What Is a Proton Pump Inhibitor (Like Dexilant)?

So...you have a prescription for a proton pump inhibitor (PPI) do you? Well, you are not alone! In fact, Nexium (a PPI) was the #11 drug sold (based on # of prescriptions) in 2011! So what are they? What do they do? They sound like something from a Star Wars movie. "Quick, Luke, aim that Proton Pump Inhibitor at the Storm Troopers!" But Proton Pump Inhibitors have nothing to do with intergalactic wars, and are unlikely to aid us against alien attacks.

A Proton Pump Inhibitor (also know as a "PPI") is a medication which can reduce the amount of acid secreted into the stomach. In this article I am going to:

• Briefly explain how PPI's work
• List all the currently available PPI's
• Explain how you can pick the most cost-effective PPI for you!

How do Proton Pump Inhibitors work?

First, we need to understand a little about how acid is secreted into the stomach. The lining of the stomach has a variety of cells which do different things. Some of these cells secrete mucus. Some cells secrete acid. These "acid cells" are known as "Parietal Cells." Stomach acid, generally speaking, is a GOOD thing. We need it for proper digestion and absorption of nutrients. The low pH created by the acid helps other digestive enzymes to work also. However, it may be helpful to reduce the amount of acid we manufacture if that acid is causing problems like heartburn, reflux, or ulcers.

The Parietal cell comes to us fully equipped with a cool enzyme system capable of moving a Hydrogen Ion (AKA a Proton) into the stomach, in a slick trade for a potassium ion. This enzyme system is known to the science geeks as the H+/K+ ATPase Enzyme System. You have my permission to forget that. To you and I this enzyme system is affectionately known as The Proton Pump. Once these hydrogen ions (protons) are in the stomach, they combine with chloride ions to form hydrochloric acid! Yep, you remember this stuff from the science lab, the bottle with the big "DANGER" sign on it. Very corrosive!

Proton Pump Inhibitors work by disabling the proton pump in the parietal cell of your stomach. No proton pump = no proton moved into the stomach. No proton moved into the stomach = no formation of hydrochloric acid! If that isn't cool, I don't know what is! Almost makes ya want to be a scientist doesn't it???

Today, Proton Pump Inhibitors are available both by prescription and also without a prescription (ie over the counter). Are the prescription PPI's necessarily better than those available without a prescription? No. In fact, both PPI's now available over the counter used to be only available by prescription, and still are available by prescription, in higher strengths. You should, however, never switch to an over the counter proton pump inhibitor without consulting with your doctor.

PRESCRIPTION ONLY PROTON PUMP INHIBITORS:

Aciphex Tablets (rabeprazole sodium): Aciphex comes in a 20mg tablet and is taken once daily for treatment and symptoms associated with GERD (Gastro Esophageal Reflux Disease). Aciphex does NOT have a generic available at this time.

Dexilant (formerly known as Kapidex) Capsules (dexlansoprazole): Dexilant is the newest PPI to emerge onto the prescription market. It is basically the same ingredient found in Prevacid, now available without a prescription (see OTC below). However, Dexilant has improved the product to some degree by adding a "dual release" mechanism which allows some medication to be released quickly, and the rest to be released several hours later for sustained relief. See picture to the right. Dexilant comes in 30mg and 60mg capsules and is NOT available as a generic. Dexilant is manufactured by Takeda Pharmaceuticals.  By the way, this company changed the name of their product from Kapidex to Dexilant because of numerous accounts of confusion with other similarly named products...specifically Casodex (for cancer) and Kadian (a morphine product for pain). 

Nexium Capsules (esomeprazole magnesium): Nexium capsules are yet another prescription PPI for the treatment of GERD. Also known as "the purple pill" Nexium and is available as a 20mg and 40mg capsule taken once daily. Like some other PPI's, Nexium is also approved to treat an ulcer-causing infection by a bacteria known as H. Pylori. Treatment for this condition requires the addition of two antibiotics (usually amoxicillin and clarithromycin). Nexium is NOT available generically.

Prevacid (lansoprazole): Prevacid is available both as a capsule (to be swallowed whole) and also as a "solutab" which can be placed on the tongue and dissolves usually within 1 minute. It should not be chewed or cut. Alternatively, the solutab can be mixed with a small amount of water, dissolved, and then swallowed. Both tablets and capsules are avaiable in 15mg and 30mg dosages. Prevacid is taken once daily, usually from 4 to 12 weeks, depending on the condition being treated. Prevacid IS now available over-the-counter (OTC) as a 15mg capsule marketed as "Prevacid 24 HR." The prescription version of Prevacid capsules recently became available generically as well.

