Pantoprazole or omeprazole, which is better reviews. What is the difference between omeprazole and pantoprazole? Indications for use

On the Internet, inaccurate information is sometimes found on this issue, so let's look at it in more detail.

Omeprazole and rabeprazole refer to proton pump inhibitors(API). Synonym - proton pump blockers... These are drugs that suppress the secretion of hydrochloric acid (HCl) in the stomach, so they belong to antisecretory agents and are used to treat increased gastric acidity. Proton pump inhibitors (proton pump blockers) decrease secretion hydrogen ions(H +, or proton) lining (parietal) cells of the stomach. The mechanism of secretion is the entry of an extracellular potassium ion (K +) into the cell in exchange for the excretion of a hydrogen ion (H +).

Classification and characterization

Currently applied 3 groups drugs that reduce acidity in the stomach:

1. proton pump inhibitors- are the most powerful antisecretory agents that suppress the formation of hydrochloric acid in the stomach. Are taken 1-2 times a day;
2. H 2 -blockers(read "ash-two") - have low antisecretory effectiveness and therefore can be prescribed only in mild cases. Accepted 2 times a day. Block histamine (H 2 -) receptors of parietal cells of the gastric mucosa. H 2 blockers include ranitidine and famotidine.

   For reference: H 1-blockers are used against allergies ( loratadine, diphenhydramine, cetirizine and etc.).

3. antacids(in translation " against acid») - means based on magnesium or aluminum compounds, which quickly neutralize (bind) hydrochloric acid in the stomach. This includes almagel, phosphalugel, maalox etc. They act quickly, but for a short time (within 1 hour), so they have to be taken often - 1.5-2 hours after eating and before bedtime. Although antacids reduce acidity in the stomach, they simultaneously increase the secretion of hydrochloric acid by the mechanism negative feedback since the body tries to return the pH (acidity level, it can be from 0 to 14; below 7 - acidic environment, above 7 - alkaline, exactly 7 - neutral) to the previous values ​​(normal pH in the stomach is 1.5-2).

TO proton pump inhibitors relate:

• (trade names - omez, moosek, ultratop);
• (trade names - nexium, emanera);
• lansoprazole(trade names - lancid, lanzoptol);
• pantoprazole(trade names - nolpaza, controll, sanpraz);
• rabeprazole(trade names - pariet, noflux, ontime, zulbex, hairabezol).

Price comparison

Omeprazole costs several times cheaper than rabeprazole.

The price of generics (analogues) of 20 mg 30 capsules in Moscow as of February 14, 2015 ranges from 30 to 200 rubles. For a month of treatment, 2 packs are needed.

Original drug price Pariet (rabeprazole) 20 mg 28 tab. - 3600 rubles. 1 pack is needed for a month of treatment.
(analogues) of rabeprazole are much cheaper:

• Ontime 20 mg 20 tab. - 1100 rubles.
• Zulbex 20 mg 28 tab. - 1200 rubles.
• Khairabezol 20 mg 15 tab. - 550 rubles.

Thus, cost of treatment per month is about 200 rubles (40 mg / day), rabeprazole using highrabezola- about 1150 rubles. (20 mg / day).

Differences between omeprazole and esomeprazole

Is an S-stereoisomer (levogyrate optical isomer ), which differs from the dextrorotatory isomer in the same way that the left and right hand or the left and right shoe differ. It turned out that the R-form much more (than the S-form) is destroyed when passing through the liver and therefore does not reach the lining cells of the stomach. Omeprazole is a mixture of these two stereoisomers.

According to the literature, has serious advantages over , however, is more expensive. taken in the same dosage as .

Price trade names is:

• Nexium 40 mg 28 tab. - 3000 rubles.
• Emanera 20 mg 28 tab. - 500 rubles. (2 packs are needed for a month).

Benefits of Rabeprazole Compared to Other PPIs

1. the effect rabeprazole starts within 1 hour after ingestion and lasts 24 hours. The drug acts in a wider pH range (0.8-4.9).
2. Dosage rabeprazole is 2 times lower than omeprazole, which gives a better tolerability of the drug and fewer side effects. For example, in one study, side effects ( headache, dizziness, diarrhea, nausea, skin rashes) were noted in 2% during treatment rabeprazole and at 15% during treatment .
3. Admission rabeprazole into the blood from the intestine (bioavailability) does not depend on the time of meal.
4. Rabeprazole more reliable inhibits the secretion of hydrochloric acid, because its destruction in the liver does not depend on the genetic diversity of variants of the cytochrome P450 enzyme. Thus, it is possible to better predict the effect of the drug in different patients. Rabeprazole affects the metabolism (destruction) of other drugs less than other drugs.
5. After you stop taking rabeprazole there is no ricochet syndrome(cancellation), i.e. there is no compensatory sharp increase in the level of acidity in the stomach. The secretion of hydrochloric acid is restored slowly (within 5-7 days).

Indications for taking proton pump inhibitors

• gastroesophageal reflux disease (reflux of acidic stomach contents into the esophagus),
• pathological hypersecretion of hydrochloric acid (including Zollinger-Ellison syndrome),
• in complex treatment it is used for the eradication (elimination) of Helicobacter pylori (Helicobacter pylori) infection, which causes ulcers and chronic gastritis.

Note. All proton pump inhibitors destroyed in an acidic environment, therefore, are available in the form of capsules or enteric tablets, which swallowed whole(you can't chew).

conclusions

Briefly: rabeprazole ≅ esomeprazole> omeprazole, lansoprazole, pantoprazole.

