Differences Between PPIs vs. NSAIDs
- PPIs (proton pump inhibitors) are gastric acid reducers used to treat gastroesophageal reflux disease (GERD) and ulcers.
- NSAIDs (nonsteroidal anti-inflammatories) are non-narcotic pain relievers used to treat pain and reduce inflammation. They are also used as fever reducers.
- Examples of PPIs include omeprazole (Prilosec, Prilosec OTC, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), esomeprazole (Nexium), and dexlansoprazole (Dexilant).
- Examples of NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), oxaprozin (Daypro), and piroxicam (Feldene).
- Side effects of both PPIs and NSAIDs are somewhat similar and include:
- Other common side effects of PPIs that are different from NSAIDs include:
- Other common side effects of NSAIDs that are different from PPIs include:
- PPIs may be used to treat ulcers caused by taking NSAIDs.
What are PPIs and NSAIDs?
- PPIs (proton pump inhibitors) work by blocking acid production in the stomach. They are used to prevent and treat acid-related conditions such as, ulcers (including NSAID-associated ulcers), gastroesophageal reflux disease (GERD), and Zollinger-Ellison syndrome.
- NSAIDs (nonsteroidal anti-inflammatory drugs) are used to treat pain and reduce inflammation from a variety of causes, such as headaches, injuries, arthritis, menstrual cramps, and muscle aches. NSAIDs are also used as fever reducers. NSAIDs work by blocking two forms of an enzyme called cyclooxygenase (COX).
What are the side effects of PPIs and NSAIDs?
Side effects of PPIs
The most common side effects of proton pump inhibitors are:
Nevertheless, proton pump inhibitors generally are well tolerated.
PPIs may increase the risk of Clostridium difficile infection of the colon. 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.
Other serious side effects associate with PPIs include:
- Serious allergic reactions
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Reduced kidney function
- Reduced liver function
- Erythema multiforme
Side effects of NSAIDs
NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.
Common side effects are:
- decreased appetite,
- headache, and
Other important side effects are:
- kidney failure (primarily with chronic use),
- liver failure,
- ulcers, and
- prolonged bleeding after injury or surgery.
NSAIDs can cause fluid retention which can lead to edema, which is most commonly manifested by swelling of the ankles.
- Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
- Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye's syndrome, a serious and sometimes fatal liver disease. Therefore, aspirin and non-aspirin salicylates (for example, salsalate [Amigesic]) should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.
- NSAIDs increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
Which drugs interact with PPIs and NSAIDs?
PPI drug interactions
Proton pump inhibitors interact with few drugs.
- The absorption into the body of some drugs is affected by the presence of acid in the stomach, and because PPIs reduce acid in the stomach, they may affect the absorption of these drugs. Specifically, PPIs reduce the absorption and concentration in the blood of ketoconazole (Nizoral) and increase the absorption and concentration of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole and an increase in digoxin toxicity.
- Proton pump inhibitors can reduce the break-down of some drugs by the liver and lead to an increase in their concentration in the blood. Omeprazole (Prilosec) is more likely than the other PPIs to reduce the break-down of drugs by the liver. For example, omeprazole (Prilosec) may increase the concentration in the blood of diazepam (Valium), warfarin (Coumadin) and phenytoin (Dilantin).
- Omeprazole (Prilosec, Prilosec OTC) reduces the effect of clopidogrel (Plavix) by blocking the conversion of clopidogrel to its active form. This combination should be avoided.
NSAID drug interactions
- NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics ("water pills") and decrease the elimination of lithium (Eskalith, Lithobid) and methotrexate (Rheumatrex, Trexall). As a result, the blood levels of these drugs may increase as may their side effects.
- NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs.
- NSAIDs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.
- NSAIDs increase the negative effect of cyclosporine on kidney function.
- Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.
What are the different types of PPIs and NSAIDs
PPI medication list
Available proton pump inhibitors include:
- omeprazole (Prilosec, Prilosec OTC)
- aspirin and omeprazole (Yosprala)
- lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour)
- dexlansoprazole (Dexilent, Dexilent Solutab)
- rabeprazole (Aciphex, Aciphex Sprinkle)
- pantoprazole (Protonix)
- esomeprazole (Nexium, Nexium IV, Nexium 24 HR)
- esomeprazole magnesium/naproxen (Vimovo)
- omeprazole/sodium bicarbonate (Zegerid, Zegerid OTC)
Note: The brand name Kapidex was changed to Dexilent to avoid confusion with other drugs.
