- What Are They?
- Why Use PPIs?
- Side Effects
- Drug Interactions
- Examples of PPIs
What are proton pump inhibitors (PPIs), and how do they work (mechanism of action)?
Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. Acid is necessary for the formation of most ulcers in the esophagus, stomach, and duodenum, and the reduction of acid with PPIs prevents ulcers and allows any ulcers that exist in the esophagus, stomach, and duodenum to heal.
What diseases or conditions do PPIs treat?
- Esophageal duodenal and stomach ulcers
- NSAID-associated ulcer
- Gastroesophageal reflux disease (GERD)
- Zollinger-Ellison syndrome
They also are used in combination with antibiotics for eradicating Helicobacter pylori, a bacterium that together with acid causes ulcers of the stomach and duodenum.
Are there differences among proton pump inhibitors (PPIs)?
Proton pump inhibitors are very similar in action and there is no evidence that one is more effective than another. They differ in how they are broken-down by the liver and their drug interactions. The effects of some PPIs may last longer; therefore, they may be taken less frequently.
What are the side effects of proton pump inhibitors (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:
What drugs interact with proton pump inhibitors (PPIs)?
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.
Latest Digestion News
Daily Health News
List of examples of brand and generic names for PPIs
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.
Proton pump inhibitors (PPIs) reduce the production of acid in the wall of the stomach (that produces acid) thereby preventing ulcers and assists in the healing of ulcers that exist on the esophagus, stomach, or duodenum. PPIs are prescribed for the prevention and treatment for acid-related conditions such as GERD (gastroesophageal reflux disease), ulcers, and Zollinger-Ellison syndrome. PPIs may also be used in combination with antibiotics for the treatment of Helicobacter pylori.
Multimedia: Slideshows, Images & Quizzes
Heartburn: Foods to Eat, Foods to Avoid
Learn the symptoms of heartburn and which foods cause heartburn or GERD. Discover home remedies and which foods may provide...
GERD Quiz: Test Your Digestive Diseases IQ
Who 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...
Picture of Gastroesophageal Reflux (GERD)
The stomach contents regurgitate and back up (reflux) into the esophagus The food in the stomach is partially digested by...
Picture of Esophagus
The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. See a picture of the Esophagus and learn more...
Related Disease Conditions
Cough: 19 Tips on How to Stop a Cough
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.Natural and home remedies to help cure and soothe a cough include staying hydrated, gargle salt water, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke. Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs. Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
H. pylori (Helicobacter Pylori) Infection
Helicobacter pylori (H. pylori) is a bacteria that causes chronic inflammation (gastritis) of the inner lining of the stomach, and also is the most common cause of ulcers worldwide. About 50% of people in the world carries or is infected with H. pylori. Common symptoms of H. pylori infection are occasional abdominal discomfort, bloating, belching or burping, and nausea and vomiting. H. pylori infection is difficult to eradicate, and treatment is with two or more antibiotics.
Esophagitis (Pain, Symptoms, Causes, Grades, and Cure)
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include a candida yeast infection of the esophagus as well as herpes. Signs and symptoms of esophagitis include cough, mouth sores, chest pain, bad breath, sore throat, heartburn, and difficulty swallowing. Treatment of esophagitis includes diet, lifestyle changes, and medication depending upon the cause.
GERD (Acid Reflux, Heartburn)
Gastroesophageal reflux disease (GERD), also called acid reflux, can cause symptoms like heartburn, chest pain, regurgitation, and nausea. Learn about causes, diagnosis, treatment and prevention.
Peptic Ulcer (Stomach Ulcer)
Peptic or stomach ulcers are ulcers in the lining of the stomach, duodenum, or esophagus. Learn about symptoms, causes, diet, and treatment.
Indigestion (Dyspepsia, Upset Stomach Pain)
Indigestion (dyspepsia, upset stomach) can be caused by problems related to, or not related to the gastrointestinal tract. Signs and symptoms are upper abdominal pain, belching, nausea, vomiting, abdominal bloating, and abdominal distention. Treatment depends upon the cause.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication,prescription medication, and surgery.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Early RA signs and symptoms include anemia, both sides of the body affected (symmetric), depression, fatigue, fever, joint deformity, joint pain, joint redness, joint stiffness, joint swelling, joint tenderness, joint warmth, limping, loss of joint function, loss of joint range of motion, and polyarthritis.
