Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs. When looking at the top 15 most prescribed medications, two PPIs reached the top: Omeprazole and Lansoprazole. Although less widely used than Omeprazole, Esomeprazole gained popularity due to its wide availability as an over-the-counter medicine.

We will discuss various aspects concerning both medicines, such as legal classification, over-the-counter and prescription-only availability, and most importantly, their effectiveness.

Proton Pump Inhibitors (PPIs) are a class of drugs used in treating and controlling symptoms of different gastrointestinal conditions, for example, treatment of ulcers, eradication of Helicobacter pylori (H. pylori), and management of ‘reflux’ symptoms.

When prescribed, PPIs, including Esomeprazole and Omeprazole, have wider licensed uses. Various over-the-counter antibiotics, such as Esomeprazole (Nexium Control) and Omeprazole (Pyrocalm Control), are used only to treat acid reflux symptoms (heartburn).

Among the different drugs used in managing acid-related symptoms, PPIs are the most effective at suppressing stomach acid production.

What Is Omeprazole?

Omeprazole is a medication that belongs to a class of drugs known as proton pump inhibitors (PPIs). It is primarily used to treat conditions related to excess stomach acid production. Omeprazole reduces the amount of acid produced in the stomach, relieving symptoms and healing conditions such as gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome.

Here are some common uses of Omeprazole:

  • Gastroesophageal reflux disease (GERD): Omeprazole is often prescribed to relieve symptoms such as heartburn, acid reflux, and regurgitation caused by the backward flow of stomach acid into the esophagus.
  • Peptic ulcers: Omeprazole can help heal and prevent the recurrence of the stomach and duodenal ulcers, open sores that develop in the stomach lining or the upper part of the small intestine.
  • Zollinger-Ellison syndrome: This rare condition leads to excessive production of stomach acid. Omeprazole is used to reduce acid levels and manage the associated symptoms.

Omeprazole was first approved by the U.S. Food and Drug Administration (FDA) on April 28, 1989. It is available in various forms, including capsules, tablets, and oral suspensions, and can be obtained with a prescription or over-the-counter (OTC) in lower strength for short-term use. As an OTC medication, it is commonly used to treat frequent heartburn. Also, read about omeprazole alternatives for acid reflux.

What Is Esomeprazole?

Esomeprazole is a medication that belongs to the class of drugs known as proton pump inhibitors (PPIs). It is commonly prescribed for treating excess stomach acid production conditions, such as gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome.

Esomeprazole reduces the amount of acid produced in the stomach, helping to alleviate symptoms such as heartburn, acid reflux, and stomach pain. It relieves the enzyme responsible for acid secretion in the stomach lining.

Esomeprazole is also part of combination therapy to eradicate Helicobacter pylori, a bacterium that can cause peptic ulcers. It may be prescribed with antibiotics to eliminate the bacteria and promote healing effectively.

Regarding the FDA approval, it’s important to note that Esomeprazole has been available in the United States since February 2001. However, specific formulations and indications may have received different approval dates. For instance, the FDA approved the delayed-release capsules of esomeprazole magnesium (Nexium) for treating GERD on February 20, 2001. It’s always recommended to consult the latest information and package inserts or consult a healthcare professional for the most accurate and up-to-date details.

How Do Esomeprazole And Omeprazole Work To Treat Gerd?

Esomeprazole and Omeprazole belong to the class of medications known as proton pump inhibitors (PPIs). While they are similar in their mechanism of action, slight differences in their chemical structure exist.

Esomeprazole and omeprazole work by reducing the production of stomach acid. They target the proton pump, an enzyme called H+/K+-ATPase responsible for the stomach’s final step of acid production. By inhibiting this enzyme, they effectively block the secretion of acid into the stomach, resulting in a decrease in acid levels.

