Proton pump inhibitors contain active ingredients that reduce the acid content in the stomach by blocking the so-called proton pump (H+/K+-ATPase). Proton pump inhibitors are certified in Germany for illnesses such as reflux disease, gastritis, ulcers in the stomach and duodenum, and a pathologically increased production of gastric acid. Frequent application finds proton pump inhibitors in addition as protection with longer income of pain means such as Aspirin, Ibuprofen or Diclofenac. In Germany the following medicines are certified, which fall under the term proton pump inhibitor: Omeprazol, Esomeprazol, Lansoprazol, Pantoprazo, Rabeprazol. For some active substances generics are already available.
Mode of action
The mode of action is the same for all proton pump inhibitors available on the market. All have in common that the proton pump in the so-called occupant cells of the stomach is irreversibly inhibited. This pump is responsible for the fact that protons (H+ ions) are transported into the inside of the stomach and stomach acid develops.
After irreversible inhibition of this pump, protons can only be transported again when the body has formed new proton pumps. The five proton pump inhibitors available in Germany differ in their respective equivalent dose. That means that in order to achieve the same effective strength in the body, different quantities of active substance must be contained in a tablet.
Thus, the equivalent doses of the respective drugs are in the standard dose: for omeprazole 20 mg, for esomeprazole 20 mg, for lansoprazole 30 mg, for pantoprazole 40 mg, and for rabeprazole 20mg. This is due to the different metabolism in the body. There are some studies that deal with the issue of whether one of the above-mentioned drugs has a clear advantage over the other drugs in its effect.
Whether this advantage exists for a certain disease pattern with a certain drug has not yet been finally clarified at the moment (as of August 2014). In particular, the active ingredient esomeprazole, which was the last one to reach the market, has been under discussion since its market launch. The manufacturer states that the administration of esomeprazole leads to better results faster than the older drug omeprazole.
Independent, objective studies have not yet been able to prove this. One difference between the available proton pump inhibitors is the price that must be paid for a therapy. For example, there is a price difference between the new drug esomeprazole and the older drugs (omeprazole, lansoprazole, pantoprazole, rabeprazole), although there are also price differences between the frequently prescribed drugs omeprazole and pantoprazole.
It is therefore worth comparing the prices of the various drugs and, if necessary, talking to your doctor about this and possibly switching to an available generic drug with the same mode of action. With regard to side effects or undesired interactions with other drugs, there is no significant, clinically relevant difference between the available drugs. A further difference between the available proton pump inhibitors lies in the respective time of taking them.
For some drugs it is important that they should be taken about 30 minutes before the start of a meal, whereas for other drugs this is independent of the meal. This should therefore be checked with the doctor treating you or read in the package insert. Overall, the available data, i.e. experience and studies on the active substance omeprazole are the most comprehensive. However, experts assume that all available drugs are equally safe and do not differ in their effect in a clinically relevant way.
