Interchangeable Use of Proton Pump Inhibitors Based on Relative Potency

Graham, David Y.; Tansel, Aylin

doi:10.1016/j.cgh.2017.09.033

Cited by 147 publications

(167 citation statements)

References 103 publications

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“…4 ). 5,6 The new generation of PPIs, the reversible potassium inhibitors, have theoretical advantages over traditional PPI as they (a) achieve full effectiveness with a single day's administration vs. requiring 3-5 days for traditional PPIs, (b) inhibit both active and non-secreting parietal cells, and (c) have a long half-life in the plasma making them as effective as twice a day PPI therapy. 4 Proton-pump inhibitors (PPIs) are the most widely used antisecretory agents.…”

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Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

2018

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Background Helicobacter pylori treatment recommendations often recommend use of double‐dose PPI or greater. This is confusing because PPIs very markedly in relative potency such that a double dose of one may not even be equivalent to the single dose of another. Objective To relate the concept of double‐dose to specific amounts of the different PPIs Methods We used data standardizing PPI potency in terms of the duration of intragastric pH >4/24 hours (pH4‐time) to rank PPIs. Relative potency varies from 4.5 mg omeprazole equivalents (20 mg pantoprazole) to 72 mg omeprazole equivalents (40 mg rabeprazole). Results We defined PPI dosing for H. pylori therapy as low dose (eg, approximately 20 mg omeprazole equivalents, b.i.d.), high or double dose as approximately 40 mg omeprazole equivalents, b.i.d.) and high dose as approximately 60 mg omeprazole equivalents, b.i.d.). For example, standard double dose PPI would thus be 40 mg of omeprazole, 20 mg of esomeprazole or rabeprazole, 45 mg of lansoprazole, or 120 mg of pantoprazole each given b.i.d. Conclusions Simply doubling the dose of any PPI achieves markedly different effects on pH4‐time. However, PPIs can be used interchangeably and cost effectively based on their omeprazole equivalency.

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Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

2018

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“…PPI effectiveness would likely be a critical variable and we believe it is likely that improvement would relate to increased the omeprazole equivalents administered once or twice daily. This approach has been shown to increases pH>4-time [5] and symptom response [12]. Further studies of large group of patients with what is considered to be inadequate PPI responses are needed to allow reliably identify subgroups for which specific therapy can be tailored to their primary abnormality, which in turn would enable the construction of reliable treatment algorithms.…”

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confidence: 99%

“…Understanding relative PPI potency in terms of improving pH>4-time increases PPI effectiveness by increasing the omeprazole equivalents administered, the frequency of PPI administration, or both. Omeprazole equivalents can be increased by increasing a PPI’s dose or substitution of a more potent PPI [5]. The most marked increase in pH>4-time is obtained by using twice-a-day dosing (i.e., approximately 10 mg of omeprazole twice-a-day is equivalent to 40 mg of esomeprazole or rabeprazole once a day.)…”

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“…The most marked increase in pH>4-time is obtained by using twice-a-day dosing (i.e., approximately 10 mg of omeprazole twice-a-day is equivalent to 40 mg of esomeprazole or rabeprazole once a day.) [5]. Since PPIs also vary remarkably in cost to the patient, it should be possible to select a combination of PPI and once or twice-a-day dosing that is most cost-effective in any specific locality.…”

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confidence: 99%

“…The omeprazole equivalents, OE, are shown for each PPI [5] as well as the mean pH4time. Adapted from Spechler et al [11].…”

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Optimal PPI Dosing for Improving GERD Symptoms: Is Timing Everything?

Graham

2018

Dig Dis Sci

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Gastroesophageal Reflux Disease

Maret-Ouda

Markar

Lagergren

2020

JAMA

213

195

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astroesophageal reflux disease (GERD) is defined by its cardinal symptoms (recurrent and troublesome heartburn and regurgitation) or by its specific complications (esophagitis, peptic strictures, and Barrett esophagus). 1 Barrett esophagus is a columnar metaplasia replacing parts of the native squamous cell epithelium that can progress to esophageal adenocarcinoma. 2 GERD can be a serious problem and should not be confused with less severe disease such as gastritis or the very common symptoms of dyspepsia or regurgitation that occur in almost all individuals without any underlying gastrointestinal pathology. GERD is caused by gastric contents' reaching the esophagus. Except for causing esophageal symptoms or complications, gastric juices can also reach more proximally (ie, into the pharynx, mouth, larynx, and airways) and cause or worsen various extraesophageal symptoms and conditions such as hoarseness, wheezing, cough, and asthma. 1 Established risk factors for developing GERD include increased body mass index, tobacco smoking, and genetic predisposition, 3 whereas infection with the gastric bacterium Helicobacter pylori can decrease this risk. 4 The prevalence of GERD is high and increasing, with greater rates in high-income countries (15%-25%) than in most low-and middle-income countries (<10%). 2,5 GERD can result in diminished health-related quality of life, and its prevalence and need for longterm treatment can consume substantial health care resources and result in high costs to society. 6,7 This review provides an update of the current evidence regarding GERD, with an emphasis on its clinical management in adults.IMPORTANCE Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries.OBSERVATIONS GERD can influence patients' health-related quality of life and is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma. Obesity, tobacco smoking, and genetic predisposition increase the risk of developing GERD. Typical GERD symptoms are often sufficient to determine the diagnosis, but less common symptoms and signs, such as dysphagia and chronic cough, may occur. Patients with typical GERD symptoms can be medicated empirically with a proton pump inhibitor (PPI). Among patients who do not respond to such treatment or if the diagnosis is unclear, endoscopy, esophageal manometry, and esophageal pH monitoring are recommended. Patients with GERD symptoms combined with warning symptoms of malignancy (eg, dysphagia, weight loss, bleeding) and those with other main risk factors for esophageal adenocarcinoma, such as older age, male sex, and obesity, should undergo endoscopy. Lifestyle changes, medication, and surgery are the main treatment options for GERD. Weight loss and smoking cessation are often useful. Medication with a PPI is the most common treatment, and after initial full-dose therapy, w...

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Interchangeable Use of Proton Pump Inhibitors Based on Relative Potency

Cited by 147 publications

References 103 publications

Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

Optimal PPI Dosing for Improving GERD Symptoms: Is Timing Everything?

Gastroesophageal Reflux Disease

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