The 6 Best Proton Pump Inhibitors
Proton pump inhibitors (PPIs) appeared on the pharmaceutical market at the end of the last century and have become a real salvation for people with peptic ulcers and other diseases in which an excess of hydrochloric acid is formed in the stomach. The editors of the KP found out how PPIs work, to whom they are prescribed, and what is the difference between the drugs in this group.

The most common diseases of the digestive system are acid-dependent diseases – gastroesophageal reflux disease (GERD), peptic ulcer of the stomach and duodenum, Zollinger-Ellison syndrome, functional dyspepsia1. All these ailments are accompanied by increased formation of acid in the stomach, which leads to damage to the mucous membrane, the appearance of erosions and ulcers on it. In the treatment of acid-dependent diseases, it is necessary to reduce the production of hydrochloric acid. This problem is solved by proton pump inhibitors, whose appearance has become a real breakthrough in the pharmaceutical industry.1.

What are proton pump inhibitors in simple words

A proton pump is an enzyme that is found in large quantities in the gastric mucosa and is involved in the synthesis of hydrochloric acid. Proton pump inhibitors inhibit the activity of this enzyme. As a result, the production of hydrochloric acid decreases and its irritating effect on the gastrointestinal tract decreases.2.

In medical practice, PPIs of 3 generations are used. They differ from each other in bioavailability, that is, the ability to be absorbed in the body. The 3rd generation drugs have the highest bioavailability.

List of top 6 inexpensive and effective proton pump inhibitors according to KP

Together with expert Tatyana Khodanovich, CEO of the educational platform PharmEdu, we found out which proton pump inhibitors are considered the most effective, figured out the pros and cons of each PPI. Currently, 6 proton pump inhibitors are registered in Russia – omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole, dexpansoprazole2. Preparations based on these active ingredients are included in our rating.

Our top is for informational purposes and cannot serve as a guide to action. Therefore, to choose the best proton pump inhibitor, consult your doctor.

1. Omeprazole

Inexpensive proton pump inhibitor. It belongs to the first generation PPI, but is not inferior to second generation drugs in terms of effectiveness. In addition to reducing the level of acidity, it inhibits the activity of the bacterium Helicobacter pylori, the main “culprit” of diseases such as chronic gastritis and peptic ulcer of the stomach and duodenum. When taken together with antibiotics, it helps to quickly stop the symptoms of peptic ulcer and achieve stable remission.3,5. It is used as a prophylactic for long-term use of non-steroidal anti-inflammatory drugs that increase the acidity of the stomach.3,5. In the pharmacy chain, it is also called Omez.

Contraindicated in pregnancy, lactation, severe liver disease and individual intolerance.

Advantages and disadvantages

affordable price in the segment, always available in pharmacies, increases the effectiveness of antibiotics against Helicobacter pylori.
not suitable for pregnant and lactating women, must be taken twice a day, may cause constipation, diarrhea, abdominal pain.

2. Pantoprazole

The second generation PPI is also available under the trade names Nolpaza and Controloc. Rapidly absorbed in the gastrointestinal tract, an hour after ingestion, it almost halves the activity of the proton pump4,5. Like omeprazole, it has antimicrobial activity against Helicobacter pylori.4.

Contraindicated in case of individual intolerance, neurotic dyspepsia, liver failure, malignant tumors of the gastrointestinal tract. Should not be taken during pregnancy and lactation.

Advantages and disadvantages

inhibits the activity of Helicobacter pylori, there are two dosage forms – tablets and injection.
not suitable for pregnant and lactating women.

3. Lancid

The active ingredient is lansoprazole, a 2nd generation PPI. After the first dose of 30 mg Lancid increases the pH of gastric juice after 1-2 hours. The duration of action is more than 24 hours, so the drug can be taken once a day4,5.

Contraindicated in the 1st trimester of pregnancy, during breastfeeding, with malignant tumors in the gastrointestinal tract and individual intolerance.

Advantages and disadvantages

it is possible to use 1 time per day, it is allowed in the 2nd and 3rd trimesters of pregnancy.
may cause headache and skin rash.

4. Dexilant

The active ingredient of the drug is the PPI dexlansoprozole. Dexilant is available in capsules that contain two types of enteric-coated granules. The rate of dissolution of the shell depends on the pH level in the small intestine. The active substance from the granules is released gradually, which helps to maintain a low level of hydrochloric acid for a long time.

The drug is contraindicated in pregnancy, lactation and hypersensitivity.

Advantages and disadvantages

a drug of prolonged action, can be taken 1 time per day, a minimum of contraindications.
may cause headache, diarrhea, abdominal pain.

5. Pariet

The original Japanese drug with the active ingredient rabeprazole. There are analogues with other trade names: Rabeprazole, Razo, Ulblock, Hairabezol. At low concentrations (20 mg per day), Pariet begins to act as early as 5 minutes after ingestion and can reduce the secretion of hydrochloric acid for up to 48 hours4,5. In addition, Pariet inhibits the activity of Helicobacter pylori and stimulates the synthesis of mucin, a component of the gastric mucosa.4.

Contraindicated in pregnancy, lactation and individual hypersensitivity.