In detail: rabeprazole It has several advantages over other proton pump inhibitors and in terms of effectiveness is comparable only with however treatment rabeprazole costs 5 times more than and slightly more expensive compared to .

According to the literature, the efficacy of Helicobacter pylori eradication does not depend on the choice of a specific proton pump inhibitor (any is possible), while in treatment gastroesophageal reflux disease most authors recommend exactly rabeprazole.

Analogy with antihypertensive drugs

Among proton pump inhibitors 3 drugs are allocated:

• (base drug with side effects),
• (improved preparation based on the S-stereoisomer of omeprazole),
• rabeprazole(the safest).

There are similar ratios among those used to treat hypertension:

• amlodipine(with side effects)
• levamlodipine(improved preparation based on the S-stereoisomer with minimal side effects),
• lercanidipine(most secure).

Read also:

of comments 7 to the note “Which is better - omeprazole or rabeprazole? Benefits of Rabeprazole "

Benefits of Hayrabesol:
Khairabezol is recommended for CHILDREN from 12 years old !!!
Shelf life of Khairabezol is 3 years.
Unique packaging in braille.
Taking Khairabezol does not depend on food intake

My story is this: the doctor prescribed Ultop for me. After a single use, there were serious side effects: severe headache; he turned red and began to see poorly in one eye; palpitations and fever. I told the doctor about this, but she does not believe me - she says there can be no such consequences from the ultop and she appointed Omez-insta. I come home, I decided to read it, and it turns out to be the same ultop, only under a different name!

In general, thanks to you, I became enlightened and I will look for myself a normal substitute without a terrible side effect. Why would a good gastroenterologist now find ... (((

1. 4 years ago, she treated gastritis with an ultratop, apparently, it did not help, since stomach erosion was discovered this year. prescribed zulbex. I almost went to the next world with 2 tablets: an hour after taking the drug on the first day, my throat ached and a cough began, my appetite disappeared, in the morning on the second day there was pain in the lower abdomen, like with cystitis. decided to take another pill. again, an hour after the intake, the temperature rose sharply to 38.5, the lower back ached, the head did not understand anything at all, the whole body aches, everything inside was rumbling. I read in the side effects only later that Zulbex often causes flu-like diseases and infections of the genitourinary system. and this is still the safest drug, you mean ??? this was not the case with ultra-top, maximum dry mouth and loss of appetite. By the way, perhaps the dosage of 20 mg is too much for me, because my weight is 39 kg

   Unfortunately, Zulbex (rabeprazole), despite its merits, is not as safe as it initially seemed. On the other hand, Ultop (omeprazole) is also capable of causing general fatigue, general weakness, weight gain, and fever. These effects are described in the instructions for the drug. As for the dosage, 10 or 20 mg of rabeprazole per day is usually used (not more than 20 mg). So rabeprazole isn't right for you, so you need to go back to omeprazole or try esomeprazole.

2. Thanks for the comment. I read it, but the doctor prescribed them to me, while he said that the drug was well tolerated and that it helped very well. Can you tell me how long it is completely excreted from the body? today I haven’t taken any pills, but the temperature is still around 37.3, the pain in my lower back is gone, my throat hurts less, there is no such weakness, my appetite has returned. the last time I took the drug a day ago. about the ultop, I remembered that my hair began to fall out very much from it (this is also spelled out in the instructions).

   By itself, rabeprazole is excreted from the body quite quickly, after a day only traces remain, but the effect of the drug lasts about a day. The side effects will most likely disappear completely within 4-5 days. As a substitute, you can either try esomeprazole or switch to H 2 blockers, but they block the secretion of hydrochloric acid much weaker.

3. Hello! I read Zhanna's review and was a little happy :) in the spring there was erosive gastritis, pariet was prescribed - he had a strong weakness, he was replaced with a zero-point - he was very ill in the solar plexus region and blurred vision. Replaced droppers with Nexium. At first there was a feeling of cold and shaking, then a feeling that sand was coming from the kidneys, on the 2nd day my throat ached and the temperature was 37, a couple of days later it still rose, ulcers on the palate. I found this in my notes - I was asked to carry such a diary.

   Gradually, the side effects passed, the drug was canceled, but I followed the diet all summer, since a small error caused a burning sensation in the area of ​​the left shoulder blade. A week ago, it began to burn again, often in the shoulder blade, against the background of 1 night cast (apparently provoked by sports on an empty stomach). Then the right side ached very badly and weakness began. I tried to help the seta with Iberogast, Chinese teas, but I had to resort to medicine. I started drinking Nexium yesterday - by the evening, body aches and weakness. Today I have no strength all day, terrible weakness, I can hardly walk. The throat again hurt and the temperature rose 37-37.5. At first I thought that I was ill, but there are no other signs of illness and rinsing does not help. In the spring it seemed to me that there were not so many side effects, at least there was not such a strong weakness. What drug can be replaced? What can you say about famotidine? About its side effects?

   Pariet (rabeprazole), nolpaza (pantoprazole), nexium (esomeprazole) belong to the group of proton pump blockers and can cause similar side effects: fever and flu-like syndrome. H2 blockers (famotidine, ranitidine, roxatidine, nizatidine) cause fever less often, so you should try them. They have other side effects, but there is a chance that you will not have them or will only have them to a small extent. For specific drug side effects, see the website. rlsnet.ru Try the H2 blockers for the price first. In general, H2 blockers are weaker than proton pump blockers. Only do not use cimetidine, it is an outdated drug with a large number of adverse reactions.

