Review article: comparison of the pharmacokinetics, acid suppression and efficacy of proton pump inhibitors

Abstract

Proton pump inhibitors have dramatically influenced the management of acid‐peptic disorders in recent years. They all have a broadly similar mechanism of action and are extensively metabolized in the liver via cytochromes P450 2C19 and 3A4. There is some variation in their potential for drug interactions due to differences in enzyme inhibition. Relatively few serious adverse effects have been reported for the proton pump inhibitors. Comparative studies of acid suppression suggest that lansoprazole and pantoprazole have a potency similar to that of omeprazole on a mg for mg basis; however, rabeprazole may have a greater potency than omeprazole. Lansoprazole and rabeprazole display a more rapid onset of maximal acid suppression than the other proton pump inhibitors. Comparative studies using proton pump inhibitors for the treatment of reflux oesophagitis, duodenal ulcer healing and Helicobacter pylori eradication show little overall difference in outcome between the proton pump inhibitors when used in their standard doses. Lansoprazole and rabeprazole provide earlier and better symptom relief than the other proton pump inhibitors in some studies of peptic ulcer treatment. The few studies of gastric ulcer treatment suggest that there is an advantage in using the proton pump inhibitors that have a higher standard daily dose.

Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease

“…The only significant difference was occurrence of lesser number of NAB episodes in the ilaprazole group. Acid suppression properties of omeprazole were consistent with other studies [33][34][35] but that of ilaprazole were found to be inferior compared to previous studies. 36,37 This could be explained by probable altered metabolism of ilaprazole in our population compared to other Asian populations, and the higher dose of ilaprazole could have produced better acid suppression than the 10 mg used in our study.…”

Pharmacokinetics of two formulations of omeprazole administered through a gastrostomy tube in patients with severe neurodevelopmental problems

“…Yet, in this study, the suspension formulation seemed to have a higher bioavailability than the MUPS® formulation in seven of 10 patients. Although the therapeutic target AUC for omeprazole is not known, the efficacy of omeprazole correlates with AUC in both adults [13][14][15] and children [16,17]. The suspension formulation therefore seems the better option for the administration of omeprazole through the gastrostomy tube in patients with severe neurodevelopmental problems.…”

Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection

“…1,2 Although there is variation in acid suppression potency between different proton-pump inhibitors, 3 it has been reported that there is no clinically significant difference in H. pylori eradication rates with different proton-pump inhibitor-based regimens. 4 However, a recent meta-analysis showed that a double dose of proton-pump inhibitors when combined with clarithromycin and amoxicillin had an approximately 10% better cure rate than a single dose, 5 confirming the adequacy of acid suppression required for H. pylori eradication therapy.…”