Advantages and disadvantages

original drug, antimicrobial activity, stimulates the synthesis of mucin and helps protect the gastric mucosa, has an effect in minimal doses, can be taken once a day, a small number of contraindications.
high price in the segment.
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6. Nexium

This is an original drug with the active ingredient esomeprazole, a 3rd generation PPI. There are also analogues of Nexium on sale called Emaner and Esomeprazole. Nexium is available in capsules, which are recommended to be taken once a day. When combined with antibiotics, the drug promotes eradication – the destruction of the bacterium Helicobacter pylori4.

It is contraindicated in breastfeeding, individual intolerance, hereditary fructose intolerance, glucose-galactose malabsorption.

Advantages and disadvantages

can be taken by children over 12 years of age for the treatment of GERD, it is possible to use during pregnancy.
can cause headache, diarrhea, flatulence, abdominal pain.

How to choose proton pump inhibitors

Proton pump inhibitors must be chosen by a doctor, usually a general practitioner or gastroenterologist. The choice will be influenced by such factors as the age of the patient, the type of acid-dependent disease that he suffers from, and the presence of other pathologies. Be sure to take into account what other drugs the patient is taking, since PPIs can change the activity of some drugs3.

Reviews of doctors about proton pump inhibitors

Kalazyan D. A., surgeon, candidate of medical sciences: “With the advent of this group of drugs, surgical interventions for peptic ulcer disease have practically come to naught. Now she is treated quite effectively with conservative methods. The incidence of peptic ulcer complications, such as perforation, has dropped dramatically.”

Shestakov I. A., surgeon, candidate of medical sciences: “Omeprazole is a cheap, time-tested drug – a proton pump inhibitor. I use it in my patients as a prophylactic when prescribing non-steroidal anti-inflammatory drugs in the treatment of surgical pathologies. I didn’t observe any side effects, you can buy it in every pharmacy.”

Boytsun A.V., psychiatrist: “Pariet was prescribed in stationary conditions for gastric ulcer and duodenal ulcer in a standard dosage in courses. The drug is quite effective and very effective. It is well tolerated, the therapeutic response is very fast. The only drawback of the drug is its price, which is why I prescribed the drug very rarely. Perhaps, this drug has no other disadvantages.

Bolotina T. A., gastroenterologist: “Nexium is an excellent PPI. There is a choice of dose. Price and quality match. I only recommend him for a long-term appointment. It is also the drug of choice for eradication. When properly canceled, there are no “ricochet” type problems. Approved for use in children, which may additionally indicate the safety of the drug. I hope it doesn’t disappear from pharmacies.”

Popular questions and answers

Acid-dependent diseases are diagnosed in 15% of people, that is, in almost every fifth person. PPIs are among the drugs of choice for these ailments and therefore appear very often in doctors’ prescriptions. Tatyana Khodanovich, CEO of PharmEdu, an educational platform for pharmacists and pharmacists, answers popular questions about proton pump inhibitors.

When are proton pump inhibitors prescribed?

With peptic ulcer, GERD, with hypersecretion of hydrochloric acid in the stomach, with long-term use of non-steroidal anti-inflammatory drugs to prevent damage to the gastrointestinal mucosa.

How long can proton pump inhibitors be taken?

These drugs are intended for course therapy. The duration of treatment is determined by the doctor, the minimum therapeutic course usually takes 2 weeks.

What are the dangers of long-term PPI use?

With prolonged use, due to a decrease in acidity, the digestion of food may be disturbed, and pathogenic bacteria will begin to multiply in the gastrointestinal tract. In addition, while taking PPIs, bone density may decrease, and magnesium, calcium, and vitamin B12 levels may decrease in the body.1.

However, side effects are rare, and preventive measures help to reduce the risk even more.1. Patients who take PPIs on a regular basis are advised to regularly check their vitamin and mineral levels and, if deficient, take a vitamin-mineral supplement. In addition, during treatment it is necessary to undergo endoscopic examinations of the gastrointestinal tract, microbiological studies of the contents of the small intestine and breath tests.1.

Sources of:

  1. Russian medical journal. No. 10 dated 30.05.2017/XNUMX/XNUMX. V. A. Akhmedov, V. A. Nozdryakov “A modern view on the safety of long-term therapy with proton pump inhibitors. Literature review”. https://www.rmj.ru/articles/gastroenterologiya/Sovremennye_vzglyady_na_bezopasnosty_dlitelynoy_terapii_ingibitorami_protonnoy_pompy_Obzor_literatury/
  2. Vidal. Reference book of medicines. Overview of drugs. proton pump inhibitors. https://www.vidal.ru/vracham/gastroenterologiya/preparaty/ingibitory-protonnoy-pompy-obzor-gruppy-preparatov
  3. Journal “Attending Doctor” dated 03.09.2020 “The choice of a proton pump inhibitor from the standpoint of efficacy and safety in a particular patient.” E. A. Lyalyukova, Yu. V. Tereshchenko, E. N. Chernysheva, A. V. Lyalyukov. https://www.lvrach.ru/2020/08/15437647
  4. A guide for doctors. Moscow 2016. Lopina O. D., Serebrova S. Yu., “Basic pharmacokinetic characteristics of proton pump inhibitors and the effectiveness of their action.” https://clck.su/S0FyN
  5. Magazine “Pharmatheca” No. 6 for 2007. A. A. Samsonov. Proton pump inhibitors are the drugs of choice in the treatment of acid-related diseases. https://pharmateca.ru/ru/archive/article/6817

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