Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Proton Pump Inhibitors (PPIS) are considered to be the most potent therapy options available to treat GERD. These classes of drugs have relatively fewer side effects and can be used and tolerated for long periods of time.
Esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex) are examples of proton pump inhibitors. Esomeprazole is a newer, improved form of omeprazole and has been found to provide sustained relief of heartburn pain more quickly than omeprazole (in
five days with esomeprazole taken at 40 mg/day versus seven to nine days with omeprazole at 20 mg/day).
How proton pump inhibitors work: These drugs are more potent than H2 blockers in blocking acid secretion from the stomach.
Who should not use these medications: Individuals who have experienced an allergic reaction to these drugs should not take them.
Use: Proton pump inhibitors are taken orally as a once-daily dose. Pharmacists may make liquid forms of omeprazole and lansoprazole for children. Contents of esomeprazole capsules may be sprinkled on a tablespoon of applesauce immediately before administration for people who cannot swallow capsules.
Drug or food interactions: These drugs may increase blood levels of diazepam (Valium), warfarin (Coumadin), phenytoin (Dilantin), and digoxin (Lanoxin), and may interfere with the absorption of iron products like ketoconazole (Nizoral) and itraconazole (Sporanox), thereby decreasing their effectiveness.
However, data have shown that PPIs can interfere with calcium homeostasis and may aggravate cardiac issues. They are also linked to hip fracture in postmenopausal women. Specifically with omeprazole, high doses and long-term use (one year or longer) may increase the risk of
osteoporosis-related fractures of the
wrist, or spine. Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.
Side effects: Common adverse effects include headache, diarrhea,
gas, and stomach pain.
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