .
In another study, 84% of patients with GERD who did not suffer from overweight had sleep disorders: reflux symptoms in the supine position and in the morning, difficulty falling asleep, interrupted sleep, morning weakness. During treatment with pantoprazole for an average of 1.4 months, 75% of the examined patients had a significant improvement in the quality of sleep; the vast majority have disappeared symptoms of reflux at night.
Modolell I. et al., in addition to assessing the clinical signs of sleep disturbance in such patients (snoring, apnea, drowsiness), conducted a polysomnographic study. Clinical and polysomnographic effect while taking pantoprazole was confirmed in 78% of patients.
Pantoprazole has also found application in anesthesiology. One of the most dangerous complications of general anesthesia is aspiration of gastric juice; A gastric pH of 2.5 and a gastric volume of 25 ml (0.4 ml/kg body weight) before surgery are considered high risk. In a double-blind study, pantoprazole 40 mg was significantly more effective than the prokinetic erythromycin 250 mg in reducing the risk of aspiration complications (when taken once at least 1 hour before anesthesia).
The issue of the efficacy and safety of PPIs in children remains poorly understood (insufficient evidence has been accumulated). Therefore, in the instructions for the appointment of pantoprazole, children's age may appear among the contraindications. However, in pediatrics, some studies are devoted to this drug. When studying the pharmacokinetics and safety of pantoprazole at a daily dose of 20-40 mg in children 6-16 years old with GERD, no data were obtained in favor of cumulation of pantoprazole and no serious adverse events were recorded. Two studies examined the efficacy and safety of different doses of the drug in the treatment of GERD in children aged 1 month to 5 years, including preterm infants. Good tolerability of pantoprazole, relief of symptoms and healing of erosive changes in the esophagus by the 8th week of treatment were shown. The frequency of adverse events did not increase with increasing dose.
Pantoprazole in the treatment of peptic ulcer, functional dyspepsia, drug gastropathy. For peptic ulcer of the stomach and duodenum, pantoprazole is used at a dose of 40 mg 1-2 times a day. As part of eradication therapy (usually in combination with metronidazole, clarithromycin or amoxicillin), without prior testing for antibiotic resistance, pantoprazole at a dose of 40 mg 2 times a day provides a Helicobacter pylori eradication rate of 71-93.8% (analysis of intent- to-treat). The triple eradication regimen with pantoprazole is as effective as that including omeprazole or lansoprazole.
A Malaysian study assessed the eradication rate, tolerability and adherence of patients to triple anti-Helicobacter therapy with pantoprazole. Participants included 26 peptic ulcer patients and 165 non-ulcer dyspeptic patients infected with H. pylori. Patients received standard triple anti-Helicobacter therapy with pantoprazole 40 mg 2 times a day for 7 days. The effectiveness of eradication was assessed using a respiratory urease test. Treatment according to the protocol was completed in 84.4% of patients, the eradication rate was 71.2%. During the treatment period, adverse events were recorded in 68 (42.5%) participants: dyspepsia, loose stools, dizziness, skin rash. In no case was the adverse event reported as serious. The authors conclude that the triple eradication regimen with pantoprazole is very well tolerated.
Pantoprazole at a daily dose of 20 mg orally is effective in the prevention of gastropathy associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). For the treatment of medicinal erosive and ulcerative lesions of the stomach and duodenum, pantoprazole is prescribed 40 mg 1-2 times a day.
A double-blind, placebo-controlled study with a total of 800 participants examined the effectiveness of pantoprazole in controlling symptoms when taking NSAIDs and assessed the influence of various factors (such as gender, age, alcohol consumption, smoking, Helicobacter pylori infection) on treatment efficacy. Pantoprazole was prescribed at a dose of 20 mg per day, the duration of therapy was 4 weeks. The severity of dyspeptic symptoms was significantly lower in the group treated with pantoprazole (p<0,0001); эффект препарата стал наиболее отчетливым через 7 дней лечения, независимо от влияния основных факторов риска .
