Options for Proton Pump Inhibitors

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Options for Proton Pump Inhibitors

Question:

I take Zegerid, which I have been told is the same as Prilosec with sodium bicarbonate. I originally took Prilosec and it didn't work as well. Is there another medicine with sodium bicarbonate in it? Zegerid is getting to be too expensive.

Answer:

You are correct. The ingredients are the same. Zegerid contains omeprazole (the active ingredient in Prilosec). Zegerid also contains 1,100 milligrams of sodium bicarbonate (about ¼ teaspoon). Omeprazole is a member of a class of drugs called proton pump inhibitors.

Proton pump inhibitors are the most potent blockers of stomach acid. To be effective, these drugs need to be absorbed from the intestine into the blood stream so they can reach the inside surface of the stomach cells. That's where proton pump inhibitors work.

Here's the problem: As the drug passes through the stomach, the acid in the stomach breaks down the proton pump inhibitor before it reaches the intestine.

To get around this problem, proton pump inhibitors (other than Zegerid) have protective coatings around the tablets. This keeps the acid from breaking down the active ingredient. (The downside is that the coating slows down the absorption of the active ingredient from the intestine into the blood stream.)

The makers of Zegerid solved the problem a different way. Instead of using a coating, they added sodium bicarbonate. The sodium bicarbonate neutralizes the acid before it can break down the active ingredient.

When the omeprazole in Zegerid reaches the intestine, it is absorbed into the blood more quickly because it doesn't have a protective coating.

I am not aware of another non-coated proton pump inhibitor with sodium bicarbonate. And taking sodium bicarbonate with generic omeprazole or Prilosec is not the same as taking Zegerid.

You might try switching to a different brand of proton pump inhibitor. Although all proton pump inhibitors work the same way, you might find one that helps you more. Other proton pump inhibitors include esomeprazole, lansoprazole, pantoprazole and rabeprazole.

Another strategy some doctors recommend is to take omeprazole or another proton pump inhibitor in the morning and a different type of acid blocker, called an H2 blocker, at night. The H2 blockers include cimetidine, famotidine, nizatidine and ranitidine.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Last updated:	July 20, 2009