Proton Pump Inhibitors: An Update

American Family Physician,  July 15, 2002  by Bruce T. Vanderhoff,  Rundsarah M. Tahboub

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TABLE 3

Indications and Recommended Dosages for Omeprazole, Lansoprazole,
and Rabeprazole

                       Omeprazole (Prilosec)

Indication             Dosage

Short-term             20 mg daily
 treatment of
 active duodenal
 ulcer

Helicobacter pylori    Triple therapy: omeprazole,
 eradication for        20 mg, clarithromycin,
 reduction of           500 mg, and amoxicillin,
 duodenal ulcer         1,000 mg, each
 recurrence             taken twice daily
                       Dual therapy: omeprazole,
                        40 mg daily, and
                        clarithromycin, 500 mg,
                        each three times daily

Maintenance            NA
 therapy for healed
 duodenal ulcer

Short-term             40 mg daily
 treatment of
 gastric ulcer

Short-term             20 mg daily
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     20 mg daily
 esophagitis

Maintenance            20 mg daily
 therapy of erosive
 esophagitis

Pathologic             Dosages vary; recommended
 hypersecretory         starting dosage is 60 mg
 conditions             daily; dosages of 120 mg
                        three times daily may be
                        needed; dosages of more
                        than 80 mg daily should
                        be divided

                       Omeprazole (Prilosec)

                       Duration of
Indication             treatment

Short-term             4 weeks; another
 treatment of           4 weeks may
 active duodenal        be required
 ulcer

Helicobacter pylori    Triple therapy: 10 days, plus
 eradication for        18 days of omeprazole
 reduction of           therapy if an ulcer is
 duodenal ulcer         present at initiation of
 recurrence             treatment
                       Dual therapy: 14 days, plus
                        14 days of omeprazole
                        therapy at 20 mg daily if
                        an ulcer is present at
                        initiation of treatment

Maintenance            NA
 therapy for healed
 duodenal ulcer

Short-term             4 to 8 weeks
 treatment of
 gastric ulcer

Short-term             Up to 4 weeks
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     4 to 8 weeks
 esophagitis

Maintenance            NA
 therapy of erosive
 esophagitis

Pathologic             Treatment for several
 hypersecretory         years may be
 conditions             required

                       Lansoprazole (Prevacid)

Indication             Dosage

Short-term             15 mg daily
 treatment of
 active duodenal
 ulcer

Helicobacter pylori    Triple therapy: lansoprazole,
 eradication for        30 mg, amoxicillin, 1,000 mg,
 reduction of           and clarithromycin, 500 mg,
 duodenal ulcer         each taken twice daily
 recurrence            Dual therapy: lansoprazole,
                        30 mg, and amoxicillin,
                        1,000 mg, each taken
                        three times daily

Maintenance            15 mg daily
 therapy for healed
 duodenal ulcer

Short-term             30 mg daily
 treatment of
 gastric ulcer

Short-term             15 mg daily
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     30 mg daily
 esophagitis

Maintenance            15 mg daily
 therapy of erosive
 esophagitis

Pathologic             Dosages vary; usual starting
 hypersecretory         dosage is 60 mg daily, up to
 conditions             90 mg twice daily; dosages
                        of more than 120 mg daily
                        should be divided

                       Lansoprazole (Prevacid)

                       Duration of
Indication             treatment

Short-term             4 weeks
 treatment of
 active duodenal
 ulcer

Helicobacter pylori    Triple therapy:
 eradication for        10 to 14 days
 reduction of          Dual therapy:
 duodenal ulcer         14 days
 recurrence

Maintenance            NA
 therapy for healed
 duodenal ulcer

Short-term             Up to 8 weeks
 treatment of
 gastric ulcer

Short-term             8 weeks
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     8 weeks; another
 esophagitis            8 weeks of
                        treatment may
                        be required if
                        not healed

Maintenance            NA
 therapy of erosive
 esophagitis

Pathologic             Treatment for
 hypersecretory         years may be
 conditions             required

                       Rabeprazole (Aciphex)

Indication             Dosage

Short-term             20 mg daily
 treatment of
 active duodenal
 ulcer

Helicobacter pylori    NA
 eradication for
 reduction of
 duodenal ulcer
 recurrence

Maintenance            NA
 therapy for healed
 duodenal ulcer

Short-term             NA
 treatment of
 gastric ulcer

Short-term             NA
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     20 mg daily
 esophagitis

Maintenance            20 mg daily
 therapy of erosive
 esophagitis

Pathologic             Dosages vary; usual
 hypersecretory         starting dosage is
 conditions             60 mg daily, and
                        dosages of 60 mg
                        twice daily may
                        be required

                       Rabeprazole (Aciphex)

                       Duration of
Indication             treatment

Short-term             Up to 4 weeks; most
 treatment of           will heal in this period;
 active duodenal        some patients may
 ulcer                  require additional therapy

Helicobacter pylori    NA
 eradication for
 reduction of
 duodenal ulcer
 recurrence

Maintenance            NA
 therapy for healed
 duodenal ulcer

Short-term             NA
 treatment of
 gastric ulcer

Short-term             NA
 symptomatic
 gastroesophageal
 reflux disease

Short-term erosive     4 to 8 weeks; if not healed
 esophagitis            after 8 weeks, another
                        8 weeks of treatment
                        may be considered

Maintenance            NA
 therapy of erosive
 esophagitis

Pathologic             Treatment for several
 hypersecretory         years may be required
 conditions

NA = not available.

Information from references 2, 6, and 8 through 10.