With high gastric hypersecretion, including Zollinger-Ellison syndrome, pantoprazole is prescribed in doses from 80 to 160-240 mg per day orally or intravenously; the duration of treatment is selected individually.
Pantoprazole is safe for long-term use. A British study examined the efficacy and tolerability of 5 years of pantoprazole in 150 patients with acid-dependent diseases (peptic ulcer or erosive reflux esophagitis) with frequent exacerbations and treatment-resistant H2-blockers. During exacerbation of diseases, the daily dose of pantoprazole was 80 mg, if it was ineffective for 12 weeks, the dose was increased to 120 mg, and when healing was reduced to 40 mg. Among others, parameters such as histological changes, the level of gastrin in the blood serum, and the population of enterochromaffin cells in the mucosa were evaluated. The proportion of patients in stable remission after one year was 82%, two years - 75%, three years - 72%, four years - 70%, five years - 68%. The duration of remission in reflux disease did not depend on H. pylori infection. In the course of treatment, the level of serum gastrin increased by 1.5-2 times (especially high values ​​were noted with Helicobacter pylori infection). In some patients episodic rises in gastrin >500 ng/l have been registered. In patients infected with H. pylori, there was a decrease in the severity of gastritis in the antrum and an increase in the body of the stomach, with the appearance of signs of atrophy. The number of enterochromaffin cells in the antrum changed insignificantly over 5 years, but in the body of the stomach it decreased by about a third. Adverse events definitely associated with taking pantoprazole were recorded in 4 patients. Thus, the tolerability of long-term treatment with pantoprazole is generally consistent with that of other PPIs.
pantoprazole and clopidogrel. In recent years, the issue of drug interactions between PPIs and clopidogrel has become acute, which is accompanied by a decrease in the therapeutic and prophylactic effect of the antiplatelet agent, an increase in the tendency to arterial thrombosis in patients at risk. PPIs are often given to these patients to prevent drug-induced gastropathy and bleeding.
The reason for concern was, in particular, the results of a retrospective cohort study that analyzed the course of the disease in 16,690 patients who underwent coronary artery stenting and received therapy with clopidogrel (9862 patients) or clopidogrel in combination with PPIs (6828 patients) with high adherence to treatment . The primary endpoint was the frequency of "major cardiovascular events" (stroke, transient ischemic attack with hospitalization, acute coronary syndrome, coronary revascularization, death due to cardiovascular disease) at 12 months after stenting. In the cohort of patients receiving only clopidogrel, the frequency of "major cardiovascular events" was 17.9%, in the cohort receiving clopidogrel and PPI - 25% (adjusted hazard ratio 1.51, 95% confidence interval (CI) 1, 39-1.64, p<0,0001). В данной работе не обнаружено существенных различий риска при приеме отдельных ИПП .
The prodrug clopidogrel is converted to the active metabolite by CYP2C19 in the liver. Since most PPIs inhibit the activity of this cytochrome P450 subunit, this may reduce the therapeutic and prophylactic effect of clopidogrel: accompanied by an increase in platelet reactivity and a tendency to arterial thrombosis. So, omeprazole reduces the AUC of the active metabolite of clopidogrel by 50%. It is also possible that there are other mechanisms for the effect of PPIs on the activity of clopidogrel.
