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Omeprazole vs Lansoprazole
Introduction
Omeprazole and lansoprazole are management medications used to treat excessive gastric acid and pepsin in conditions such as Zollinger-Ellison Syndrome, chronic acid reflux, erosive esophagitis, and non-cancerous stomach and intestinal ulcers.
These compounds are proton pump inhibitors (PPIs) that interfere with the body's gastric acid production, thus inhibiting its secretion. These drugs are extremely effective, but long-term use is not recommended because of their serious side effects.
About Omeprazole and Lansoprazole
What is Omeprazole?
Omeprazole is a proton-pump inhibitor (PPI) that binds to the enzyme H+, K(+)-ATPase, which is found in the epithelial cells of the stomach lining. This enzyme is part of the acid secretion process, and by inhibiting it, omeprazole stops it from reacting to stimuli which stops secretion.
What conditions is omeprazole approved to treat?
Omeprazole was FDA-approved in 1989 to treat:
- Pathological hypersecretions of gastric acid, such as in Zollinger-Ellison Syndrome
- Intestinal and gastric ulcers in adults
- Gastroesophageal reflux disease (GERD) in adults and children above the age of one
- Erosive esophagitis
How does omeprazole work for Zollinger-Ellison Syndrome?
Omeprazole has been shown to be an effective treatment for the excessive gastric secretion seen in Zollinger-Ellison Syndrome. Clinical results show a single 60 mg dose of omeprazole reduced gastric by 50% in three hours, then 78% in four hours.
What is Lansoprazole?
Lansoprazole is also a proton-pump inhibitor (PPI) that works similarly to omeprazole by binding to the enzyme H+, K(+)-ATPase. By blocking this enzyme's action, it reduces gastric acid secretion.
What conditions is lansoprazole approved to treat?
Lansoprazole was FDA-approved in 1995 to treat:
- Pathological hypersecretions of gastric acid, such as in Zollinger-Ellison Syndrome
- Benign and NSAID-associated gastric ulcers
- Intestinal ulcers
- Erosive esophagitis in adults and children
- GERD in adults and non-erosive GERD in children
- H. pylori infections with amoxicillin or clarithromycin to prevent intestinal ulcers
How does lansoprazole work for Zollinger-Ellison Syndrome?
Clinical research has shown that 60 – 180 mg of lansoprazole effectively reduces gastric acid in patients with Zollinger-Ellison Syndrome. Even when dosages were re-adjusted, the gastric acid level remained low, and the drug was seen to be well tolerated with long-term use, i.e., more than 5 years.
Effectiveness
How effective are omeprazole and lansoprazole for treating Zollinger-Ellison Syndrome?
Omeprazole and lansoprazole are equally effective in reducing excess gastric acid and pepsin in patients with Zollinger-Ellison Syndrome. However, lansoprazole has been shown to be better tolerated by patients using it long-term with fewer adverse reactions when compared to omeprazole.
Dosage information
How is omeprazole administered for Zollinger-Ellison Syndrome?
Omeprazole is available as a delay-released oral capsule and oral suspension.
Oral Capsule
The capsule must be swallowed whole without chewing or breaking. If patients are unable to swallow the pill whole, they can open the capsule and sprinkle the pellets over one tablespoon of soft food such as room-temperature yogurt or applesauce. The mixture cannot be stored and must be immediately ingested, followed by a glass of cool water to ensure all pellets are completely swallowed.
Oral Suspension
The oral suspension is administered by emptying the packet into water and stirring, then allowing it to thicken for 2 to 3 minutes. The patient must drink this mixture within 30 minutes. The amount of water depends on the packet dose, i.e., 2.5 mg packets are mixed in 5 ml of water while 10 mg are mixed in 15 ml.
Patients who use a gastric or nasogastric tube, French size 6 or larger, can also take the oral suspension via a catheter-tipped syringe. Following the same water measurements per package, allow the mix to thicken in the syringe for 2 to 3 minutes, then shake and inject into the tube within 30 minutes.
How is lansoprazole administered for Zollinger-Ellison Syndrome?
Lansoprazole is available as a delayed-release capsule and orally disintegrating tablet.
Oral Capsule
The capsule must be swallowed whole without breaking, chewing, or crushing. If patients cannot swallow the capsule, it can be opened, and its pellets can be sprinkled over one tablespoon of applesauce, cottage cheese, yogurt, strained pears, or ENSURE pudding. This mixture cannot be stored and must be swallowed immediately.
Alternatively, the pellets inside a capsule can be emptied in 60 ml (2 oz) of orange juice, apple juice, or tomato juice. This mix should be stirred briefly and immediately swallowed. To ensure the complete dose has been administered, the glass should be rinsed with two to three more volumes of liquid and swallowed immediately.
The capsule can also be given to patients with a nasogastric tube (French size ≥16) by mixing the pellets inside with 40 ml of apple juice only. No other liquid is advised as it has been tested in clinical trials. This mix can be injected into the tube.
Oral Disintegrating Tablet
The disintegrating tablet is administered by placing it under the tongue and allowing it to dissolve without water. This generally takes less than a minute. Do not spit out excess saliva. The disintegrating tablet should not be chewed or swallowed whole.
Those unable to keep the tablet under their tongue can be administered via oral syringes and water. For the 15 mg tablet, use 4 ml of water; for the 30 mg tablet, use 10 ml. With the tablet and liquid in the oral syringe, gently shake until the tablet has disintegrated. Administer within 15 minutes. Refill the oral syringe with 2 – 5 ml of water and a gentle shake to ensure the complete dose has been administered.
The disintegrating tablet can also be administered via Nasogastric Tube (French size ≥8), similar to an oral syringe.