4. What is the safest analogue of rabeprozole (pariet, noflux, ontime, zulbex, hairabezole)?

   In theory, all analogs should be equivalent. Pariet is the brand drug (reference, first to enter the market). In general, it is believed that the best medicines are from European, American and Israeli manufacturers. But keep in mind that fakes are sometimes sold in Russia. Therefore, you can use any analogue (generic), if it helps you and does not cause side effects.

5. I have been ill since 1994. I have a fixed catarrhal hiatal hernia, catarrhal reflux esophagitis, erosion of the antrum, superficial gastroduodenitis. Previously, there was a stomach ulcer and a scar was found in the duodenum. She was regularly treated at the place of residence. Including constantly (almost every day) I took Omeprazole, which helped insignificantly and for a short time (sometimes I had to take several pills at a time to relieve severe heartburn). Heartburn practically never stops. Around the same time, I developed vasomotor rhinitis. There was nothing to breathe. I spray hormonal sprays as directed. They hardly help. Over the past 4-5 years, she has greatly recovered (from size 46 to 56-58). Soon there will be nothing left of the hair. Over the past two years, I began to choke. There was an attack of suffocation such that I was blue-violet. For some reason, the therapist prescribed a penicillin-containing antibiotic, to which I always have a terrible allergic reaction like Quincke's edema (I warned you). For a long time she treated allergies with pills and droppers with hormonal drugs (in the hospital). The last year I began to choke more and more. Hemoglobin dropped to 88, protein to 72-73. Now I am being treated by a hematologist: moderate anemia, anemic heart. (Forced to take sorbifer. Maltofer hematologist categorically forbade, he does not cure). The gastroenterologist has now prescribed Pariet. I very much doubted the need to take such an expensive drug. But I read the information on your website about the effectiveness of drugs and complications from them, I realized that perhaps only he can help me. And all the complications in the form of severe shortness of breath, bronchospasm, weight gain, hair loss, blurred vision (I began to see poorly both with glasses and without glasses), greatly weakened and much more, you cannot describe everything, from Omeprazole. I did not even imagine that Omeprazole could do more harm than good, and be simply hazardous to health, it seemed to me so reliable and, importantly, cheap.

   Will I ever be able to breathe normally now, will my eyesight be restored, will my weight return to normal, ...? (Allergy tests are negative, I cannot ask for a referral to a pulmonologist). Can anyone professionally answer me, give me any advice on how to deal with this?

   Rabeprazole and omeprazole are from the same group, so they have similar side effects. There is no need to hope for a radical improvement.

   Asthma and vasomotor rhinitis are most likely associated with the reflux of acid from the esophagus into the bronchi. This is a typical complication.

   Why omeprazole does not work well is not entirely clear. To check, you should make a daily pH meter.

   However, I am sure that omeprazole works, and the real cause of your problems is a hiatal hernia. The only option to eliminate it (and then life, most likely, will begin to improve) is a surgical one. Your situation is somewhat neglected, so you will need preparation before the operation (increase hemoglobin, etc.). However, it is necessary to operate, because it will be even worse further.

Diseases associated with the digestive system torment a huge number of people of all age and social groups. This is facilitated by improper nutrition, poor ecology and bad habits that modern society is subject to. The pharmaceutical industry does not stand still and is actively developing new means to combat diseases of the digestive system.

Proton pump inhibitors (for example, "Omeprazole" or "Pantoprazole") are a fairly large class of drugs used in the treatment of peptic ulcer disease. Is there a difference between these analogs and how significant is it? first, let's get to know these tools more closely to give an answer to this question.

Before comparing the two drugs, let's understand a little about what each of them is.

Omeprazole is an active active ingredient; on its basis, both the drug of the same name and is produced. Omeprazole acts in two directions: firstly, it reduces the acidity of gastric juice due to its neutralizing effect, and secondly, it has a suppressive effect on the secretion of hydrochloric acid at the cellular level.

All this creates a favorable environment for the healing of erosion and damage to the mucous membrane of the walls of the stomach.

The indications for taking the drug are:

• ulcers of the stomach and duodenum;
• reflux esophagitis;
• symptomatic gastroesophageal reflux disease;
• dyspepsia, against a background of increased acidity;
• Zollinger-Ellison syndrome.

The drug begins to act half an hour or an hour after administration, the effect lasts for a day. After the course of treatment is completed, acid production returns to its previous level in a few (up to five) days.

The process of removing the drug from the body creates an additional burden on the liver, therefore it is not recommended to take "Omeprazole" to persons suffering from liver diseases.

Contraindications for admission are intolerance to drug components such as lactose or fructose; children under four years old (children under eighteen only in especially severe cases by the decision of the attending physician). Admission during pregnancy should be justified and weighed, since the safety of the drug for the unborn child has not been clinically proven.

Brief information about Pantoprazole

Although this drug belongs to the same group as Omeprazole, the active ingredient is different here - pantoprazole. The principle of action is absolutely identical to the work of "Omeprazole", the drug blocks the release of acid and lowers the level of acidity in the stomach. It is used in the treatment of stomach and duodenal ulcers, reflux esophagitis and Zollinger-Ellison syndrome.

The dosage, of course, is calculated individually, but on average it is 40 mg per day (depending on the form of release, this is one or two capsules). The maximum safe dose that healthcare organizations prohibit exceeding is 80 mg per day.