The recommendations of the All-Russian Scientific Society of Cardiology (VNOK) in patients with stable manifestations of atherothrombosis emphasize that although the clinical significance of the interaction of PPIs and clopidogrel has not been finally determined, the manufacturer of the original clopidogrel does not recommend its simultaneous use with drugs that suppress CYP2C19. At the congress of the European Society of Cardiology in August 2011 in Paris, new recommendations for the treatment of non-ST-segment elevation ACS were presented, according to which the use of new antiplatelet drugs prasugrel and ticagrelor is recommended for the treatment of ACS. Treatment with clopidogrel is justified only in cases where the appointment of the first two drugs is not possible. In patients receiving dual antiplatelet therapy, treatment with a proton pump inhibitor (preferably not omeprazole) is indicated if there is a history of gastrointestinal bleeding or peptic ulcer disease, as well as in the presence of several risk factors for gastrointestinal bleeding.
It should be noted that the effect of pantoprazole on CYP2C19 activity is significantly weaker than that of other PPIs. Its neutrality with respect to clopidogrel was demonstrated in a population-based case-control study that included 13,636 patients who were recommended to take this antiplatelet agent after myocardial infarction. The study examined the incidence of recurrent or recurrent heart attack within 90 days of hospital discharge and its association with PPI use. Statistical analysis showed that concurrent (within the previous 30 days) PPI use was associated with an increased risk of recurrent/recurrent myocardial infarction (odds ratio 1.27, 95% CI 1.03-1.57). No association was found with PPI use more than 30 days prior to a recurrent coronary event. Stratified analysis showed that pantoprazole did not suppress the preventive effect of clopidogrel and did not increase the risk of recurrent/recurrent myocardial infarction (odds ratio 1.02, 95% CI 0.70-1.47).
For a more in-depth study of the interaction of clopidogrel, omeprazole and pantoprazole, 4 randomized placebo-controlled studies with a crossover design were conducted; 282 healthy volunteers participated in them. Clopidogrel was given at a loading dose of 300 mg followed by a maintenance dose of 75 mg daily, omeprazole 80 mg concomitantly (Study 1); then at 12 hour intervals (Study 2). The effect of increasing the dose of clopidogrel to 600 mg (loading) and 150 mg (maintenance) (study 3) and interaction with pantoprazole (at a dose of 80 mg) (study 4) were also studied. The study showed that the addition of omeprazole led to a decrease in the area under the pharmacokinetic curve (AUC) for the active metabolite of clopidogrel, as well as an increase in platelet aggregation in the presence of adenosine diphosphate, and increased platelet reactivity. Pantoprazole had no effect on the pharmacodynamics and effect of clopidogrel.
The interaction of clopidogrel and double-dose pantoprazole was studied in another randomized cross-over study. Twenty healthy volunteers received clopidogrel (600 mg loading dose and 75 mg daily maintenance dose) and pantoprazole (80 mg daily) for a week. Pantoprazole was prescribed simultaneously with clopidogrel or with a gap of 8 or 12 hours. Prior to the randomization procedure, subjects received only clopidogrel for a week. Platelet function was assessed by different methods at different time points. It has been shown that high dose pantoprazole has no effect on the pharmacodynamic effects of clopidogrel, regardless of the mode of administration.
Thus, pantoprazole (Nolpaza®) is characterized by high efficacy in the treatment of acid-dependent diseases, comparable to the efficacy of other modern PPIs, and good tolerance even with long-term use.
The high selectivity of pH-mediated activation of pantoprazole suggests less systemic exposure to the drug. This issue requires special comparative studies.
The drug is safe in old age; not contraindicated in severe pathology of the liver and kidneys.
The undoubted advantage of pantoprazole is the low potential for interaction with other medicinal substances, which is especially important in the treatment of elderly patients who may take several drugs or receive drugs with a narrow "therapeutic corridor". In patients taking clopidogrel, pantoprazole has established itself as a drug that does not significantly affect the action of the antiplatelet agent.

