Digestive enzymes vs. omeprazole (Prilosec)

• Pancreatic enzyme products (PEPs) and omeprazole (Prilosec) are used to treat different types of gastrointestinal problems.
• Pancreatic enzyme products are used when the pancreas is unable to produce enough digestive enzymes to treat people with pancreatic diseases, such as cystic fibrosis, Shwachman-Diamond syndrome, chronic pancreatitis, pancreatic cancer or tumors, and removal of all or part of the pancreas. PEPs may also be used in gastrointestinal disorders, including Celiac disease, Crohn's disease, and certain cases of poor digestion that are associated with deficiencies in pancreatic enzymes.
• Omeprazole is used to treat ulcers, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, duodenitis, erosive esophagitis, heartburn, and H. pylori infection.
• Pancreatic enzyme products and omeprazole belong to different drug classes. Pancreatic enzyme products are a combination of enzymes normally produced by the pancreas and omeprazole is a proton pump inhibitor (PPI).
• Side effects of pancreatic enzyme products and omeprazole that are similar include headache, diarrhea, nausea, vomiting, and dizziness.
• Side effects of pancreatic enzyme products that are different from omeprazole include stomach pain, gas, constipation, cough, sore throat, upset stomach, neck pain, stuffy nose, heartburn, ear pain, and nosebleed.
• Side effects of omeprazole that are different from pancreatic enzyme products include rash, nervousness, abnormal heartbeat, muscle pain, and weakness.

Digestive enzymes are complex proteins naturally produced by the pancreas to help digest and break down the foods we eat. Oral digestive enzymes are used when the pancreas is unable to produce enough digestive enzymes. The main digestive enzymes are proteases for digesting proteins, lipases for digesting fats, and amylases for digesting carbohydrates. Pancreatic enzyme products (PEPs) are used in people with pancreatic diseases, such as cystic fibrosis, Shwachman-Diamond syndrome, chronic pancreatitis, pancreatic cancer or tumors, and removal of all or part of the pancreas. PEPs may also be used in gastrointestinal disorders, including Celiac disease, Crohn's disease, and certain cases of poor digestion that are associated with deficiencies in pancreatic enzymes.

Omeprazole (Prilosec) is a proton pump inhibitor (PPI) used to treat ulcers, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, duodenitis, erosive esophagitis, heartburn, and H. pylori infection. Other PPIs include lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome, which are all caused by stomach acid. Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.

Digestive enzymes

Although rare, some patients can experience life-threatening allergic reactions when taking this medicine. Patients should stop their medication immediately and seek emergency medical help if they have any of the following signs or symptoms.

• Difficulty breathing or talking
• Swelling of the mouth, face, lips, tongue, or throat
• Chest tightness
• Rash or hives
• Itching
• Red, swollen, blistered, or peeling skin
• Wheezing

Other side effects of digestive enzymes include:

• Stomach pain
• Headache
• Gas
• Constipation
• Cough
• Sore throat
• Diarrhea
• Upset stomach
• Nausea or vomiting
• Neck pain
• Stuffy nose
• Heartburn
• Ear pain
• Dizziness
• Nosebleed

This medication can increase the risk of developing a rare but serious bowel problem called fibrosing colonopathy in which there is localized inflammation and scarring in the colon. Patients are advised to call their doctor right away if they have very bad

• Stomach pain
• Constipation
• Upset stomach
• Vomiting
• Diarrhea

Many digestive enzymes are derived from pork and, therefore, should not be used by patients who are allergic to pork.

Omezprazole

Omeprazole like other PPIs is well tolerated. The most common side effects are:

• Diarrhea
• Nausea
• Vomiting
• Headaches
• Rash
• Dizziness

Other important side effects include:

• Nervousness
• Abnormal heartbeat
• Muscle pain
• Weakness
• Leg cramps and water retention, which occur infrequently

Each packet of Zegerid powder for oral suspension contains 460 mg of sodium and each capsule contains 304 mg of sodium. This should be taken into consideration in patients who need a sodium-restricted diet.