Difference between drugs

In order to understand where these two drugs converge, and what is the difference, consider them in the context of their main characteristics.

Price and manufacturer

Pantoprazole is produced by the Russian pharmaceutical company Kanonpharma and its cost is 200-300 rubles per pack (depending on the dosage). Omeprazole is presented on the market by several manufacturers (Russia, Serbia, Israel), and its cost ranges from 30 to 150 rubles.

Active active ingredient

It has been proven that the indicator of the comparative intensity of the antisecretory effect of the proton pump inhibitor in omeprazole is higher than that of pantoprazole. At the same time, the time required for a substance to block the secretion of pantoprazole is almost three times longer than that of omeprazole.

Release form

Omeprazole is available in the form of hard gelatin capsules. "Pantoprazole" is produced in the form of coated tablets.

The time it takes for the drug to achieve the effect

"Omeprazole" begins to act in about half an hour or an hour after ingestion (the time may vary slightly in each individual case). Pantoprazole takes about two to two and a half hours to reach the highest plasma concentration.

Contraindications

The list of contraindications for "Omeprazole" is quite short, it includes intolerance to the components of the drug, pregnancy and lactation, childhood, as well as simultaneous administration with certain drugs. "Contraindications to taking" Pantoprazole "are:

• intolerance to the components of the drug;
• age is less than 18 years;
• dyspepsia (neurotic genesis);
• malignant formations in the gastrointestinal tract;
• a one-time admission with the drug "Atazanavir".

Reception against the background of treatment with other drugs. Observation of patients taking "Omeprazole" showed that long-term intake of a dose of 20 mg per day did not affect the concentration in the blood of substances such as caffeine, theophylline, diclofenac, naproxen, propranolol, ethanol, lidocaine and some others. It is undesirable to use the drug in parallel with drugs, the absorption of which depends on the pH value, since "Omeprazole" reduces their effectiveness.

Pantoprazole works in a similar way. However, it can be taken by the following patient groups without any risk:

• With diseases of the cardiovascular system. An example of drugs: "Digoxin", "Nifedipine", "Metoprolol";
• With diseases of the gastrointestinal tract. An example of antibiotics: "Amoxicillin", "clarithromycin";
• Taking oral contraceptives;
• Taking non-steroidal anti-inflammatory drugs;
• For diseases of the endocrine system, an example of drugs: "Glibenclamide", "Levothyroxine sodium";
• In the presence of anxiety and sleep disorders, taking "Diazepam";
• With epilepsy, taking "Carbamazepine" and "Phenytoin";
• After transplantation, taking Cyclosporin, Tacrolimus.

Side effects

The list of possible negative reactions of the body to taking "Omeprazole" is quite wide, however, most of them were encountered in isolated cases. Relatively common (less than 10% of prescriptions) include: lethargy, headache and digestive problems such as stool disturbance, nausea, vomiting, increased gas production, abdominal pain.

Much less often, in less than 1% of cases, insomnia, dizziness, hearing impairment, allergic skin reactions, weakness, swelling of the extremities, fragility of bones, an increase in the level of liver enzymes in the blood may be observed.

As for "Pantoprazole", in less than ten percent of cases, headaches, abdominal pains, problems with stools, and gas formation are observed. Less often, in less than 1% of values, sleep problems, dizziness, blurred vision, allergic skin manifestations (redness, itching, rash), general weakness and malaise, and nausea are encountered.

Overdose

Cases of reactions to an overabundance of "Omeprazole" were observed with the following symptoms: a state of confusion, decreased clarity of vision, drowsiness, a feeling of dry mouth, headache, nausea, heart rhythm disturbances. An overdose of "Pantoprazole" was not observed. But the manufacturer recommends, in any case, symptomatic treatment. Hemodialysis in both cases shows low efficiency.

Summing up, we can say that the difference between "Omeprazole" and "Pantoprazole" is not too significant. The drugs vary in price, as well as in the active ingredient. Moreover, the mechanism of their effect on the stomach is absolutely identical. "Omeprazole" has been used in pharmacology for much longer, the way it affects the body is better studied.

In this case, an overdose of "Pantoprazole" did not occur, side effects when taking it are less common. In any case, it is worth discussing with your doctor which medication is more preferable in this particular case and not making any decisions on your own.

Read more:

Nolpaza is a one-component preparation. Manufacturer - KRKA, Slovenia. The composition of Nolpaz 40 contains 40 mg of the active ingredient - sodium pantoprazole, as well as auxiliary substances. Nolpaza 20 contains, respectively, a half dose of 20 mg. The medicine is available in the form of oval tablets in a cream-colored shell. The package can be 14, 28 or 56 pieces.

Action

Nolpaza is a proton pump inhibitor (PPI), that is, a drug that reduces the synthesis of hydrochloric acid in the stomach, acting directly in the parietal cells. Nolpaza does not affect the motility of the stomach or intestines.

Indications

As can be seen from the action of the drug, Nolpaza is prescribed to reduce the production of excess hydrochloric acid:

• with gastric or duodenal ulcers and erosions;
• with gastroesophageal reflux (reverse reflux of gastric contents into the esophagus);
• with Zollinger-Ellison syndrome;
• for prophylaxis with long-term use of non-steroidal anti-inflammatory drugs;
• as part of a treatment protocol aimed at eliminating Helicobakter Pylori.

