Are the orally administered proton pump inhibitors equivalent? A comparison of lansoprazole, omeprazole, pantoprazole, and rabeprazole

Abstract

Four proton pump inhibitors (PPIs) are currently marketed in various parts of the world, and all of these (lansoprazole, omeprazole, pantoprazole, and rabeprazole) are available for prescription use in the United States. As a therapeutic group, the PPIs are highly useful for the relief of symptoms and healing of gastroesophageal reflux disease, gastric and duodenal ulcer disease, eradication of Helicobacter pylori infection, prevention and treatment of nonsteroidal anti-inflammatory drug (NSAID)-associated damage, management of hypersecretory states such as Zollinger-Ellison syndrome, and care of patients with non-variceal upper gastrointestinal bleeding, or non-ulcer dyspepsia. The pathophysiologic basis of these management benefits lies in the potent gastric acid inhibitory effects of the PPIs. There are differences between the PPIs in their pharmacokinetics, pharmacodynamics, influence by food and antacids, clinical efficacy, and potential for drug interactions. It is not always clear whether these often subtle variations are necessarily of clinical importance. The physician's choice of one PPI over another must rest with her/his interpretation of the clinical importance of the generally small differences between PPIs, their approval for treatment of specific clinical indications within the physician's practice jurisdiction, and the strength of the evidence based on the quantity and quality of the supporting clinical trials.

Potent Gastric Acid Inhibition in Helicobacter pylori Eradication

“…One particular difference of this drug as compared with the foregoing PPIs is its lesser affinity for the hepatic cytochrome P450, and thus its potential (albeit of doubtful clinical relevance) advantages regarding pharmacologic interactions. [62,[66][67][68][69][70][71][72][73] As previously stated, PPIs possess in vitro antibacterial activity against H. pylori, but differences do exist in this aspect depending on the type of PPI. Thus, again in vitro, pantoprazole is less effective against H. pylori than omeprazole or lansoprazole.…”

The Power of Pharmacological Sciences: The Example of Proton Pump Inhibitors

“…Subsequently other PPIs were developed that are similar to omeprazole in terms of structure, mechanism of action, pharmacokinetics, effi cacy and safety [21,22] . These drugs all have a sulfi nyl group between substituted benzimidazole and pyridine rings.…”

“…These drugs all have a sulfi nyl group between substituted benzimidazole and pyridine rings. After diffusion from the blood into the acid environment of the stomach secretory canaliculi, the PPIs form a sulfenamide which irreversibly inactivates the ATPase [9,21,22] . This phenomenon allowed for once-a-day dosing in most patients [9,21] .…”

“…Several questions were answered with the availability of safe and potent, specifi c, irreversible inhibitors of H + ,K + -ATPase that permit essentially 90-100% inhibition of stomach acid production around the clock in compliant patients receiving adequate doses [9,21,22] . Demonstrated even in the initial clinical trials, inhibition of acid production by PPIs led to rapid healing, symptomatic relief and near elimination of complications in patients with peptic diseases of the stomach and duodenum even in the face of continued H. pylori infection, an exceptional result.…”

Gli inibitori della pompa protonica nelle patologie acido correlate: il ruolo di rabeprazolo in una strategia di cost-minimisation

“…Esistono in letteratura numerose reviews che confrontano l'efficacia clinica dei diversi IPP [7]: in particolare il lavoro di Stedman e Barclay [8] ha confrontato i risultati emersi da 14 lavori in termini di efficacia clinica di diversi IPP per il trattamento della MRGE, evidenziando come per la maggior parte degli studi sia stata dimostrata sul campo una medesima risposta al farmaco sia in acuto sia per il mantenimento. Uno studio accurato della letteratura sull'argomento mostra come sia diffusa la consapevolezza nella classe medica di una simile efficacia fra i diversi IPP [9,10].…”