Interchageable Use of Proton Pump Inhibitors Based on Relative Potency.Graham DY, Tansel A. Clin Gastroenterol Hepatol. 2017 Sep 28. pii: S1542-3565(17)31168-0

Although proton pump inhibitors (PPIs) are widely used, their relative potency and ideal dosing regimens remain unclear. We analyzed data from randomized clinical trials that performed pH testing in patients receiving solid-dose PPI formulations (omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole) for a minimum of 5 days.

We used omeprazole equivalency and the surrogate biomarker, pH4time (percentage time pH>4 over 24-hour period), to compare PPI effectiveness for different PPIs given once, twice or three times daily. We found that increasing strength of once-daily PPIs (9 -64 mg omeprazole equivalents) increased pH4time linearly from approximately 10 hrs to 15.6 hrs; higher doses produced no further increase in pH4time. Increasing the frequency to twice-daily PPI increased pH4time linearly, from approximately 15.8 hrs to 21 hrs. Three-times daily PPIs performed similarly to twice-daily PPIs. The costs of PPIs varied greatly, but the cost variation was not directly related to potency. We conclude that PPIs can be used interchangeably based on potency. Using twice-daily PPIs is more effective in increasing efficacy increasing once-daily PPI dosage. Omeprazole and lansoprazole (30 mg) and 20 mg of esomeprazole rabeprazole are functionally equivalent.

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