Side Effects
omeprazole and lansoprazole have a very low overall incidence of side effects, less than 5%. They are relatively well tolerated when compared to other medications. However, they have documented adverse reactions and contraindications.
What are the most common side effects of omeprazole?
- Headaches
- Abdominal pain
- Nausea
- Diarrhea
- Vomiting
- Flatulence
- Acid regurgitation
- Constipation
- Dizziness
- Rash
- Back pain
Are there any potential serious side effects of omeprazole?
- 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
Are there the most common side effects of lansoprazole?
- Diarrhea
- Abdominal pain
- Nausea
- Constipation
- Headaches
- Dry mouth
- Insomnia
- Drowsiness
- Rash
- Blurred vision
Are there any potential serious side effects of lansoprazole?
- 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
Contraindications and Interactions
Warnings and general precautions for omeprazole and lansoprazole
Omeprazole and lansoprazole are contraindicated in patients with known hypersensitivities to either formulation. Additionally, these medications are not treatments for gastric malignancies that can increase gastric secretions.
Clinical research has suggested that PPI treatment is associated with a higher risk of Clostridium difficile- associated diarrhea (CDAD), particularly in hospitalized patients.
Additionally, both medications are associated with increasing the risk of osteoporosis-related hip, spine, and wrist fractures. While these findings indicate that PPI therapy should not be continued beyond a year, it is needed for patients with conditions such as Zollinger-Ellison Syndrome (ZES). PPI therapy is not advised for ZES patients who are pregnant, planning to get pregnant, or breastfeeding, as there is insufficient evidence to verify its safety.
Furthermore, PPI therapy also affects CYP2C19 activity. CYP2C19 is an enzyme necessary for certain medications, such as tertiary amine tricyclic antidepressants (TCAs). Omeprazole and lansoprazole inhibit their function, therefore reducing the effectiveness of TCAs.
Finally, omeprazole and lansoprazole reduce gastric acid levels, increasing the GI tract's pH. This action hinders the digestion, absorption, and bioavailability of pH-dependent drugs. It also affects the absorption of nutrients such as magnesium, iron, calcium, and vitamin B12. Clinical findings have shown significant hypomagnesemia and other nutrient deficiencies in patients with prolonged PPI therapy.
Contraindications and important interactions for Omeprazole and Lansoprazole
Contraindications
Omeprazole
Not recommended for patients with hypersensitivity to omeprazole formulation or other similar medications such as pantoprazole esomeprazole, rabeprazole, lansoprazole
Not recommended for patients with hypersensitivity to benzimidazoles
Not recommended in patients with kidney problems, breathing problems, impaired liver function, or low bone density
Not recommended for patients with a history of low magnesium, iron, or calcium levels.
Lansoprazole
Not recommended for patients with hypersensitivity to lansoprazole formulation or other similar medications such as pantoprazole esomeprazole, rabeprazole, omeprazole
Not recommended in patients with kidney problems, breathing problems, low bone density, or on HIV medication
Not recommended for patients with a history of liver disease, lupus, or chronic low magnesium, iron or calcium levels.
Drug Interactions
Omeprazole
Do not co-administer with Atazanavir Tacrolimus Saquinavir methotrexate and nelfinavir as it reduces levels of these medications
Do not co-administer with drugs whose bioavailability is affected by gastric pH (e.g., ketoconazole, iron salts, ampicillin esters, and digoxin).
Do not co-administer 80 mg of omeprazole with clopidogrel. If it must be given, wait 12 hours.
Do not co-administer with cilostazol as it increases systemic exposure to its active ingredients.
Do not co-administer with drugs metabolized by cytochrome P450 (e.g., diazepam, warfarin, phenytoin, cyclosporine, disulfiram, benzodiazepines
Do not co-administer with inhibitors of CYP 2C19 and 3A4, such as voriconazole, as it can increase omeprazole level
Lansoprazole
Do not co-administer with HIV medication that contains rilpivirine
Do not co-administer with diuretics or antibiotics
Do not co-administer with digoxin, atazanavir, warfarin, tacrolimus, atorvastatin, theophylline, or methotrexate
Do not co-administer with medications that require low pH for absorption, such as ketoconazole, iron salts, ampicillin esters, and digoxin
Food/Beverage/Supplement Interactions
Omeprazole/Lansoprazole
Clinical research has not shown any severe food, beverage, or supplement interactions with PPIs. However, it has been seen that PPI treatment is most effective on an empty stomach.
There is research that herbal supplements such as ginkgo biloba and St. John's wort may reduce the effectiveness of PPIs such as omeprazole and lansoprazole by hindering their absorption.
Cost Comparison
How much do Omeprazole and Lansoprazole cost?
Omeprazole costs an average of $0.63 per 20 mg tablet, approximately $13.23/per week for an adult taking 60 mg of this medication daily.
Lansoprazole costs an average of $0.94 per 30 mg tablet, translating to approximately $13.16/per week for an adult taking 60 mg of medication daily.
Popularity of Omeprazole and Lansoprazole
Omeprazole and lansoprazole are considered essential medications by the World Health Organization, and both are now available in generic form.
Omeprazole is the 8th most commonly prescribed medication in the US, with over 50 million prescriptions in 2020. On the other hand, lansoprazole is the 191st most commonly prescribed, with approximately 2.6 million prescriptions in the US.
Conclusion
Takeaway
Lansoprazole and omeprazole are both effective treatments for conditions such as Zollinger-Ellison syndrome, where pathological hypersecretions of gastric acid are seen. They both have similar pharmacology and side effects. However, when considering long-term use, lansoprazole has fewer contraindications, drug interactions, and fewer incidences of adverse effects. These findings suggest it is a better-tolerated PPI treatment for ZES.