NSAID medication list
The following list is an example of NSAIDs available:
- celecoxib (Celebrex)
- diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
- diflunisal (Dolobid - discontinued brand)
- etodolac (Lodine - discontinued brand)
- ibuprofen (Motrin, Advil)
- indomethacin (Indocin)
- ketoprofen (Active-Ketoprofen [Orudis - discontinued brand])
- ketorolac (Toradol - discontinued brand)
- nabumetone (Relafen - discontinued brand)
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- oxaprozin (Daypro)
- piroxicam (Feldene)
- salsalate (Disalsate [Amigesic - discontinued brand])
- sulindac (Clinoril - discontinued brand)
- tolmetin (Tolectin - discontinued brand)
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PPIs (proton pump inhibitors) reduce stomach acid and are used to treat gastroesophageal reflux disease (GERD) and ulcers. NSAIDs (nonsteroidal anti-inflammatories) are non-narcotic pain relievers used to treat pain, fever, and reduce inflammation.
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- Rheumatoid Arthritis (RA)
- Stomach Ulcer (Peptic Ulcer)
- Gastroesophageal Reflux Disease (GERD)
- Reflux Laryngitis
- Psoriatic Arthritis
- Acid Reflux (Gastroesophageal Reflux Disease or GERD)
- Heartburn (GERD) Drugs: A New Caution
- Arthritis Pain Relief Update
- NSAIDs: FDA Warning on Bextra, Celebrex
- Heartburn (GERD) Dialogue
- Arthritis Treatment Update
- Arthritis and Active Sports
- Psoriatic Arthritis: Diagnosis and Treatment
- Specific References - GERD
- Osteoarthritis Specific References
- GERD: Putting Out the Fire of Heartburn
- Tummy Trouble FAQs
- Pain FAQs
- GERD Gastroesophageal Reflux Disease FAQs
- Will Rheumatoid Arthritis Nodules Go Away?
- Living With Rheumatoid Arthritis
- Rheumatoid Arthritis vs. Osteoarthritis
- 5 Surprising Facts About Rheumatoid Arthritis
- Patient Story: Rheumatoid Arthritis and Pregnancy
- Treatment Update on Rheumatoid Arthritis
- Patient Story: Rheumatoid Arthritis Symptoms
- Rheumatoid Arthritis Joint Symptoms and Signs: What Do They Mean?
- Rheumatoid Arthritis: Which Patients Do Best?
- Ulcers: What Causes Ulcers?
- Gonorrhea Treatment Recommendations Update
- GERD Surgery - No Good?
- GERD: Questions To Ask Your Doctor About GERD (Heartburn)
- Alzheimer's Disease - NSAID Protection?
- Ulcers May Be Caused By Your Cat
- GERD Surgery Doesn't Prevent Cancer
- Heartburn: Is Heartburn Inherited?
- Esophageal Cancer Linked to Heartburn
- IBS, GERD, Hepatitis C: Doctors Dialogue
- GERD: Types of antacids for GERD?
- GERD: Safe GERD medications for pregnancy?
- GERD Acid reflux during pregnancy?
- GERD: Relief from GERD?
- GERD Symptoms improve with weight loss?
- Why is acid reflux GERD worse at night time?
- GERD Symptoms After Exercise?
- Bad breath from GERD?
- GERD Best treatment for Barrett Esophagus?
- GERD How long can you take Prilosec safely?
- GERD: Any substitute for Propulsid in treating GERD
- GERD: Use of Propulsid GERD
- Heartburn Diagnosis
- Heartburn or Heart Attack? Emergency In Flight
- Chondroitin & Glucosamine & NSAID's
- Pain Management: OTC NSAIDs - Doctors Dialogue
- Pain Management Over-The-Counter
- Doctors Answer Pain Questions
- Can H. Pylori Ulcer Pain Continue After Treatment?