Contraindications

Studies on children have not been conducted, therefore Nolpaza is not prescribed until the age of 18. An allergic reaction may occur to pantoprazole or auxiliary components, in which case the drug is canceled. During pregnancy and breastfeeding, reception is possible only with strict indications. With caution and under the supervision of a physician, the drug is prescribed for liver failure (pantoprazole is metabolized in the liver).

Side effects

Usually Nolpaza is well tolerated. In rare cases, patients complained of abdominal pain, dry mouth, nausea and vomiting, and diarrhea after taking the drug. Headaches and decreased mood were even less common. The drug is prescribed for strict indications, therefore it is canceled only if the side effects are severe or an allergic reaction has occurred. Side effects often go away on their own in 1-2 days.

Application

In mild cases of gastroesophageal disease and for prophylactic purposes, 20 mg of the drug is prescribed once a day, usually in the morning on an empty stomach. When treating ulcers or erosion, eradication of Helicobacter, 40 mg tablets are taken once or twice a day. The course of treatment can take up to two months, depending on the indications. The tool is allowed to be taken simultaneously with antacids.

Full analogues

Analogs of the drug for the active substance (pantoprazole):

• Controlok - manufacturer Nycomed, Germany;
• Sanpraz - manufacturer of San Pharmaceuticals, India;
• Pantaz - Medley Pharmaceuticals, India;
• Peptazole - Kimica Montpellier, Argentina;
• Crossacid - Micro Labs, India;
• Zipantola - Pliva Hrvatska, Croatia;
• Ultera - Actavis Group, USA.

As you can see, all these analogs are imported. However, Nolpaza (LLC Krka-RUS) and Ultera (LLC Aktavis) are simultaneously produced under license in Russia, so they cost less than other drugs. Russian counterparts are not inferior in quality to imported products, but are cheaper due to the absence of customs duties. Ultera is available only in a dosage of 20 mg, the rest of the drugs - both 20 and 40 mg.

Controllers from a German company will cost more. If Nolpaza 40 mg (14 pcs.) Costs about 150 rubles, then Controloc 40 mg - about 600. What is better to buy depends only on the wishes of the buyer. There are no complaints from doctors about the Russian and Slovenian drug, but Controlok shows a slightly longer action and is better tolerated.

Another analogue is Sanpraz, an Indian drug. Available in packs of 30. In terms of cost, Sanpraz is slightly more expensive than Nolpaza, and in terms of quality it is approximately comparable to it.

Other PP inhibitors

Omeprazole

Other proton pump blockers are used concurrently with pantoprazole. the most popular is omeprazole (original - Losek). Preparations containing omeprazole are produced by pharmaceutical factories around the world. You can find both Russian and imported counterparts. Omeprazole is found in medicines with names such as Omez (India), Losek (Sweden), Demeprazole (Turkey), Gastrozole (Russia), Ultop (Slovenia) and others. In terms of cost, of course, these funds differ significantly. The price varies from 25 rubles for the Russian omeprazole 20 mg to 1500 for the Swedish 40 mg. Omez costs about 300 rubles on average. Slovenian Ultop - 150 for 14 tablets of 40 mg.

Esomeprazole

Another popular PPI is esomeprazole. Contained, in particular, in the Emaner preparation. Emanera is also produced in Slovenia by KRKA. This drug is better than Nolpaza or Controloc in that additional tests were carried out, and it is prescribed to children from 12 years of age in case of gastroreflux disease. However, Emanera is more expensive than Nolpaz, about 300 rubles for 14 capsules of 40 mg each.

If we compare the cost of the Emaner and Omez products, then they are almost the same.

Sometimes doctors appoint not Emanera, but Nexium. This is a drug with the same active ingredient, only produced at pharmaceutical companies in Sweden or Great Britain. Nexium is much more expensive - 1800 rubles for 14 tablets of 20 or 40 mg. Nexium is the first drug to contain esomeprazole. Previously, while it was protected by a patent, patients had no choice, they had to buy an expensive medicine.

Now that its counterparts have filled pharmacies, buyers have a choice. Which is better, Nexium or, for example, Emanera, Neo-Zext, containing the same esomeprazole, is a moot point. Considering that the course of treatment reaches 8 weeks, and at the same time you have to take several medications, Nexium can ruin the patient.

Rabeprazole

Another substance - a more recent development - rabeprazole. Contained in drugs such as Pariet, Noflux. It should be noted that the Belgian Pariet is an expensive drug, a package of 20 or 40 mg tablets costs more than 3 thousand rubles. But he also has an analogue - the Slovenian drug Zulbeks (650 rubles).

Comparison

Pantoprazole preparations (Nolpaza, Controloc) have less antisecretory activity than those containing Omeprazole (Omez, Ultop, Sanpraz), this affects the dose of the drug.

If we talk about the withdrawal syndrome, when after the end of treatment the acidity level rises sharply, then when taking PPIs it is usually not there, unlike histamine blockers, which we will discuss below. At the same time, many doctors discontinue PPIs after a long course, gradually switching from 40 to 20 mg. When taking rabeprazole (Pariet) drugs, the secretion of hydrochloric acid is restored slowly, so they do not have a "rebound" effect.

Due to the peculiarities of pharmacodynamics, preparations containing omeprazole are prescribed twice a day, and pantoprazole (Controloc, Nolpaza) and esomeprazole (Emanera, Nexium) are enough to take once.

The metabolism of rabeprazole (Pariet) does not depend on genetic variants of the hepatic enzyme that breaks down such substances. Therefore, Pariet acts more reliably and efficiently. Patients with liver diseases are prescribed Pariet and Nexium, while the dose is also adjusted - no more than 20 mg.

