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Proton pump inhibitors

Medically reviewed on May 16, 2018 by C. Fookes, BPharm

Other names: PPIs

What are Proton Pump Inhibitors (PPIs)?

PPIs reduce the production of acid by the stomach. They work by irreversibly blocking an enzyme called H+/K+ ATPase which controls acid production. This enzyme is also known as the proton pump and is found in the parietal cells of the stomach wall.

What are Proton Pump Inhibitors used for?

PPIs treat conditions that are caused by either an overproduction of stomach acid or exacerbated by stomach acid. Taking a PPI once a day inhibits around 70% of proton pumps, so a small amount of acid is still available for food digestion.

PPIs may be used for the treatment of:

What are the differences between Proton Pump Inhibitors?

All PPIs work in the same way, by inhibiting the proton pump. However, there are differences in their propensity for drug interactions, and in the way they bind to the proton pump. This can affect how long they last for.

All the PPIs available in the U.S. are metabolized in the liver by certain liver enzymes (mainly CYP2C19 and 3A4). There is a lot of individual variation in the way these liver enzymes work, and experts have identified three categories of people; extensive metabolizers (homEM), poor metabolizers (PM), and people that sit somewhere in between (hetM).

Approximately 3% of Caucasians and 15-20% of Asians are PM. PM take longer to excrete the drug and therefore their response to PPIs is increased several fold. For example, the pH of gastric acid is around 6 in PM after PPIs compared to around 3-4 in extensive metabolizers (where 1 is the most acidic pH). Metabolism is also affected in people of an older age and in those with liver disease. Esomeprazole is the only PPI that is well tolerated by people with liver disease. The extent somebody is able to metabolize a PPI can also affect their risk of drug interactions. 

Generic name Brand name examples
dexlansoprazole Dexilant, Kapidex
esomeprazole Nexium
lansoprazole Prevacid
omeprazole Prilosec
pantoprazole Protonix
rabeprazole Aciphex

Are Proton Pump Inhibitors safe?

When taken at the recommended dosage for the recommended duration of time, PPIs are considered safe. However, they have been associated with several serious adverse effects including:

In addition, there is a risk that the use of PPIs may mask the symptoms of gastric cancer. All patients with a suboptimal response to PPIs or whose symptoms recur following PPI withdrawal should have additional diagnostic testing, and an endoscopy should be considered in older people before treatment initiation.

Patients should only take PPIs as directed by their doctor or according to the instructions on the packet if bought over the counter.

What are the side effects of Proton Pump Inhibitors?

PPIs are generally well tolerated. The more common side effects reported with their use include:

For a complete list of side effects, please refer to the individual drug monographs.

List of Proton pump inhibitors:

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Drug Name Reviews Avg. Ratings
Dexilant SoluTab
generic name: dexlansoprazole
1 review
   
10
Nexium 24HR
generic name: esomeprazole
3 reviews
   
9.7
Protonix IV
generic name: pantoprazole
4 reviews
   
9.2
Aciphex (Pro)
generic name: rabeprazole
49 reviews
   
9.1
Prevacid OTC
generic name: lansoprazole
1 review
   
9.0
Prevacid (Pro)
generic name: lansoprazole
52 reviews
   
8.8
Nexium IV
generic name: esomeprazole
1 review
   
8.5
Zegerid (Pro)
generic name: omeprazole / sodium bicarbonate
26 reviews
   
8.5
Kapidex (Pro)
generic name: dexlansoprazole
29 reviews
   
8.3
Prilosec OTC
generic name: omeprazole
15 reviews
   
8.3
Nexium (Pro)
generic name: esomeprazole
119 reviews
   
8.0
Protonix (Pro)
generic name: pantoprazole
63 reviews
   
8.0
Zegerid OTC
generic name: omeprazole / sodium bicarbonate
4 reviews
   
8.0
Prilosec (Pro)
generic name: omeprazole
36 reviews
   
7.9
Dexilant (Pro)
generic name: dexlansoprazole
143 reviews
   
7.3
Prevacid SoluTab
generic name: lansoprazole
1 review
   
7.3

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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