- Can Glucosamine Treat Arthritis?
- Are Tums or Rolaids Good for Heartburn?
- What Can You Take for MCTD Inflammation Beside NSAIDs?
- Does Magnetic Therapy for Arthritis Work?
- What Is the Relationship Between GERD and Scleroderma?
- What Kind of Doctor Treats Ankylosing Spodylitis & Reactive Arthritis?
- Can You Be Too Young for a Knee Replacement?
- Do NSAIDs Interact With Coumadin?
- What Is Vesicoureteral Reflux in Children?
- How Is Arthritis Diagnosed?
- Osteoarthritis vs. Carpal Tunnel: What's the Difference?
- Can You Prevent Osteoarthritis?
- Does Lipitor Help Rheumatoid Arthritis?
- What Are Foods to Avoid With GERD?
- Does Stress Cause Ulcers?
- Can My Diet Improve Arthritis?
- What's the Rheumatoid Arthritis Prognosis?
- What Are Home Remedies for Rheumatoid Arthritis?
- Patient Story: Rheumatoid Arthritis Treatment
- Rheumatoid Arthritis: Living With a Chronic Disease
- Osteoarthritis Symptoms
- When to Call the Doctor for Fever, Nausea, Diarrhea, Colds, and Coughs
- Bleeding Ulcer Symptoms and Causes
- Pain Relievers and High Blood Pressure
- Heartburn: Carbonated Soda & Sleeping Pills Increase Nighttime Heartburn
Medications & Supplements
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Corticosteroids vs. NSAIDs
- Ketorolac vs. ketoprofen
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- Aspirin vs. NSAIDs (Side Effect and Use Differences)
- Prilosec (omeprazole) vs. Nexium (esomeprazole)
- Prilosec vs. Zantac 360
- Types of Osteoarthritis Medications and Treatments
- esomeprazole (Nexium)
- lansoprazole (Heartburn Relief 24 Hour, Heartburn Treatment 24 Hour, Prevacid 24)
- rabeprazole (Aciphex)
- ibuprofen (NSAID)
- Dexilant (dexlansoprazole)
- Types of Rheumatoid Arthritis Medications
- Types of Arthritis Medications
- hydrocodone and ibuprofen, Vicoprofen
Digestive Disorders Resources
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Top PPIs vs NSAIDs Related Articles
aspirin (acetylsalicylic acid, Bayer, Ecotrin, and others)Aspirin (Aspirin, Arthritis Foundation Safety Coated Aspirin, Bayer Aspirin, Bayer Children's Aspirin, Ecotrin, and many others) is a NSAID used to treat fever, pain, and inflammation in the body that results from forms of arthritis, and soft tissue injuries. Aspirin is also used for decreasing the risk of heart attacks and strokes. Side effects, drug interactions, pregnancy information, and pregnancy safety information should be reviewed prior to taking any medication.
Fever in Adults and ChildrenAlthough a fever technically is any body temperature above the normal of 98.6 F (37 C), in practice, a person is usually not considered to have a significant fever until the temperature is above 100.4 F (38 C). Fever is part of the body's own disease-fighting arsenal; rising body temperatures apparently are capable of killing off many disease-producing organisms.
Cold, Fever and Flu Symptoms in Children: Medications and Home RemediesHow long does a cold last? How long is a cold contagious? Colds and fevers are some of the most common ailments in children. Learn common cold symptoms, treatment options, over the counter (OTC) medicines for cold and fever, home remedies, and how to relieve a sore throat.
Esomeprazole (Nexium, Nexium 24HR, Nexium IV) is a proton pump inhibitor prescribed for the treatment of gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, and for the treatment of H. pylori in combination with antibiotics. Side effects, dosing, warnings and precautions, and pregnancy safety should be reviewed prior to taking any medication.
GERD PictureThe stomach contents regurgitate and back up (reflux) into the esophagus The food in the stomach is partially digested by stomach acid and enzymes. See a picture of Gastroesophageal Reflux (GERD) and learn more about the health topic.
GERD (Acid Reflux, Heartburn)GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are:
- regurgitation, and
GERD QuizWho is at risk for developing GERD? Are you? Take this quiz to learn what GERD is, if you're at risk, and what you can do about it.
