Proton Pump Inhibitors (PPIs): medications in this class

Overview

PPIs block the pumps in the stomach lining that secrete acid, reducing acid production more completely and for longer than H2 blockers. They heal an inflamed esophagus and ulcers, control reflux symptoms, protect people on long-term anti-inflammatories or blood thinners, and are part of the regimen that eradicates Helicobacter pylori.

Omeprazole and pantoprazole are the usual choices; esomeprazole, lansoprazole, rabeprazole and dexlansoprazole are alternatives. They work best taken before a meal. Guidelines favor the lowest effective dose for the shortest time, with a step down to an H2 blocker or as-needed use once symptoms are controlled, because long-term use has been associated with low magnesium, fractures, certain infections and other concerns.

Omeprazole reduces the activation of clopidogrel; pantoprazole is preferred for people who need both.

How the drugs in this class differ when you pay cash

All the PPIs in common use are available as generics, and quotes for the same prescription can differ between pharmacies. Esomeprazole was long sold as the brand Nexium. Delayed-release capsules, tablets and packets for suspension are separate products, so a quote applies only to the form on the prescription.

Over-the-counter omeprazole, esomeprazole and lansoprazole are the same molecules at the lower strengths and need no prescription; ask the prescriber or pharmacist whether an over-the-counter pack is equivalent to your prescription. Prescription strengths and the suspensions are where a prescription is needed.

Lansoprazole and omeprazole also come as orally disintegrating tablets and as packets for suspension, used for children and people who cannot swallow capsules; those are separate products from the standard capsules. If a brand is named on the prescription, ask the prescriber to allow substitution.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Omeprazole
  Delayed-release capsules (generic), Packets for delayed-release oral suspension (Prilosec), Capsules and packets with sodium bicarbonate (generic)
  Generic: Yes · Once a day
• Pantoprazole
  Delayed-release tablets (Protonix and generic), Delayed-release granules for oral suspension (Protonix and generic), Injection, given in hospitals (Protonix I.V. and generic)
  Generic: Yes · See the guide
• Esomeprazole
  Delayed-release capsules, Granule packets for oral suspension, Over-the-counter capsules and tablets
  Generic: Yes · Once a day
• Lansoprazole
  Delayed-release capsules, Orally disintegrating tablets (SoluTab), Over-the-counter capsules and dissolving tablets
  Generic: Yes · Once a day
• Rabeprazole
  Delayed-release tablets
  Generic: Yes · Once a day
• Dexlansoprazole
  Delayed-release capsules
  Generic: Yes · Once a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Should I take it before a meal, and which meal?
• Is the over-the-counter version equivalent to my prescription?
• How long should I stay on it, and what is the plan to step down?
• Does it interact with clopidogrel or my other medicines?
• Which symptoms need investigation rather than a stronger acid reducer?