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

For the treatment of inflammatory processes in the stomach, drugs belonging to the group "proton pump inhibitors" are used. These drugs contain various active ingredients, such as omeprazole or esomeprazole. What is the difference between them? Consider 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 work of cells responsible for the production of hydrochloric acid in the stomach. On its basis, both the drug of the same name and are produced.

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

In addition, omeprazole has a neutralizing effect, reducing the acidity of existing gastric juice. 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. Ulcer of the stomach, duodenum, including those provoked by stress, taking medications;
2. Reflux esophagitis;
3. Tumor of the islet apparatus of the pancreas.

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

When prescribing the drug, it should be borne in mind that the excretion of omeprazole from the body creates an unnecessary 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, the patient's age is 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 recurrence caused by Helicobacter pylori), prevention of recurrence 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 composition of the drug;
• Simultaneous appointment 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;
• It is not recommended during pregnancy and lactation, since there are no official data on the safety of the drug for the child.

Comparison of Esomeprazole and Omeprazole

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

Manufacturer and price

Omeprazole is represented on the domestic market by manufacturers from various countries (Russia, Serbia, Israel). 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 for packing.

active ingredient

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

Release form

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

Contraindications

"Omeprazole" is very versatile, its popularity is due to the fact that there are few contraindications to its use. It is prohibited for use by young children, people with intolerance to omeprazole and other components of the drug, as well as pregnant and lactating women.

In exceptional cases, when it comes to serious medical indications, Omeprazole can be prescribed to children aged four years and older, as well as to expectant mothers, however, this is rather an exception to the rule.

Neither "Omeprazole" nor "Esomeprazole" should be thoughtlessly used in renal and hepatic insufficiency, since the removal of these compounds from the body imposes an additional burden on these organs, which can lead to side (including severe) effects.

Side effects

In any instructions for Omeprazole, you can read a fairly impressive list of side effects, after reading which it will become scary to take such a dangerous drug. At the same time, one 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 passes without any negative reactions. Those that do occur go away quickly without any special treatment.

So, most often against the background of taking Omeprazole, pain in the head, upset stool, nausea, and abdominal pain may occur. Even rarer, less than 1% cases of admission, sleep disturbance, itching and rashes on the skin, swelling of the extremities are observed.

In the list of possible side effects from taking Esomeprazole, you can also see disorders from:

• blood and lymphatic system;
• immune system;
• metabolism and nutrition;
• nervous system;
• organs of hearing, respiration, skin;
• hepatobiliary disorders;
• muscle and bone-articular changes;
• renal disorders;
• reproductive and sexual sphere;

But still, most often, less 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, no effect on plasma concentration of most other medicinal substances was observed.

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 their effectiveness decreases if they are taken together. Esomeprazole works the same way.

Summing up the above, it is impossible to unequivocally answer the question of which of the drugs is better. Based on the practice of application, we can say that the use of "Esomeprazole" in the treatment of reflux disease is more effective.

However, in the case of the treatment of peptic ulcer, the results of the use of both drugs are approximately the same. The main difference is the price of the drug, and also (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 an important factor. That is why the decision on the choice of the drug should be made by the attending physician, taking into account the financial capabilities of the patient.

Read more:

Proton pump inhibitors have changed the perception of the possibilities of treatment of gastritis, peptic ulcer and reflux esophagitis, allowing to reduce the percentage of relapses and complications.

The article tells about Esomeprazole, the most effective remedy of this group, gives practical advice on choosing analogues based on the properties of drugs and their comparison, instructions for use, prices and reviews.

Drug properties

Esomeprazole is a levorotatory isomer of omeprazole, an improved version of a reliable inhibitor of the gastric proton pump. The product reduces acidity.

The original drug esomeprazole - Nexium, which is prescribed in the form of oral forms and intravenous infusions. It is used in the form of tablets of 20 and 40 milligrams and vials with 20 mg of esomeprazole in the form of a powder for the preparation of an infusion solution.

Orally, Nexium is used to treat:

• gastroesophageal reflux disease, esophagitis;
• ulcers of the stomach and duodenum;
• other erosive lesions and ulcerative processes associated with the use of anti-inflammatory drugs;
• in Helicobacter pylori eradication schemes in combination with antibiotics;
• gastrointestinal bleeding, Zollinger-Ellison syndrome.

Esomeprazole is used to prevent stomach and duodenal damage in people taking non-steroidal anti-inflammatory drugs.

The infusion form is used in cases where oral administration of the drug is not possible.

Tablets are prescribed at a dose of 20-40 mg 1 time per day. In the treatment of Helicobacter pylori infection, Nexium is used twice at 20 mg with antibacterial agents in a course of 1-2 weeks. It is administered intravenously in the same doses, with severe bleeding, the daily dose reaches 160 mg. With reflux disease, the course of maintenance therapy lasts up to six months.

