Proton pump inhibitors in comparison

introduction

Proton pump inhibitors contain active ingredients that reduce the acid content in the stomach by blocking the so-called proton pump (H + / K + -ATPase).

Proton pump inhibitors are approved in Germany for diseases such as reflux disease, gastritis, ulcers in the stomach and duodenum, as well as abnormally increased production of gastric acid. Proton pump inhibitors are also frequently used to protect against prolonged use of painkillers such as aspirin, ibuprofen or diclofenac.

The following drugs are approved in Germany, which come under the term proton pump inhibitors: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazo, Rabeprazole. Generics are already available for some active ingredients.

Mode of action

The Mode of action is the same for all proton pump inhibitors available on the market. They all have in common that the proton pump in the so-called Parietal cells of the stomach irreversibly inhibited becomes. This pump is responsible for that Protons (H + ions) into the interior of the Stomach and stomach acid is produced. After irreversible inhibition of this pump, protons can only be transported again when the body new proton pumps formed Has.
This is different for the five proton pump inhibitors available in Germany respective equivalent dose. This means that in order to achieve the same potency in the body, different amounts of active ingredient must be contained in a tablet. The equivalent doses of the respective drugs in the standard dose are: for omeprazole 20 mg, for esomeprazole 20 mg, for lansoprazole 30 mg, for pantoprazole 40 mg, and for rabeprazole 20 mg. This is due to the different metabolism in the body traced back.

There are some studies that have looked into whether one of the drugs mentioned above is used a clear advantage in its effect has over the other drugs. At the moment (as of August 2014), it has not yet been finally clarified whether this advantage exists for certain clinical pictures with a certain drug. Especially the active ingredient Esomeprazolewhich was the last to hit the market has been under discussion since its launch. The manufacturer states that the administration of esomeprazole is compared with the older drug omeprazole faster to better results leads. Independent, objective studies have not yet been able to prove this.

A difference between the proton pump inhibitors available is the pricethat has to be paid for therapy. There is a price difference between the new drug esomeprazole and the older drugs (omeprazole, lansoprazole, pantoprazo, rabeprazole), although there are also price differences between the frequently prescribed drugs omeprazole and pantoprazole. So it's worth having one Comparison of the different drugs in terms of price and, if necessary, to speak to the attending physician about it, and possibly switch to an available generic drug with the same mode of action.

Regarding the side effects or undesirable interactions with other drugs, there are between drugs available no significant, clinically relevant difference.

Another difference between the proton pump inhibitors available is that respective time of intake. With some drugs it is important that they about 30 minutes before starting the meal should be taken, whereas other drugs do regardless of the food is. This should therefore be asked of the attending physician or read in the instruction leaflet.

Overall, the available data, i.e. experiences and studies on the active ingredient Omeprazole the most extensive. However, experts believe that all drugs available immediately sure are and are in action clinically not relevant to differentiate.

criticism

Immediately after the introduction of the drug esomeprazole, it was in severe criticism. The manufacturer stated that through the Dosage form (Nexium Mups®), and the slower metabolism (Processing of the active ingredient in the liver) the active substance esomeprazole a significant Advantage over conventional, older drugs exist. This claim should be backed up with studies that actually showed little benefit in cure rates. However, it is critical to see that in these studies always 40mg of the active substance esomeprazole with 20mg of the active substance omeprazole was compared.

One benefit of the drug is like that before Accept the start of the study. An expert from the Medical Drugs Agency said that objectively no advantage of the active ingredient esomeprazole compared to omeprazole. Critical voices suspected that the manufacturer of the drug wanted to bring another drug with a new patent to the market shortly beforehand due to the expiry of the patent for omeprazole, without necessarily adding any added value to the mode of action.