These medications are particularly useful in treating gastroesophageal reflux disease (GERD) because they help alleviate the symptoms caused by excessive acid reflux into the esophagus. GERD occurs when the lower esophageal sphincter (LES), a muscle that separates the esophagus from the stomach, does not close properly, allowing stomach acid to flow back into the esophagus.

Esomeprazole and Omeprazole can help heal the esophagus and relieve symptoms such as heartburn, regurgitation, and chest pain associated with GERD by reducing stomach acid production. They provide longer-lasting acid suppression than other acid-reducing medications, making them practical for the long-term management of GERD.

Esomeprazole Vs Omeprazole: OTC Availability

Esomeprazole and Omeprazole were exclusively available via prescription in the United States. However, the FDA has recently approved some of these drugs for over-the-counter usage.

In the United States, Esomeprazole, marketed under the trade name Nexium, is available as an over-the-counter drug in the 20 mg strength. It is approved for the short-term treatment of frequent heartburn in adults (occurring two or more days per week). It is critical to follow the product packaging’s instructions and recommended period of use.

Omeprazole, marketed under numerous brand names such as Prilosec, is also accessible over the counter in the United States. Omeprazole is commonly available over-the-counter as 20 mg tablets or capsules. It is used to relieve frequent heartburn.

Esomeprazole Vs Omeprazole: Prescription Only Options

When it comes to prescribing, Omeprazole is much more commonly prescribed than Esomeprazole, primarily due to the lower cost of Omeprazole. Omeprazole is one of the most common prescription drugs.

Prescription-Only Omeprazole Comes In The Following Forms:

  • Omeprazole 10mg , 20mg, 40mg. Available in the form of capsules and tablets as generic and branded drugs.
  • Omeprazole 10mg, 20mg, and 40mg are available as dispersible, gastro-resistant tablets (Losec MUPS).
  • Omeprazole liquid
  • Omeprazole powder for oral suspension

Prescription-Only Esomeprazole Is Available As:

  • Esomeprazole 20mg, 40mg. Available as tablets and capsules, including branded Nexium and other generic forms of Esomeprazole.
  • Nexium 10 mg (Esomeprazole 10mg) granules for oral suspension (for mixing with water)

Note: Nexium Control, available over the counter, contains 20mg of Esomeprazole, equivalent to prescription-only Esomeprazole 20mg.

What Is The Difference Between Esomeprazole And Omeprazole?

We already established that both drugs belong to the same class of drugs. Both drugs are used in the treatment of the same conditions. The name ‘Esomeprazole’ suggests there are some similarities in terms of chemistry between both drugs. Quite rightly, this is the case. Both drugs have the same chemical formula; however, their arrangement in ‘space’ differs. Both drugs are called isomers.

Esomeprazole vs Omeprazole: a visual representation of isomers. In other words, if your left hand represents Omeprazole, the right hand would be Esomeprazole. Both hands look the same, but they are mirror images of themselves. In pharmaceuticals, it is possible to bring isomers to the market as separate drugs and market them accordingly. This is what happened to Esomeprazole.

Esomeprazole Vs Omeprazole: Which’s Effectiveness Is Better?

Proton pump inhibitors are considered safe and effective drugs for managing acid-related conditions. Their effectiveness relates to the mechanism of action, which targets the last stage of stomach acid production – acid excretion into the stomach by a proton pump.

Other drugs used to manage acid-related conditions stop stomach production by targeting one out of three ways with which stomach acid is produced, hence making them less effective. For example, some drugs called H2 receptor antagonists, such as Ranitidine and Gaviscon, and alternative products neutralize stomach acid.

Is Esomeprazole Better Than Omeprazole?

One study looked at all clinical trials and aided in seeing if Esomeprazole is better than Omeprazole in gastroesophageal reflux disease and Helicobacter pylori infection. Esomeprazole was more effective in the treatment of Esophagitis (inflammation of the tube that connects the throat to the stomach).

