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Lansoprazole vs. Omeprazole
Introduction
Lansoprazole and omeprazole are both drugs used to manage gastric tract-related medical conditions such as chronic acid reflux in gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, and peptic ulcer disease.
Classified as proton pump inhibitors (PPIs), these compounds are the most potent type of acid secretion inhibitors currently available. They are more effective than acid secretion antagonists such as antacids, making them some of the most prescribed medications worldwide.
However, given their potency, organizations advise patients to take the lowest effective dose of PPI for the desired effect. The FDA goes on to recommend a maximum of three 14-day treatment periods over the course of a year to reduce the risk of long-term adverse effects.
About Lansoprazole and Omeprazole
What is Lansoprazole?
Lansoprazole is a proton-pump inhibitor (PPI) that reduces acid in the stomach by inhibiting the protein H, K-ATPase in the last stages of hydrochloric acid production. It is a one-to-one mixture of the PPIs dexlansoprazole and levolansoprazole.
What conditions is lansoprazole approved to treat?
Lansoprazole was approved by the FDA in 1995 to treat acid reflux in GERD, benign ulcers in the small intestine and stomach, and NSAID-induced ulcers in adults and children above the age of one. Additionally, it is given with antibiotics to treat bacterial infections in the intestine, such as H. pylori.
How does lansoprazole work for GERD?
Lansoprazole manages acid reflux in gastroesophageal reflux disease (GERD) by reducing the amount of acid in the stomach. With less acid, there is less chronic backwash of acid up the esophagus, giving it time to heal and preventing further damage in the future.
What is Omeprazole?
Omeprazole is also a proton-pump inhibitor (PPI) that works just like lansoprazole to reduce acid in the stomach. It also stops the protein, H, K-ATPase in the last stages of hydrochloric acid production.
Omeprazole's composition is such that it undergoes a chemical shift once absorbed in the body, doubling its active form concentration. However, this shift is done by specific enzymes that are not found equally in all populations. Therefore, some individuals are poor metabolizers of omeprazole, making it an unsuitable option.
What conditions is omeprazole approved to treat?
Omeprazole was approved by the FDA in 1988 to manage acidity in GERD along with prevent upper gastrointestinal bleeding and treat benign peptic ulcers, Zollinger–Ellison syndrome, and eosinophilic esophagitis in adults and children above the age of one. Similar to other PPIs, it can also be given with antibiotics to treat H. pylori infections in the gut.
How does Omeprazole work for GERD?
Similar to other PPIs like lansoprazole, omeprazole decreases the amount of acid in the stomach by inhibiting its production. This reduces backwash up the esophagus and reduces acid reflux.
Effectiveness
How effective are Lansoprazole and Omeprazole for treating GERD?
Both lansoprazole and omeprazole are similarly effective in managing gastroesophageal reflux disease (GERD) to the extent that they can be used interchangeably under a physician's guidance.
However, some studies suggest that lansoprazole has a faster effect, relieving symptoms of GERD more effectively than omeprazole.
Dosage information
How is lansoprazole administered for GERD?
Lansoprazole is administered orally via capsules that are swallowed whole. If a patient faces difficulty swallowing, the capsule can be opened, and the contents can be sprinkled over 1 tbsp of food that does not need to be chewed, such as applesauce or yogurt. Alternatively, the contents of a capsule can be mixed in 60 ml of juice and swallowed immediately. In both situations, the food or liquid should not be hot as that can reduce the effectiveness of the medication.
For orally dissolving tablets, i.e., sublingual tablets, place the tablet under the tongue and let it dissolve without chewing. This usually happens within a minute, and it is important not to spit any extra saliva that formed. Any remaining particles can be swallowed with or without water.
An oral injection is possible via an oral syringe where 15 mg tablets are crushed in 4 ml of water, and 30 mg is crushed in 10 ml. However, it must be given orally within 15 minutes. To ensure complete administration, draw up another 2 – 5 ml in the same syringe, shake gently, and administer orally.
Finally, a capsule can also be administered via a nasogastric tube. The contents of the capsule can be added to 10 – 20 ml of water and injected directly into the tube. It may be necessary to inject more water to ensure no particles are left in the tube.
How is Omeprazole Administered for GERD?
Omeprazole is available as a capsule and oral suspension that is administered orally. Capsules must be swallowed whole. If patients are unable to swallow the capsule, it can be opened, and its contents can be sprinkled on 1 tbsp of food that does not require chewing, such as cooled applesauce or yogurt. Ingest immediately. Alternately the contents of a capsule can be mixed into 5 – 10 ml of water and swallowed immediately.
Oral suspension packets are emptied into a container with water, stirred, and left for 2 – 3 minutes to thicken before drinking. If any contents remain after drinking, 5 – 10 ml of water should be added and swallowed immediately for complete dosage. Do not use other liquids or foods with oral suspensions.
Side Effects
Generally well tolerated, PPIs have a very lower number of adverse effects that are similar to a placebo, with overall incidences of adverse effects below 5%. However, the most common side effects of lansoprazole and omeprazole that have been observed in clinical trial studies are listed below.
What are the most common side effects of lansoprazole?
The most common side effects of lansoprazole are given below:
- Diarrhea
- Abdominal pain
- Nausea
- Constipation
- Headaches
- Dry mouth
- Insomnia
- Drowsiness
- Rash
- Blurred vision
Are there any potential serious side effects of lansoprazole?