Preparations containing omeprazole (Omez, Losec, Gatrozole, Ultop) show more side effects than new developments. Pariet, according to the medical literature, causes side effects in 2% of cases, and Omez, Ultop, in 15%. Nexium, Controloc is also considered a mildly acting drug with a minimum of side effects.

Pariet acts faster, therefore it is prescribed for severe heartburn, severe pain and other symptoms of an ulcer. If there is no severe pain, Omez or Ultop, Sanpraz are prescribed.

If we compare omeprazole (Omez, Gastrozol, Ultop) and pantoprazole (Nolpaza, Controlok, Sanpraz), then it should be noted that the first is strictly prohibited during pregnancy and breastfeeding, while the second is allowed to be taken.

Other drugs to reduce the acidity of gastric juice

In addition to PPIs, the secretion of hydrochloric acid is reduced by other substances - blockers of histamine H₂ -receptors. Kvamatel (130 rubles), Ranitidine (25 rubles). Today they are not the drugs of choice in the treatment of stomach ulcers, since they are not as effective as PPIs, they have more side effects, and they have to be taken more often to achieve the effect. In addition, drugs such as Ranitidine have a withdrawal syndrome.

But at the same time, it is worth noting that Ranitidine and its analogues (Famotidine, Kvamatel) are often prescribed, since there are allergies to PPI drugs, or, conversely, resistance to them. Any drug is prescribed taking into account individual tolerance, so Ranitidine has not yet disappeared from pharmacies. PPIs and histamine blockers are not given at the same time.

In addition to all the listed funds, antacids reduce the acidity of gastric juice, but they are usually used as symptomatic treatment (for heartburn) and are not prescribed by the course.

Other remedies for stomach ulcers

PPIs are not prescribed separately, but in treatment regimens for various acid-dependent gastrointestinal diseases. For the eradication of Helicobacter Pylori with stomach ulcers, an antibiotic and a drug that protects the mucous membrane - gastroprotector (De Nol) are taken simultaneously with them. PPI drugs (Controlok, Omez, Pariet and their analogues) are not an antibiotic, as some people think. These medicines do not get rid of the bacteria. De Nol is also not an antibiotic, but it has an antiseptic effect against Helicobacter, since it is made on the basis of bismuth. De Nol must be taken simultaneously with a drug that reduces acidity, and the antibiotic destroys the cause of the disease - the bacterium.

The drug De Nol is also prescribed in cases where there is no Helicobacter in the analyzes. Thus, De Nol can be taken together with a product containing omeprazole (Omez, Ultop), pantoprazole (Controloc, Sanpraz, Nolpaza), rabeprazole (Pariet, Noflux) or other PPIs (lansoprazole). The principle of action of the drug De Nol is that it creates a protective film precisely in the places of erosion or ulcers, allowing the mucous membrane to recover, reduces the likelihood of recurrence of the ulcer. PPI and De Nol drugs can be prescribed simultaneously if the patient is treated with non-steroidal anti-inflammatory drugs for a long time. De Nol is taken once a day and is usually well tolerated, only it should be drunk separately from other medications.

The average cost of this product is 600 rubles for 56 tablets. Cheaper domestic analogue of the drug De Nol - Novobismol (350 rubles).

So, to summarize, it can be noted that all PPIs (omeprazole, pantoprazole, rabeprazole, etc.) are new generation drugs that effectively treat acidity in case of ulcers and other gastrointestinal diseases. Prescriptions of this or that drug depend on the state of health, concomitant diseases, individual tolerance and other points. Along with PPIs, you need to take other medications - De Nol, antibiotics, prokinetics, and so on. This is important for the complex treatment of the disease.

Proton pump inhibitors are indispensable in modern gastroenterology for the treatment of acid-dependent stomach disorders. For about 20 years, pharmaceuticals of this group have been used with a high therapeutic effect. Recently, two more similar products, Pariet and Nolpaza, have appeared in our pharmacies.

In order not to think about an alternative in front of a pharmacy showcase - Nolpaza or Pariet: which is better to buy? Let's make a small comparative analysis of these drugs.

Preparations Pariet and Nolpaza

The acidic environment in the stomach is formed due to its parietal cells. In the wall of the secretory tubules of these cells there is a special carrier H + / K + ATPase, the so-called proton pump or pump, which, in exchange for potassium ions, transports hydrogen ions from the cell into the lumen of the tubule. It is paired with another pump, anionic, which ensures the delivery of chlorine ions there. The result is hydrochloric acid. Normally, the cells are reliably protected from its damaging effect by a layer of mucus covering the walls of the stomach. If the integrity of the protective layer is violated, the cells are damaged, ulcers are formed. If acid production is not reduced, the process will progress.

Pariet and Nolpaza: similarities and differences

The chemical nature of the active ingredients of both drugs, as well as their clinical efficacy, are similar. Rabeprazole (Pariet) and pantoprazole (Nolpaza) are benzimidazole derivatives. Acting at the cellular level, they bind hydrogen ions and themselves attach to the carrier molecule, thereby disrupting its work.

Nolpaza or Pariet with the same frequency are found in the list of appointments for patients suffering from gastric and duodenal ulcers. They are also used for complex therapy, the purpose of which is to eliminate Helicobacter pylori from the stomach. These drugs are also indicated for gastroesophageal reflux (GERD).