However, the comparison was made between Esomeprazole 40mg and Omeprazole 20mg (week 8 of the treatment). At week 4 of the study, both drugs were equally effective. No difference in the effectiveness of the drugs was observed in treating H. Pylori eradication. Fifteen studies were included in this analysis. (Teng et al., 2015).

On the other hand, a smaller study (with fewer participants) showed ‘improved’ control of stomach acid when Esomeprazole was used compared to Omeprazole. It was suggested that the optimal therapy is Esomeprazole 40mg taken in the morning, which offers the most effective treatment of acid reflux disease (Dent, 2003).

More studies exist that favor Esomeprazole as a more effective PPI in controlling acid production when compared to Omeprazole (Scott et al., 2002). It is also suggested that Esomeprazole has improved ‘chemical’ properties, which allows for more extended acid production control than other proton pump inhibitors (Johnson & Hedge, 2002).

Esomeprazole was effective in patients who failed to respond to other PPIs (8 weeks of treatment) and were still experiencing continuing gastrointestinal reflux symptoms.

A group of 99 patients was given Esomeprazole 40mg daily following a lack of response to other PPIs, with 78% of patients responding to the treatment just over four days after the start of the treatment. It was concluded that Esomeprazole (40mg) significantly improved gastro-oesophageal reflux disease (GORD) symptoms (Jones & Patrikios, 2008).

Furthermore, Esomeprazole was more effective than Omeprazole when treating H. pylori infection in patients with duodenal ulcers. In a large study (over 5000 patients), Esomeprazole (40mg) was also more effective in healing rates than Lansoprazole (Scott et al., 2002).

Esomeprazole Vs Omeprazole: Side Effects

As a whole group, PPIs have several common side effects associated with their use.

Esomeprazole and Omeprazole share similar common side effects:

  • Constipation, diarrhea, flatulence
  • Abdominal pain
  • Headache
  • Fundic gland polyps (benign) – stomach polyps

Please read the product information leaflet for a list of all (less common side effects).

Can I Take Esomeprazole with Omeprazole for acid reflux?

Taking Esomeprazole and Omeprazole together is typically not advised unless under medical care. This is because both medications belong to the same drug class and have similar mechanisms of action. Combining them may increase the risk of unwanted effects while delivering no additional benefits.

If you currently use one of these medications and are not providing adequate relief, you should consult your doctor. They can assess your symptoms, adjust the dosage, or recommend different drugs to help you control your acid reflux.

It’s important to note that self-medication and combining drugs without medical supervision might be dangerous. Individuals may react differently to drugs, and drug interactions or contraindications may occur. It is always advisable to seek the advice of a healthcare professional who can assess your unique condition and make suitable recommendations.

Final Words From AzDrug

Esomeprazole and Omeprazole belong to the same class of drugs. Although very similar, Esomeprazole may be a more effective treatment option in managing gastrointestinal reflux-related conditions, as confirmed by several studies.

Although Esomeprazole is more expensive compared to Omeprazole, the use of Esomeprazole should be promoted in patients who failed to respond to other PPIs. Patients must remember that self-treatment with over-the-counter Esomeprazole or Omeprazole is usually limited to two weeks. Patients who have not achieved symptom relief during that time or need ongoing treatment of over two weeks need to speak to their doctor.

Can omeprazole cause weight gain?

Weight gain: Patients with GERD who have been taking omeprazole for a long time are more likely to gain weight.

Can Esomeprazole cause weight gain?

Nexium and other heartburn medications might cause weight gain.

How long should I take Esomeprazole?

Esomeprazole is prescribed for 4 to 8 weeks. If you need more time to heal, your doctor may suggest a second course of treatment.

What medications should not be taken with Omeprazole?

Aminophylline or theophylline, amphetamine, ampicillin, astemizole.

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Disclaimer: Please see your healthcare practitioner for any medical queries or concerns. Peer-reviewed research and information from medical societies and government agencies are used to support the articles in Health Guide. They are not, however, a replacement for expert medical advice, diagnosis, or treatment.

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