Continuous use of lansoprazole for longer than three months increases the risk of the following potential serious side effects:
- Rashes, hives, itching
- Swelling of the face, eyes, lips, throat, mouth, or tongue
- Difficulty swallowing or breathing
- Hoarseness of voice
- Peeling, blistering, or bleeding skin
- Sores on the nose, mouth, lips, or genitals
- Gland swelling
- Fever or flu-like symptoms
- More or less frequent urination
- blood in the urine
- Loss of appetite
- Joint pain
- Fast, irregular heartbeat
- Muscle spasms
- Uncontrollable shaking of various body parts
- Seizures
- Bone fractures in hips, wrists, and spine
- Fundic gland polyps
Are there the most common side effects of omeprazole?
The most common side effects of omeprazole are:
- Headaches
- Abdominal pain
- Nausea
- Diarrhea
- Vomiting
- Flatulence
- Acid regurgitation
- Constipation
- Dizziness
- Rash
- Back pain
Are there any potential serious side effects of omeprazole?
Continuous use of omeprazole for longer than three months increases the risk of the following potential serious side effects:
- Peeling or bleeding skin
- Sores on the nose, mouth, lips, or genitals
- Gland swelling
- Fever or flu-like symptoms
- Rashes, hives, itching
- Swelling of the face, eyes, lips, throat, mouth, or tongue
- Difficulty swallowing or breathing
- Fast, irregular heartbeat
- Muscle spasms
- Joint pain
- Sensitivity to sunlight
- More or less frequent urination
- Bone fractures in hips, wrists, and spine
- Fundic gland polyps
Contraindications and Interactions
Warnings and general precautions for Lansoprazole and Omeprazole
As lansoprazole and omeprazole are both PPIs, they share similar warnings and general precautions. Both should be avoided in patients with a medical history of hypersensitivity, osteoporosis, hypomagnesemia, liver disease, or kidney disease.
For patients who are breastfeeding, pregnant, or planning to get pregnant, it is recommended that they avoid using either PPI. There still isn't enough conclusive evidence to determine whether it is safe in such cases, and PPIs are believed to cross over to the fetus.
PPIs also increase the pH of the stomach. This action affects the absorption of certain compounds, such as weak bases and acids normally dissolved by the stomach acid. This decreases their absorption in the gut and their concentration in the bloodstream. While PPIs are recommended not to be co-administered with such medications, patients must discuss their medicines with a doctor.
Finally, it is important to realize that gastric acid is an essential part of the digestive system and breaks down food to release nutrients the body needs. PPIs interfere with this, and long-term use can reduce the absorption of calcium, magnesium, iron, and vitamin B12. Studies have shown significant magnesium deficiencies in people using PPIs for over three months. Such results have healthcare providers rethinking the choice to prescribe PPIs such as lansoprazole and omeprazole for chronic conditions and suggest using antagonist medication instead.
Contraindications and important interactions for Lansoprazole and Omeprazole
Contraindications
Lansoprazole
Not recommended for patients with severe hypersensitivity to its formulation or a medical history of hypersensitivity
Omeprazole
Not recommended for any patient with hypersensitivity to any component of the formulation or substituted benzimidazoles
Drug Interactions
Lansoprazole
Do not co-administer with atazanavir, warfarin, tacrolimus, theophylline, or methotrexate
Do not co-administer with medications that require low pH for absorption, such as ketoconazole, iron salts, ampicillin esters, and digoxin
Omeprazole
Do not co-administer with atazanavir, nelfinavir, saquinavir, cilostazol, warfarin, tacrolimus, methotrexate, or clopidogrelCombining with voriconazole may increase the blood concentration of omeprazole
Food/Beverage/Supplement Interactions
Lansoprazole/Omeprazole
PPIs are not known to have any definitive interaction with particular foods, beverages, or supplements. However, PPIs are most effective on an empty stomach and should be taken in the morning before eating.
Additionally, research suggests that herbal supplements such as St. John's wort and ginkgo biloba may reduce the blood concentration of PPIs
Cost Comparison
How much do Lansoprazole and Omeprazole cost?
Omeprazole costs an average of $0.86 per tablet, which translates to approximately $6.13/per week for an adult taking this medication daily.
Omeprazole costs an average of $0.63 per tablet, which translates to approximately $4.41/per week for an adult taking this medication daily.
Popularity of Lansoprazole and Omeprazole
Both lansoprazole and omeprazole are on the World Health Organization's List of Essential Medicines and are available in generic form. While both are popular in the US, Omeprazole was patented in 1978 and was approved for use ten years before lansoprazole.
Given its early start, there is more clinical trial research into omeprazole efficacy and long-term effects, which is why it is prescribed more. In fact, omeprazole was the eighth most prescribed medication in 2020, with over 56 million prescriptions, while lansoprazole was the 191st, with over 2.5 million prescriptions.
Conclusion
Takeaway
Lansoprazole and omeprazole are effective medications for treating GERD and other gastric conditions such as ulcers and Zollinger-Ellison syndrome. Not only is their mechanism of action the same, but they also share similar adverse effects, contraindications, drug precautions, and interactions.
However, with omeprazole having a much richer clinical trial history, costing less, and having multiple formulations compared to lansoprazole, it is the preferred drug for treatment.