Nolpaza is produced in the form of tablets of 20 and 40 mg. It is also the only proton pump inhibitor available in injectable form. The difference between Pariet and Nolpaza is that it contains a lower dose of the active ingredient (10 or 20 mg).

The dosage of Pariet, like Nolpaza, depends on the type and severity of the disease. For ulcers and GERD, your doctor may prescribe Pariet 10 or 20 mg once a day. Together with antibiotics for the eradication of Helicobacteria, it is usually prescribed 20 mg 2 times a day.

The variety of Nolpaza's dosage forms gives a wider range of possibilities for complex or intensive therapy. For example, the drug can be administered intravenously to quickly control acidity. The recommended dose of Nolpaza is 20 mg per day. With an exacerbation, 40 mg of the drug is prescribed.

Of course, the dilemma "Pariet or Nolpaza: which is more effective for your disease?" it is better for a specialist to decide, as well as in what dosage to use them.

Possible side effects after taking both drugs are:

• change in appetite
• dry mouth
• stomach ache,
• vomit,
• constipation or diarrhea
• dizziness, drowsiness, headache,
• bone and muscle pain
• leuko- and thrombocytopenia,
• allergic reactions.

The contraindications for both drugs are similar. They are not recommended for intolerance to their components and children under 12 years of age. Choice Pariet or Nolpaza in patients with sorbitol intolerance it is better to do in favor of Pariet, since Nolpaza contains sorbitol as an excipient.

Pregnancy and breastfeeding are contraindications for taking Pariet, while the instructions for use of Nolpaza say about its possible careful use in these cases.

Nolpaza is produced in Slovenia by KRKA. The price of 14 tablets of 20 mg each averages 160 rubles. Pariet is produced by Johnson & Johnson Corporation at the Japanese pharmaceutical company EISAI, which is probably why it costs significantly more. The cost of the same amount and dosage of Pariet is about 1,844 rubles.

PPIs, or proton pump inhibitors, belong to a group of pharmacological drugs used in the treatment of gastric pathologies. Medicines quickly resolve symptoms triggered by excess hydrochloric acid production. The most effective are modern representatives of PPIs: Rabeprazole, Omeprazole, Lansoprazole, Pantoprazole, etc. They are used in the complex treatment of various types of gastritis and ulcerative lesions. Before prescribing proton pump inhibitors, the gastroenterologist examines the results of laboratory and instrumental studies. When prescribing dosages and determining the duration of treatment, the doctor takes into account the general state of health of the patient and the presence of diseases in the anamnesis.

Omeprazole is the most famous member of the group of proton pump inhibitors

Features of pharmacological drugs

For a long time, antacids have been used to raise the pH of gastric juice. When it enters the human body, the active substances of the drugs enter into a chemical reaction with hydrochloric acid. The resulting neutral products are removed from the digestive tract with each bowel movement. But antacids have serious drawbacks:

• lack of long-term therapeutic action;
• failure to address the underlying cause of the disease.

Therefore, the synthesis of the first representative of proton pump inhibitors () made a breakthrough in the treatment of ulcers and gastritis. While antacids help reduce the level of hydrochloric acid that has already been produced, PPIs interfere with the production of hydrochloric acid. This avoids the development of dyspeptic disorders in a person - excessive gas formation, nausea, vomiting, heartburn and sour belching. The undoubted advantage of proton pump inhibitors is the ability to maintain the maximum therapeutic concentration in the systemic circulation for a long time. Only after 15-20 hours the parietal cells of the stomach begin to produce hydrochloric acid again.

It takes different times to activate PPIs in the digestive tract:

• Rabeprazole has the fastest therapeutic effect;
• Pantoprazole has the slowest action.

Proton pump inhibitors have general properties. For example, after penetration into the gastrointestinal tract, all PPIs suppress the production of caustic acid by more than 85%.

Warning: “When choosing a drug for the treatment of gastritis or ulcerative lesions, doctors take into account the individual sensitivity of patients to the active ingredient of a certain proton form inhibitor. It manifests itself in a rather peculiar way - even with the recent intake of tablets, the pH of the gastric juice drops sharply. This concentration of acid is determined for about an hour, and then there is a sharp improvement in human well-being. "

The action of drugs in the human body

PPIs are precursors to drugs. The therapeutic effect begins only after the addition of a hydrogen proton to them in the gastrointestinal tract. The active form of drugs acts directly on the enzymes responsible for the production of hydrochloric acid. Proton pump inhibitors do not immediately begin to show their medicinal properties, but only as the basic compounds accumulate in tissues and are converted into sulfenamides. The rate of decline in hydrochloric acid production may vary depending on the type of drug.

But such a difference is only possible in the early days of using the API. In the course of clinical studies, it was proved that after a week of using any proton pump inhibitors, their therapeutic efficacy levels off. This becomes possible due to the similar chemical composition of drugs. All PPIs are substituted benzimidazole derivatives and are formed as a result of a weak acid reaction. After activation in the small intestine, the drugs begin to affect the glandular cells of the gastric mucosa. It goes like this:

• PPIs penetrate the tubules of parietal cells, turning into tetracyclic sulfenamides;
• the proton pump contains cysteine ​​receptors, with which sulfenamides bind via disulfide bridges;
• the action of (H +, K +) -ATPases located on the apical membranes of glandular cells begins to be suppressed;
• slows down, and then completely stops the transfer of hydrogen protons into the stomach cavity.