Esomeprazole should not be combined with clopidogrel- the main antiplatelet agent for the prevention of myocardial infarction and stroke, used by the majority of patients with cardiac and vascular pathology.

It is not combined with diazepam, antiretroviral agents, methotrexate.

The drug is well tolerated, occasionally there may be undesirable effects in the form of dyspeptic disorders, swelling and drowsiness, allergic reactions are rare. P contraindications are associated with age restrictions and allergies- the parenteral form of Nexium is used from the age of 18, tablets are not prescribed for children under 12 years of age, the remedy is not used if its components are intolerant.

The cost of 14 tablets of 20 and 40 mg is 1500 and 2000 rubles, a bottle with 40 mg of the drug for infusion costs 600 rubles.

Inexpensive analogues of Nexium

In addition to the expensive original medicine, pharmacies sell cheap synonyms for esomeprazole and other PPIs.

Based on Esomeprazole

Generic tablet preparations of esomeprazole, identical to Nexium:

• Neo-Zext and Emanera (Slovenia) 28 tablets of the first, 20 and 40 mg each, cost 2100 and 2600 rubles, the second drug is cheaper, 14 capsules of 20 mg each cost 220 rubles;
• domestic generic - Esomeprazole Canon, the price of 14 tablets of 20 and 40 mg - 190 and 300 rubles.

These drugs completely repeat the composition and action of Nexium, have the same indications and features of use.

The drug for parenteral use is Esomeprazole-native (LLC Nativa, Russia), it is registered, but not yet on sale. The injection form of Nexium will have to be replaced with drugs of a different composition- products based on omeprazole and pantoprazole.

Other PPIs

As a replacement for esomeprazole, other proton pump inhibitors can be successfully used: pantorazole (Controloc, Nolpaza), omeprazole (Omez), rabeprazole, lansoprazole.

Omez

PPI drug, the first to appear in pharmacies. Available in capsules of 10 and 20 mg, and vials of 40 mg. Used to treat adults and children from 1 year. The oral form is taken 1 caps 2 times a day.

Popular due to the optimal ratio between price and quality. 30 capsules of 20 mg and 1 bottle cost 170 rubles. Domestic Omeprazole from different manufacturers is 3-5 times cheaper.

Controloc

The original preparation of pantoprazole in tablets of 20 and 40 mg and vials of 40 mg. It is prescribed 1 tablet per day. Provides strong and long-lasting acidity reduction. It has the fewest drug-drug interactions among PPIs.

May be given with clopidogrel. The parenteral form is the main proton pump inhibitor for prophylactic use in surgical departments. The price of 14 tablets is 350 rubles, a bottle of medicine costs 400 rubles. The generic drug Nolpaza costs 140 and 200 rubles for 14 tablets of 20 and 40 mg.

Rabeprazole

Capsules of 10 and 20 mg, which are taken 1 time per day. Used for medicinal purposes only contraindicated in pregnancy and lactation. 14 capsules are sold for 100 and 150 rubles.

Lansoprazole

It has fewer indications and more restrictions - it is not recommended for prevention, it is not used at the beginning of pregnancy, while breastfeeding and for the treatment of children. The Russian drug is available in capsules of 0.03 grams under the name "Epicurus". Package number 14 costs 400 rubles.

When choosing a proton pump inhibitor, it should be taken into account that the main drugs with the greatest effectiveness are esomeprazole and pantoprazole. In addition to efficiency, the difference lies in drug interactions and the rate of development of the effect.

In a simplistic approach to drug selection, esomeprazole is recommended for young patients and pantoprozole for older people on long-term or life-long medications such as clopidogrel or benzodiazepines.

There are no differences in the schemes for the eradication of Helicobacter pylori when choosing PPIs, the decisive role in the success of combination therapy is determined by the combination of antibiotics. In such cases, they are all taken 2 times a day along with antibacterial agents.