Proton Pump Inhibitors

What are proton pump inhibitors, anyway?
Chances are, your child is has been on one or is on one now, since PPI’s are a primary weapon in the arsenal against reflux and esophagitis. Here’s how they work: Your stomach produces acid to help break down food so it is easier to digest. In certain circumstances, this acid can irritate the lining of your stomach, esophagus and duodenum (the top end of your small intestine), causing indigestion and even ulceration and bleeding. The proton pump inhibitors work by blocking the production of stomach acid. They do this by inhibiting (shutting down) a system in the stomach known as the proton pump.

As with Prilosec and all of the PPIs, the granules are enteric-coated and delayed release. Absorption begins only after the granules have passed through the stomach. So, the capsule should be swallowed without chewing, but the granules can be emptied into juice or applesauce, for instance. The drug needs to remain intact until it reaches the stomach.

Nexium versus Prilosec
So, your child’s been on Prilosec for three years and it seems to be doing the job, but you are hearing a lot about this NEW proton pump inhibitor, Nexium. What’s new about it? Specifically, there’s a change in its chemical structure: Nexium (esomeprazole) contains just the S-isomer of omeprazole. Prilosec contains both R- and S-isomers.

According to the American Gastroenterological Association, “a review of randomized clinical trials comparing two or more proton pump inhibitors found that there are minimal clinical differences between the products. Omeprazole (Prilosec), Iansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex) all produce comparable rates of healing and remission of sores in the esophagus caused by reflux. Time to healing for esomeprazole (Nexium) may be shorter than the
other PPIs; however, the clinical significance of this is not substantiated.”

Should your child be on Nexium instead?
Obviously, this is a question for your child’s doctor. If Prilosec (or one of the other PPIs) is working well for your child, there doesn’t look to be any reason to switch. Coincidentally, Prilosec’s manufacturer, Astro Zenica, is also the maker of Nexium. And Prilosec has just gone generic. For more on that, read on.

Prilosec Generic
In recent months, a generic form of prescription Prilosec has come on the market. The cost difference at this point is not huge. Prilosec costs about $4 a capsule; generic omeprazole is about $3.50/capsule. But, says Gayla Waller, manager of clinical services, CVS/pharmacy, the generic price should drop to about $2/capsule within a year.

Unlike purple Prilosec, the generic version now available is a dusty yellow color and the granules contained inside are significantly larger.

What about the liquid omeprazole formula (especially helpful for g-tube dependant children) some ea|tef children have been given during hospital stays? According to Waller, the manufacturer does not make a liquid form. Rather, hospital pharmacists may make a liquid by combining the capsule contents with sodium bicarbonate. This is called “compounding” and some retail pharmacists do this too. Your best bet is to contact your pharmacist and ask for a referral if he/she is unable to make it up for you.

Over-the-Counter Prilosec
In June, the U.S. Food and Drug Administration approved a form of Prilosec (omeprazole) for over-the-counter sales. Prilosec OTC will be available in 20 mg delayed-release tablet form. The same amount of the active drug will be available in both the OTC and prescription forms of Prilosec, according to Gayla Waller of CVS. The difference will be in the dosage recommendation. Prilosec OTC should be taken once a day, every day for 14 days; it is recommended for people who
experience frequent heartburn.

Prescription Prilosec, first approved by the FDA in 1989, will remain available as a treatment for gastroesophageal reflux disease (GERD), inflammation of the esophagus (esophagitis) and ulcers.
Gayla Waller predicts that Prilosec OTC will be available in the next month or two. There is no cost information yet available, but generic versions of the medication will not be available for three years.

- Elizabeth F. McNamara