Proton pump inhibitors may increase the risk of Clostridium difficile infection. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).

Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.

Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

Digestive enzymes

Digestive enzymes are available over-the-counter (OTC) or by prescription.

• OTC products are not approved by the FDA and should not be used with the intent to cure or treat any aliments.
• OTC digestive enzymes are mainly used as dietary supplements to help with digestion.
• OTC dietary supplements are not regulated by the FDA and may contain impurities and varying quantities of active ingredients.

Speak to your doctor or pharmacist if you are interested in starting an OTC regimen.

Prescription digestive enzymes come in various formulations and may contain different amounts of individual digestive enzymes. Therefore, prescription digestive enzymes are not clinically interchangeable and are not considered bioequivalent by the FDA.

Omeprazole

For ulcers, GERD, erosive esophagitis and eradication of H. pylori, the recommended dose for adults is 20 to 40 mg daily. Ulcer healing usually occurs within 4 to 8 weeks.

H. pylori infections are treated for 10 to 28 days.

The usual dose for prevention of upper gastrointestinal bleeding in critically ill patients is 40 mg daily for 14 days.

Omeprazole is used for treating heartburn for up to 2 weeks, and the usual dose is 20 mg daily.

For the management of Zollinger-Ellison syndrome, the starting dose for adults is 60 mg daily, and the dose is adjusted based on either the response of symptoms or the actual measurement of acid production. Doses greater than 80 mg should be divided. Doses up to 120 mg 3 times a day have been used in the treatment of Zollinger-Ellison Syndrome.

For maximal efficacy, omeprazole tablets should be taken before meals, swallowed whole and should not be crushed, chewed, or opened.

Digestive enzymes

The effectiveness of oral digestive enzymes may decrease when they are given with antacids containing calcium or magnesium.

Digestive enzymes containing amylase or other carbohydrate digesting enzymes may reduce the effectiveness of alpha-glucosidase inhibitors -- for example, acarbose (Precose), miglitol (Glyset) -- a class of oral anti-diabetes medications that are used to reduce the activity of the carbohydrate digesting enzymes.

Omeprazole

Omeprazole potentially can increase the concentrations in blood of diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin) by decreasing the elimination of these drugs by the liver.

The absorption of certain drugs may be affected by stomach acidity. Therefore, omeprazole as well as other PPIs reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may reduce the effectiveness of ketoconazole or increase digoxin toxicity.

Through unknown mechanisms, omeprazole may increase blood levels of saquinavir and reduce blood levels of nelfinavir and atazanavir, drugs that are used for treating patients with infection caused by the human immunodeficiency virus (HIV). Accordingly, the dose of saquinavir may need to be reduced to avoid toxicity, and the doses of nelfinavir and atazanavir may need to be increased to maintain efficacy.

Clopidogrel (Plavix) is converted to its active form by enzymes in the liver. Omeprazole reduces the activity of these enzymes and potentially can reduce the activity of clopidogrel. Omeprazole should not be used with clopidogrel.

Omeprazole increases the concentration of cilostazol (Pletal). The dose of cilostazol should be reduced from 100 mg twice daily to 50 mg twice daily when given with omeprazole.

Omeprazole may increase blood levels of methotrexate (Rheumatrex, Trexall) and tacrolimus (Prograf).

Digestive enzymes

Oral digestive enzymes have not been adequately studied in pregnant women. Oral digestive enzymes should only be used during pregnancy if the potential benefits to the mother outweigh the potential risks to the unborn baby.

It is not known whether oral digestive enzymes are excreted into breast milk. Pancreatic enzymes mostly act locally in the gastrointestinal tract and are generally not absorbed into the bloodstream to make their way to the fetus.

Omeprazole

Use of omeprazole in pregnant women has not been adequately evaluated. Omeprazole should only be used during pregnancy if the benefits justify the unknown risks.

Omeprazole is excreted in breast milk and potentially could cause adverse effects in the infant.