Proton pump inhibitors (PPIs): Uses, most common brand names, and safety information
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By the 1970s, researchers discovered that a newly found proton pump (H+/K+ ATPase) in the parietal cells of the stomach was the final step in acid secretion. In 1975, timoprazole was shown to inhibit acid secretion but studies also showed it caused thyroid gland enlargement due to the inhibition of iodine. While timoprazole never made it to market, a derivative, omeprazole, was discovered in 1979. Clinical trials in the 1980s showed it to be more effective at reducing stomach acid than antacids and H2 receptor antagonists (H2-blockers). This led to the launch of omeprazole in 1988 as Losec in Europe and 1990 as Prilosec in the U.S. Since the release of Prilosec (omeprazole), there have been several analogs of omeprazole that have made it to the market. The global proton pump inhibitor (PPI) market is expected to reach a value of $3.26 billion by 2026.
The list below includes proton pump inhibitors (PPIs) approved by the U.S. Food and Drug Administration (FDA) and their pricing:
List of Proton pump inhibitors (PPIs)
Prilosec is indicated to treat gastric and duodenal ulcers, GERD, H. pylori eradication, esophagitis, and hypersecretory conditions.
Nexium is indicated to treat GERD, esophagitis, Zollinger-Ellison syndrome, dyspepsia, and NSAID-induced gastric ulcer.
Prevacid is indicated to treat GERD, NSAID-associated gastric ulcers, heartburn, and hypersecretory conditions.
Prevacid SoluTab (lansoprazole)
Prevacid SolutTab is indicated to treat GERD, NSAID-associated gastric ulcers, heartburn, and hypersecretory conditions.
Dexilant is indicated to treat GERD and erosive esophagitis.
Aciphex is indicated to treat GERD, duodenal ulcers, H. pylori eradication, and hypersecretory conditions.
Protonix is indicated to treat GERD, erosive esophagitis associated with GERD, and Zollinger-Ellison syndrome.
Some other combination medications that contain PPIs include:
- Yosprala (aspirin/omeprazole)
- Zegerid (omeprazole/sodium bicarbonate)
What are proton pump inhibitors (PPIs)?
Proton pump inhibitors (PPIs) are a class of medications that decrease the production of gastric acid by inhibiting an enzyme in the wall of your stomach. They are the most potent acid suppressants available on the market today. By lowering acid levels in the stomach, they reduce acid reflux into your esophagus and help prevent heartburn. This also allows damaged tissue in your digestive tract time to heal.
PPI therapy is now the first-line treatment in gastrointestinal conditions such as gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). You can find some PPIs over-the-counter (OTC) while others will require your doctor to write a prescription. While PPIs are considered safe, long-term use of PPIs has been associated with an increased incidence of serious adverse events.
How do proton pump inhibitors (PPIs) work?
Stomach acid, gastric acid, and hydrochloric acid all refer to the acid naturally produced by the cells lining your stomach. This acid serves a variety of functions such as breaking down food as well as activating digestive enzymes in the stomach and small intestine. It also kills bacteria and helps release vitamin B-12 from food so it can be absorbed. If your stomach produces too much acid, it can lead to complications such as GERD or stomach ulcers.
Proton pump inhibitors (PPIs) reduce acid secretion in your stomach. They are prodrugs that need to be activated under acidic conditions to work. Once activated, PPIs inhibit the H+/K+ ATPase enzyme (proton pump) in the parietal cells in your stomach, which controls acid production. Taking a PPI daily inhibits approximately 70% of the proton pumps, so a small amount of acid is still available to digest food.
What conditions are proton pump inhibitors (PPIs) used to treat?
Proton pump inhibitors (PPIs) are a class of medications used in the treatment of:
- Erosive esophagitis
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease (PUD)
- Gastric and duodenal ulcers
- Prevention of nonsteroidal anti-inflammatory drug (NSAID) ulcers
- Zollinger-Ellison Syndrome
- Part of the triple therapy regimen for Helicobacter pylori infections
Are proton pump inhibitors (PPIs) safe?
The use of PPIs is relatively safe and effective when taken as prescribed. Your prescribing physician should be aware of your medical conditions, including:
- Hypomagnesemia (low magnesium levels)
- Hypocalcemia (low calcium levels)
- Liver disease
- Kidney disease
- Vitamin B12 deficiency
- Are pregnant, plan on becoming pregnant, or are breastfeeding
You should also make sure they are aware of all the medications you take, including prescription drugs, over-the-counter medications, and supplements, as they may cause drug interactions:
- Plavix (clopidogrel)
- Dilantin (phenytoin)
- Valium (diazepam)
- Coumadin (warfarin)
- Lanoxin (digoxin)
- Nizoral (ketoconazole)
- Trexall (methotrexate)
Can you take proton pump inhibitors (PPIs) while you are pregnant or breastfeeding?
Most PPIs are classified as Pregnancy Category B drugs, except for Prilosec (omeprazole). It is classified as a category C medication. However, multiple studies since their classification have shown Prilosec (omeprazole) to be as safe as other PPIs in pregnant women. Generally, PPIs are considered safe to use during pregnancy.
There is little data on the use of PPIs during lactation. Prilosec (omeprazole) and Protonix (pantoprazole) have limited evidence that supports their use but other PPIs are also probably safe to use.
You should always discuss the risks and benefits of any medication you need with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
What are the common side effects of Proton pump inhibitors (PPIs)?
Some common adverse effects of proton pump inhibitors (PPIs) include:
- Flatulence (gas)
- Abdominal pain
- Altered taste
Long-term proton pump inhibitor use can sometimes cause serious side effects, including:
- Low magnesium levels
- Increased risk of osteoporosis and bone fractures when taking high doses of PPIs
- Increased risk of clostridium difficile infection
- Rebound acid secretion after discontinuing long-term PPI use
- Vitamin B-12 deficiency
- increased risk of community-acquired pneumonia (CAP)
- Possible increased risk of gastric cancer
- Possible increased risk of dementia
This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.
How much do Proton pump inhibitors (PPIs) cost?
Proton pump inhibitors (PPIs) are very expensive with an average cost of up to $1,000 per year for the brand name medication.
You can purchase Proton pump inhibitors (PPIs) for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.
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