Heartburn vs. Acid Reflux (Differences and Similarities)
Heartburn and acid reflux are not the same thing. Heartburn is actually a symptom of acid reflux. Heartburn gets its name because it feels like a burning sensation around the heart. Another symptom that occurs with heartburn is a bitter or sour taste in the mouth, usually when you eat or lye down. Heartburn affects more than 60 million people in the US at least once a month. Acid reflux, or GERD, occurs when stomach acid backs up into the esophagus, which irritates it. Heartburn is just one symptom of acid reflux. Other symptoms of acid reflux include: Belching Nausea after eating A feeling of fullness during or after eating Abdominal bloating Upset stomach Belching Wheezing Reflux laryngitis A tightness in the throat Problems swallowing Indigestion In some people, vomiting Causes of acid reflux and heartburn include: Being obese Slouching (poor posture) Medications like calcium channel blockers, theophylline, nitrates, and antihistamines Foods and drinks like caffeine, citrus fruits and vegetables, alcohol, and chocolate Pregnancy Diabetes Increase in stomach acid Eating a heavy meal Eating before bed The treatment for heartburn and acid reflux is to treat the underlying cause, for example, GERD, with over-the-counter (OTC) medicine, prescription medicine, natural remedies, and lifestyle changes like a eating a healthy, less fatty, spicy diet, not eating big meals, not eating before bed, and getting regular exercise to improve your posture.Sometimes a heart attack can mimic heartburn and acid reflux because they feel very similar. If you have symptoms of chest pain, tightness in the chest, heartburn, acid reflux, jaw, tooth, or head pain; shortness of breath, nausea, vomiting, sweating, discomfort in the upper middle of the abdomen, arm or upper back pain, or the general feeling of being ill, go to the nearest Emergency Department immediately because these are the symptoms of a heart attack.REFERENCES:American College of Gastroenterology. "Acid Reflux." 2017.<http://patients.gi.org/topics/acid-reflux/> familydoctor.org. "Heartburn." Updated: Mar 2014.<https://familydoctor.org/condition/heartburn/> National Library of Medicine; PubMed Health. "Heartburn and GERD: Treatment options for GERD." Updated: Nov 18, 2015.<https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072436/>
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn. Learn the symptoms, causes, and treatments for Barrett's esophagus.
Reflux Laryngitis (Diet, Home Remedies, Medicine)
Reflux laryngitis is caused by acid refluxing back up through the esophagus and voice box. Reflux laryngitis causes irritation and inflammation of the lining of the esophagus, larynx, and throat; and can lead to symptoms, signs, and other problems like esophagitis, sinusitis, strictures, throat clearing, swallowing problems, asthma, chronic cough, and growths on the vocal cords. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with diet chanes, OTC medication, prescription medication, and lifestyle changes.
Nonsteroidal Anti-inflammatory Drugs and Ulcers
Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Is H. pylori Contagious?
H. pylori (Helicobacter pylori) infection: Is it contagious? H. pylori infection is caused by fecal contamination in either food or water, and by poor hygiene practices such as not washing the hands often. Common symptoms of H. pylori are a discomfort or pain in the area of the stomach. Some individuals describe the pain as gnawing or burning. Treatment of H. pylori infection is antibiotic therapy.
Schatzki's ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. Symptoms include food stuck in the esophagus. Treatment is generally a procedure to stretch or fracture the rings.
What Is Eosinophilic Esophagitis (EOE)?
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
GERD (Acid Reflux) in Infants and Children
GERD (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.
Treatment & Diagnosis
- GERD Gastroesophageal Reflux Disease FAQs
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Ulcers: What Causes Ulcers?
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- Medication Disposal
- Dangers of Mixing Medications
- Bleeding Ulcer Symptoms and Causes
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
Prevention & Wellness
- Could Heartburn Meds Spur Growth of Drug-Resistant Germs in Your Gut?
- Connecting the Dots Between Heartburn Drugs and Kidney Damage
- Popular Heartburn Meds Linked to Higher Risk of Heart Attack
- Generic Aciphex Approved to Treat Chronic Heartburn
- FDA Panel Backs New Device for Chronic Heartburn
- Study: Stomach Acid Drugs Linked to Fracture Risk
- Acid-Reducing Drugs May Not Be Risky in Pregnancy
- Infections, Fractures Linked to Acid Reflux Drugs
Subscribe to MedicineNet's General Health Newsletter
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
FDA Prescribing Information