Prilosec (omeprazole): Prilosec was the first prescription PPI (introduced in 1989) and comes in 10mg, 20mg, and 40mg capsules. Prilosec is also available without a prescription as Prilosec OTC in a 20mg tablet (more on this below). Depending on your prescription plan and coverage, you may discover it is less expensive to use the OTC version. Talk with your doctor or pharmacist to find out.

Protonix (pantoprazole sodium): Protonix was originally a product of Wyeth pharmaceuticals, which then was acquired by Pfizer pharmaceuticals who now holds the rights to this product. Protonix comes in 20mg and 40mg tablets and IS avaiable as a generic. Generics are generally less expensive and will typically be the lowest tier on your insurance copay.

Zegerid (omeprazole with sodium bicarbonate): Zegerid is the unique proton pump inhibitor manufactured by Santarus pharmaceuticals Inc. What is unique about it? Zegeris is the only PPI that immediately releases medication into your system. All other PPI's have a delayed-release mechanism, taking several hours for the drug to get into your blood stream. Does this make Zegerid better? Well...not really. The fact is that no matter how fast it gets into your blood stream, proton pump inhibitors take several days before they are most effective. Nice try anyway Santurus. Zegerid comes in 20mg and 40mg capsules, as well as powder for suspension. Zegerid does NOT have a generic.

There are presently 2 Proton Pump Inhibitors available over the counter, without a prescription.

Prilosec OTC:  Prilosec OTC is available for patients who suffer from heartburn symptoms 2 or more days per week and are at least 18 years old.  It should generally not be used beyond 2 weeks without consulting a physician.  Why?  Well, it is not because it is dangerous to use for more than 2 weeks.  But it COULD be dangerous if you in fact have a more serious condition and you delay or avoid getting treated while taking Prilosec OTC.  Take my advice:  If you have symptoms that persist after a 2 week trial of Prilosec OTC...please...see your doctor! 

Prevacid 24 HR:  Prevacid 24 HR is also available without a prescription for symptoms of heartburn.  Like Prilosec, it should only be used by those 18 years or older, and not for more than 14 days continuously.  The packaging does permit the use of another 14 day course of therapy in 4 months if needed.  As I said before, if your symptoms persist beyond 14 days...see your doctor!

A note about these OTC Products:  If you have been prescribed prescription strength Prilosec or Prevacid, you may want to compare the cost of buying it yourself OTC.  If this would save you money (remember that you have to compare the strengths to your prescription product) then you should ask your doctor about using the OTC version instead.  They are the same medication and should work exactly the same way. 

Do you have a prescription for a Proton Pump Inhibitor? Has the cost given you worse stomach pains than you had BEFORE the visit to the doctor? There are a few things you can do to reduce the cost of your prescription proton pump inhibitor.

1) If the prescription is for Prevacid or Prilosec, check the price of the OTC versions mentioned above. Your pharmacist can help you compare the cost and see if this will save you money.

2) Remember that Prilosec, Protonix and Prevacid are all available generically by prescription. Make sure you try the generic product if you can.

3) Know your insurance. Do you know what tier your Proton Pump Inhibitor is? You can look it up on your insurance formulary. Most formularies can be found online, or you can call your insurance company and ask them. A lower tier means a lower cost to you! For an example of what an insurance formulary for Proton Pump Inhibitors looks like, see the picture below!

4) Take advantage of Prescription Manufacturer Website Coupons! If you are on a prescription OR OTC Proton Pump Inhibitor, the manufacturer might have discount coupons you can print right from their website! Here are some links to coupons for the following products:

• Aciphex
• Kapidex
• Nexium
• Prilosec OTC
• Prevacid 24 Hour

5) Finally, check out my other articles on how to save money on prescription drugs for more tips!

As a pharmacist I get questions about medication all the time. I hope this article has answer your question "What are Proton Pump Inhibitors?" I also hope I have provided some useful information about the PPI's currently available and how to make some cost effective decisions about them with your doctor. Feel free to leave me a question if there is anything else about Proton Pump Inhibitors you would like to know!

Sincerely,

Your Pharmacist