The six remaining studies were a hodge-podge group of trials comparing various PPIs at different doses, none of which demonstrated any superiority. Andrea : All of the studies, except for the two that compared esomeprazole and omeprazole, found that there were no differences among any of the drugs in the treatment of GERD.
As for the two studies that suggested esomeprazole was better than omeprazole, the studies were not fair comparisons. Both studies used higher dosages of esomperazole compared with omeprazole. This cannot be considered a true comparison of effectiveness. In the study comparing esomeprazole with omeprazole, esomeprazole did better.
Well, that's no surprise—esomeprazole is the active isomer of omeprazole, and the study authors used a dosage four times that of omeprazole. Breaking this down, they used 40 mg of active drug esomeprazole versus 10 mg of active drug omeprazole the dosage is actually 20 mg, but since omeprazole is a racemic mixture, that is only 10 mg of active drug , and guess what? The drug not going off patent did better!
And who sponsored the study? Astra-Zeneca, the manufacturer. Bob : I knew you would jump on the inappropriate comparison of esomeprazole with omeprazole. Another problem with this comparison is that a true clinical end point is not being measured. But I have the same complaints as I did with the GERD studies regarding the use of unequal dosages and using endoscopic cure rates as the end point. And do I even have to do the H.
Sixteen studies with no differences noted among any PPIs. Bob : Meta-analysis can be tricky. A series of principles needs to be followed for the results to be valid. In this study, the authors appropriately identified a clear study question, performed a fairly comprehensive review of available databases although they did not include any abstracts from presentations at symposia or obtain unpublished clinical trials from the FDA or the drug companies , and used clear end points to determine cure or failure—so far, so good.
The most obvious faux pas the authors made was not grading the quality of the studies they incorporated in this meta-analysis. They did, however, redeem them-selves slightly by incorporating only randomized prospective trials. Mark : This faux pas is a problem.
How do we know that the studies they included were any good? We don't. I like their conclusions and I am sure they are correct, but they need to grade the papers included in their analysis; other-wise, we have no assurance that they were any good.
Bob : I feel comfortable saying there are no differences in efficacy among any PPIs for the above conditions. It also has been suggested that PPIs are associated with increased rates of community-acquired pneumonia 1 and Clostridium difficile colitis. Andrea : There are no differences among PPIs except cost, so go with the cheapest. However, the cheapest is not what ends up in our sample cabinet.
Mark : I agree—save your patient some cash and go for the less expensive drug. I sleep much better. I reported this to my doctor, but he only pooh-poohed the whole thing saying millions take Aciphex. I don't understand the doctor's philosophy. I have nearly lost a year out of my life, and here the doctor still thinks Aciphex is a wonder drug.
I am also very surprised that the literature that came with Aciphex at the pharmacy said that it had no reported potential side effects. I also believe that not many doctors know anything about its dangerous side effects. As to how I cope with acid reflux, I would certainly recommend changing your diet and lifestyle. I stopped eating spicy food, started to chew my food very well so that the esophagul sphincter did not get strained when letting food into my stomach, and lastly I sip a glass of milk through each day.
Also, try not to stress yourself. Watch out for those moments when you tighten your stomach muscles unknowingly while sitting erect in front of computer or at a desk, so that you can relax those muscles.
All these things are great because they work and you are not dependent on any drugs any more. Not only has the esophagus healed, I think the sphicter has healed too. What's really important to know is that our body is divine and ha. I would rate Aciphex as slightly less effective than Protonix but still very good. I avoid things that disturb my stomach such as onions, cinnamon, pizza sauce, pepperoni. That's a small price to pay for relief from the extreme pain I was suffering, enough to be hospitalized.
Nexium did not touch my GERD. I was taking Vicodin or Hydrocodone to ease my stomach pain which I would rate as severe. After no relief from Nexium my internist prescribed Protonix. For me it was a minor miracle. With one dose my pain subsided. I had relief and it has not come back. I was given samples for 6 - 8 months and then the VA put me on Aciphex Rabeprazole. I was worried about the switch but it's doing the trick too. I understand they are all very expensive.
The pain was too severe for me to ever go back to something else. In my case Protonix and Aciphex were superior to Nexium and Prilosec both in initial relief and as a maintenance medication in the relief of severe GERD. Aciphex I had no problems with Aciphex, but did have side effects from Prilosec and also seem to have some side effects from Protonix.
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If you have any questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Review this Drug. Tips for Good Reviews Only rate drugs or treatments you've tried. Proton pump inhibitors PPIs are the most commonly prescribed class of medication for the treatment of heartburn and acid-related disorders. They work by blocking the site of acid production in the parietal cell of the stomach.
Because there are millions of parietal cells that are constantly reproducing, complete inhibition of stomach acid production is virtually impossible. This probably explains the tremendous safety of these medications. However, side effects can occur, and some people are at increased risk for adverse events see below. The medications are structurally and chemically similar. There are relatively few comparisons of these drugs with each other.
There are no significant differences in overall healing and symptom improvement rates between the medications. Omeprazole Prilosec and lansoprazole Prevacid have been available the longest and consequently are the most familiar to physicians and patients. Omeprazole and lansoprazole are now available over-the-counter. While the newer medications, rabeprazole Aciphex and pantoprazole Protonix have data to suggest better suppression of stomach acid compared to omeprazole, there is no proof that the differences are clinically important.
Rabeprazole and pantoprazole are smaller and may be better for patients who have problems swallowing capsules. Pantoprazole is marketed as being cheaper, and may be better for patients paying for their own medications. Zegerid is a combination of omeprazole and sodium bicarbonate. Information on side effects from studies where a PPI is compared to a placebo shows that the most common side effects are headache, abdominal pain, bloating, diarrhea and nausea.
Interestingly, the incidence of these side effects is the same as when patients take the placebo. It is hard to compare side effect profiles between the medications, but there is no reason to believe that there are significant differences.
There is no scientific data to guide physicians on how to deal with the relatively few patients that have side effects from one of the PPIs. However, nearly all physicians have had the experience of switching from one PPI to another successfully. If you are having side effects from a PPI, you will not necessarily develop the same side effects if you switch to another PPI.
Discuss this option with your physician. The only exception may be in the extremely rare instance of severe allergic reactions. Source: U.
A study published in JAMA ; was conducted to determine whether there is an association between long-term proton pump inhibitor PPI therapy and the risk of hip fracture. The study concluded that long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.
Question What does this study mean for people who benefit from taking a PPI? The currently available PPIs include:. This is the latest in a series of articles that have questioned the safety of these powerful, widely used medications. Worldwide, PPIs have been available for over 20 years. In the s there were concerns that, by profoundly decreasing stomach acid production, they might lead to other health problems such as serious infections, poor absorption of vitamins and minerals, even gastrointestinal cancers.
However, by the mids, based largely on anecdotal experience, it was becoming clear that PPIs were remarkably safe. Formal studies looking at the use of PPIs in hundreds of patients showed virtually no long term side effects.
As a result, new PPIs were developed, PPIs became generic and ultimately available over the counter without a prescription. This was a great advance in our ability to treat the millions of patients worldwide that have acid-peptic diseases. In the last few years, researchers have been able to evaluate the side effects and complications of medications by using large databases of millions of patients.
They were able to identify over 13, people with a hip fracture and compare them to over , people who did not have a hip fracture. They also found that the risk increased further if the patients were taking the PPI a longer period of time, or at higher doses. This is probably due to impaired calcium absorption when there is less acid in the stomach.
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