After inhibition of (H +, K +) -ATPase, the production of hydrochloric acid by the cells of the gastric mucosa becomes impossible. Antisecretory therapy is indicated for patients with any form of gastritis, even with low acidity. This is necessary for the rapid regeneration of damaged tissues - the main cause of pain in the epigastric region.

Advice: “Do not skip taking PPIs or interrupt treatment. A prerequisite for rapid tissue regeneration is the constant presence of drugs in the human body. Ulceration heals and scarring occurs a few weeks after starting proton pump inhibitors. ”

Proton pump inhibitors with Pantoprazole enhance the effect of antibiotics

All types of proton pump inhibitors

Gastroenterologists use five representatives of proton pump inhibitors, differing from each other in active ingredients, to treat gastrointestinal pathologies. If one PPI is ineffective, the doctor replaces it with another drug. On the shelves of pharmacies, each type of antisecretory agent is represented by many structural analogs of Russian and foreign production. They can have significant price differences, despite the same dosage and number of capsules.

Choosing between analogs of one of the PPI representatives, the gastroenterologist often recommends a more expensive drug to the patient. Do not blame the doctor for any self-interest - such a preference in most cases is justified. For example, the Russian drug Omeprazole has analogues:

• Indian Omez;
• Ultop produced in Slovenia.

Many patients will not feel the difference when taking these drugs, as they exhibit approximately the same therapeutic effect. But for some people, recovery will come after a course of treatment with Ultopom. This is due not only to the quality of the active ingredient, but also to the various auxiliary ingredients used to form capsules and tablets. Proton pump blockers are drugs that require an individual approach when prescribing dosages and the duration of a course of treatment.

Omeprazole is the most common and widely used proton pump inhibitor in the treatment of gastrointestinal tract pathologies. It relieves inflammation of the mucous membranes, promotes rapid regeneration of damage. Its effectiveness has been proven in the treatment of patients diagnosed with a malignant neoplasm in the stomach, provoking an increased production of hydrochloric acid. Omeprazole significantly enhances the bactericidal effect of antibiotics when administered simultaneously. An hour after taking the drug, its maximum concentration is found in the blood, which persists for 2.5-4 hours.

Lansoprazole

The bioavailability of this representative of the PPI group is close to 90%. The mechanism of action of Lansoprazole differs from other drugs in the construction of radicals, which provide an antisecretory effect. The drug promotes the formation of specific immunoglobulins to Helicobacter pylori. As a result, the growth of gram-negative bacteria is successfully suppressed. This proton pump inhibitor has no effect on the motility of the digestive tract. Structural analogues of Lansoprazole include: Lancid, Epikur, Lanzap.

Pantoprazole

Unlike other PPIs, Pantoprazole can be used for a long time in the treatment of gastritis and ulcerative lesions. This method does not provoke the development of side effects. Pantoprazole is used regardless of the pH of the gastric juice, since this does not affect its therapeutic efficacy. The undoubted advantage of a proton pump inhibitor is the absence of diagnosed exacerbations of the disease after its course of administration. Pantoprazole is produced by manufacturers in the form of oral capsules and injection solutions. The most famous structural analogs of the drug are Krosacid, Controloc, Nolpaza.

Rabeprazole

This antiulcer agent differs from Omeprazole in the structure of the pyridine and imidazole rings, which allows Rabeprazole to more effectively bind protons and potassium ions. The proton pump inhibitor is available in enteric-coated capsules. After the use of Rabeprazole, ulcerative lesions are completely healed one month after the start of taking the drug. Gastroenterologists include the drug in the therapeutic regimen of gastritis provoked by Helicobacter pylori. Structural analogues of Rabeprazole include: Zolispan, Khairabezol, Bereta.

Esomeprazole

Due to the presence of only one S-isomer, Esomeprazole is not metabolized as rapidly by hepatocytes as other proton pump inhibitors. The drug is in the systemic circulation for a long time at the maximum therapeutic concentration. The therapeutic effect of Esomeprazole lasts about 15 hours, which is the highest among all PPIs. The most famous analogues of this drug are Emanera, Nexium.

Benefits of proton pump inhibitors

Manufacturers produce proton pump inhibitors in the form of capsules, tablets, solutions for parenteral use. Injectable drugs are used for exacerbation of gastric pathologies when it is required to quickly reduce the production of hydrochloric acid. The active ingredients of solid dosage forms are covered with a durable shell. It is necessary to protect proton pump inhibitors from aggressive gastric juices. Without the shell, the main compound of the drugs would quickly collapse without having time to exert any therapeutic effect.

The presence of such protection ensures that the PPI enters the small intestine and the active substance is released in an alkaline environment. This path of penetration allows drugs to exhibit maximum therapeutic properties. The undoubted advantages of drugs include:

• quick and effective elimination of heartburn and pain in the epigastric region in patients with increased production of gastric juice and digestive enzymes;
• a longer and more intense decrease in the production of hydrochloric acid in comparison with antacid drugs and H2-receptor antagonists;
• the highest efficiency in the treatment of patients with gastroduodenitis, gastric ulcer and duodenal ulcer;
• the presence of a short half-life and negligible renal clearance;
• fast absorption in the small intestine;
• high level of activation even at low pH values.

Proton pump inhibitors are drugs that gastroenterologists always include in the therapeutic regimen if Helicobacter pylori has been detected in patients during laboratory tests. These gram-negative bacteria often cause ulcers and gastritis. Pathogenic microorganisms are equipped with flagella with which they are.