GERD (Acid Reflux) in Infants and ChildrenGERD (gastroesophageal reflux disease) is the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Common symptoms of GERD in children include colic, feeding problems, poor growth, frequent vomiting or coughing, heartburn, regurgitation, recurrent wheezing, pneumonia, choking, or gagging. Treatment may involve elevating the child's bed, keeping the child upright after eating, limiting foods that seem to make the reflux worse, encouraging your child to exercise, and serving several small meals a day.
hydrocodone and ibuprofen, VicoprofenHydrocodone and ibuprofen (Vicoprofen) is an opioid analgesic prescribed for the management of moderate to severe pain, used on a short-term basis. Review side effects, drug interactions, warnings and precautions prior to taking any medication.
ibuprofen (Advil, Motrin, Nuprin)Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce mild to moderate pain, inflammation, and fever. Ibuprofen works by blocking an enzyme that makes prostaglandin (a hormone-like substance that participates in a variety of body functions), which results in lower levels of prostaglandins in the body. Lower levels of prostaglandins reduce pain, inflammation, and fever. Ibuprofen is prescribed to treat diseases and conditions that cause mild to moderate pain, fever, and inflammation. Review side effects, drug interactions, storage, dosage and pregnancy safety.
Ketorolac vs. ketoprofenKetorolac and ketoprofen are nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat different types of pain. Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. Ketoprofen is used for the management of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and primary dysmenorrhea.
naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
Naproxen (Aleve, Anaprox, Naprelan, Naprosyn) is in the class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is prescribed for the treatment of mild to moderate pain, inflammation, and fever. Side effects, drug interactions, and pregnancy information should be reviewed prior to taking this medication.
Neuropathic PainNeuropathic pain is a chronic condition that leads to ongoing pain symptoms. Patients can be predisposed to developing neuropathic pain who have conditions such as diabetes, cancer, stroke, HIV, vitamin deficiencies, shingles, and multiple sclerosis. Patient history and nerve testing are used to diagnose neuropathic pain. Antidepressants, antiseizure medications, and other types of medications are used to treat neuropathic pain. Many people with neuropathic pain are able to attain some level of relief.
omeprazole (Prilosec, Zegerid)
Omeprazole, omeprazole/sodium bicarbonate (Prilosec, Zegerid, Prilosec OTC, Zegerid OTC) is a proton pump inhibitor drug (PPI) prescribed for the treatment of ulcers, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, duodenitis, erosive esophagitis, heartburn, and H. pylori infection. Side effects, drug interactions, warnings and precautions, and patient information should always be reviewed prior to taking any medication.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
Prilosec (omeprazole) vs. Nexium (esomeprazole)
Prilosec (omeprazole) and Nexium (esomeprazole) are both proton pump inhibitors (PPIs) used to control production of stomach acid. Overproduction of stomach acid is a chief factor in gastroesophageal reflux disease (GERD) and other digestive disorders. Prilosec and Nexium are nearly identical on a molecular level, but Nexium is the more potent medication. Learn about dosages, side effects, and pregnancy safety information for these medications.
Prilosec vs. Zantac 360Prilosec (omeprazole) and Zantac 360 (famotidine) are used for the treatment of conditions such as ulcers and gastroesophageal reflux disease (GERD) caused by stomach acid. Both drugs work in different ways to reduce stomach acid; one is a proton-pump inhibitor and the other is an H2 blocker.
15 Ways to Reduce PainChronic pain can be a symptom of many conditions, including arthritis, headaches, and others. Comprehensive chronic pain management therapy may include physical therapy, lifestyle strategies such as exercise, diet changes, meditation, journaling, medications, and avoiding alcohol and tobacco use. Make helpful changes to manage your chronic condition.
Tummy Trouble QuizTummy Troubles? Get a better idea of what's causing the nausea, vomiting, bloating, gas, constipation, diarrhea, pain, and other gastrointestinal discomforts and problems. Take the Tummy Troubles Quiz!
What Is the Safest Anti-Inflammatory to Take?Non-steroidal anti-inflammatory drugs or NSAIDs are some of the most commonly used medicines available. Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe.