ppisupdate-final.pdf
TRANSCRIPT
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Cntents
2: OurRecommendations
4: Welcome
6: What Are PPIs andWho Needs Them?
8: Choosing a PPIOur Best BuyPicks
14: Tips to TalkingWith Your Doctor
15: How We Picked theBest BuyPPIs
16: Sharing this Report
16: About Us
17: Reerences
Using the Proton Pump Inhibitors to Treat
HeartburnandStmachAcidRefuxCopARgEECvEESS,SAEy,ApRCE
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Proton pump inhibitors (PPIs) are a class o very
eective and generally sae medicines used to treat
heartburn, gastroesophageal reu disease (RD),and gastric ulcers.
But not everyone who eperiences heartburn needs
one. Several o the PPIs have been widely advertised
to consumers and heavily promoted to physicians, and
this has led to an overuse o the drugs in the treatment
o garden-variety heartburn. PPIs are among the
highest-selling classes o drugs in the U.S., with $9.5
billion in sales last year, and one o them, Neium, was
the top-selling o all drugs, earning nearly $6 billion in
2012, according to IS Health, which tracks drug salesand marketing.
I you suer rom occasional heartburn and have not
been diagnosed with RD, nonprescription antacids
such as aalo, ylanta, Rolaids, and Tums, or
acid-reducing drugs known as H2 blockers, such as
cimetidine (Tagamet), amotidine (Pepcid), nizatidine
(Aid), and ranitidine (Zantac) will very likely provide
relie. All o those products are available without a
prescription as low-cost generics.
Talk with your doctor about the role that dietary and
liestyle changes can play in alleviating heartburn,
too, such as eating smaller meals and not lying down
or at least three hours ater eating, losing weight i
you need to, and avoiding alcohol. I, however, you
eperience heartburn twice a week or more or weeks
or months on end, have requent regurgitation o ood
into your throat or mouth (with or without heartburn),
or i your heartburn is not relieved by the drugs
mentioned above, you may have RD and may need
a PPI. RD is a condition that makes you prone toacid reu and, over time, can cause damage to your
esophagus.
The seven available PPI medicines
are roughly equal in eectivenessand saety but dier in cost. Three
omeprazole (Prilosec, Prilosec OTC),
lansoprazole (Prevacid, Prevacid
24HR), and omeprazole/sodium
bicarbonate (Zegerid, Zegerid OTC)
are available as both prescription and
nonprescription drugs.
fourlansoprazole, omeprazole, omeprazole/sodium
bicarbonate, and pantoprazole (Protoni)are
available as both brand-name drugs and generics
that contain the same active ingredient but cost
signicantly less.
Taking the evidence or eectiveness, saety, cost,
and other actors into account, i you need a PPI, we
have chosen the ollowing as Consumer Reports Best
Buy Drugs:
eneric omeprazole OTC
eneric lansoprazole OTC
ourRecmmendatins
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Both o these drugs are available without a prescription.
You could save $200 a month or more by choosing one
o these medicines over more epensive prescriptionPPIs. I you have health insurance, nd out i your plan
will help pay or generic omeprazole OTC or generic
lansoprazole OTC. I not, talk with your doctor about
taking the PPI with the lowest out-o-pocket cost or
you. I you have esophagitis (inammation o the
esophagus), you might want to consider esomeprazole
(Neium), pantoprazole (Protoni and generic), or
rabeprazole (AcipHe). Some research suggests those
drugs could provide better healing rom esophagitis.
Safetynote: Several studies have now linked PPIsto a higher risk o pneumonia and inection with
a bacterium called Clostridium difcile, and other
studies have ound that long-term use o PPIs may
be associated with an increased risk o ractures. Talk
with your doctor about those risks, especially i you
must take a PPI over a long period o time. People
who are 65 and older and those with chronic medical
conditions should be vaccinated against pneumonia
and get a u shot every year. And we emphasize this
recommendation or people in those categories who
are also taking a PPI.
In addition, anyone taking clopidogrel (Plavi and
generic), a blood thinner used to prevent clots ater
heart attacks and stent placement, should be especiallycautious with PPIs, particularly omeprazole and
esomeprazole because they can reduce clopidogrels
eectiveness, which could increase the risk o another
heart attack. Our medical advisers recommend that
people taking clopidogrel should not take PPIs unless
other treatments have not been adequate.
This report was updated in July 2013.
ourRecmmendatins
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Proton pump inhibitors (PPIs) are a class o drugs
used to treat heartburn, gastroesophageal reu
disease (RD), and gastric ulcers.
Heartburn and RD are quite common. Heartburn
is the main symptom o RD but does not always
signal it (see page 6 or a more detailed eplanation).
Between a quarter and a third o adults in the U.S.
will have RD symptoms at some point. It is most
common among people ages 50 and older but can
strike at any age. Pregnant women are also highly
prone to RD.
This evaluation o PPIs is part o a Consumer Reportsproject to help guide you to medicines that are most
eective and sae, and give you the best value or your
health-care dollar. To learn more about the project
and the other classes o drugs we eamine, go to
www.CRBestBuyDrugs.org.
Si PPIs and one combination drug are currently
available. They are listed below.
Delansoprazole (Deilant) was approved by the fDA
in January 2009 (The brand name was changed rom
Kapide to Deilant in 2010 because the previous
name was sometimes conused with other medications
that had similar names). Because ew studies have
been done using Deilant, less is known about its
eectiveness. In addition, its saety prole is not ully
established yet. for those reasons, we recommendsticking with the other PPIs, especially our Best Buy
picks, until more is known about this drug.
Welcme
generic ameBrand Aailableasa
prescritin
genericru?
Aailableasa
nrescritin
ru?
someprazole Neium No No
Delansoprazole Deilant No No
ansoprazole Prevacid, Prevacid 24HR(a nonprescription version)
Yes Yes
Omeprazole Prilosec, Prilosec OTC Yes Yes
Omeprazole/Sodium Bicarbonate
Zegerid, Zegerid OTC Yes Yes (brand name only)
Pantoprazole Protoni Yes No
Rabeprazole AcipHe No No
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four PPIslansoprazole, omeprazole (Prilosec),
omeprazole/sodium bicarbonate (Zegerid), and
pantoprazole (Protoni)are available as genericprescription drugs. Three o the PPIs are available
over-the-counter without a prescriptionlansoprazole
(Prevacid 24HR and generics), omeprazole (Prilosec
OTC and generics), and omeprazole/sodium
bicarbonate (Zegerid OTC). The cost or those
nonprescription medications is signicantly lower than
the prescription versions, i you are paying out-o-
pocket. None o the available studies on Zegerid met
the criteria or inclusion in the scientic analysis that
orms the basis o this Best Buy Drugs report.
Other prescription and nonprescription medicines are
available to treat heartburn and acid reu. Among
them are the over-the-counter antacids aalo,
ylanta, Rolaids, and Tums, all o which are available
as generics. These medicines work within minutes
to relieve heartburn and acid indigestion. But their
eect lasts only a ew hours.
Another class o drugs, called H2 blockers, is also
available over-the-counter to treat mild, occasional
heartburn and ecess stomach acidity. Thenonprescription versions o drugs in this class include
cimetidine (Tagamet OTC), amotidine (Pepcid AC),
nizatidine (Aid AR), and ranitidine (Zantac 75, Zantac
150), all o which are available as low-cost generics.
H2 blockers take longer to work than antacids30
minutes to an hourbut they provide heartburn relie
or up to 12 hours.
Stronger doses o H2 blockers are also available
by prescription, and all are also available as lower-
cost generics.
Studies have ound that PPIs reduce
stomach acid more over time thanantacids or H2 blockers. But PPIs
are not intended or the immediate
relie o heartburn. Antacids and H2
blockers actually do a better job at
that. The main advantage o treatment
with PPIs, in addition to reducing
stomach acid or longer periods
o time, is that they treat people
diagnosed with RD or ulcers.
This report evaluates only PPIs, which have become
the most widely prescribed medicines in the U.S.
to treat heartburn and RD when symptoms persist,
are chronic or severe, or are unrelieved by antacids
or H2 blockers.
This report was published in July 2013.
Welcme
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WhatAreppsand
Wheedshem?
PPIs work by blocking an enzyme that is necessaryor making acid in the stomach. When this enzyme is
blocked, acid production decreases.
PPIs are very eective and relatively sae. But not
everyone needs one. Several o them have been widely
advertised to the public and promoted to physicians
particularly Neium (the purple pill), which earned
nearly $6 billion in sales in 2012, making it the top
seller among all medications, according to IS Health.
any physicians think the heavy promotion has led
to an overuse o PPIs in the treatment o occasionalheartburn. figures rom IS Health show the number
o prescriptions written in the U.S. or PPIs in 2012
topped 127 million, making them among the most
commonly prescribed class o drugs.
Beore you start taking a PPI, we advise
talking with your doctor about other
medicines that may be useul i you
have only occasional heartburn (oncea week or less) and have not been
diagnosed with RD.
Also, talk with your doctor about the role that dietary
and liestyle changes can play in alleviating heartburn,
such as eating smaller meals and not lying down or at
least three hours ater eating, losing weight i you need
to, and avoiding alcohol.
Almost everyone has heartburn once in a whileoreample, ater a heavy or spicy meal, or ater drinking
alcohol. Heartburn is an uncomortable sensation that
usually starts just below your breastbone and can
radiate into your throat. You may also get a sour or bitter
taste in your mouth or throat.
Occasional heartburn is not worrisome or dangerous,and can be largely relieved by taking over-the-counter
antacids or H2 blockers. ven i you have a period
o timesay a couple o weeksin which you get
heartburn airly regularly, you may not need anything
stronger than those drugs.
However, i you have heartburn at least twice a
week or weeks or months on end, have requent
regurgitation o ood into your throat or mouth (with or
without heartburn), or i your heartburn is not relieved
by antacids or H2 blockers, you may have RD.
RD (gastroesophageal reu disease) is not just the
result o requent heartburn or ecessive eating, as
commonly thought. Its caused by a physical condition
that many people appear prone to, when the ring o
muscle between the esophagus and stomach doesnt
work properly. The muscle usually opens when ood is
passing through on its way to the stomach. In people
with RD, however, the muscle seems to open at
other times. Or it stays open too long ater ood has
passed through. When either happens, acid rom thestomach can ow back up into the esophagus. This is
called acid reu.
There are no denitive studies o how many Americans
actually have RD. By some estimates, more than
60 million eperience heartburn at least once a month
and 15 million suer rom it daily. So it is possible
that tens o millions o people may have the condition.
The bottom line is that i you have heartburn twice a
week or more you could meet the criteria or RD
and should see a doctor i your symptoms are notcontrolled by liestyle changes, over-the-counter
antacids, or H2 blockers.
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WhatAreppsand
Wheedshem?
In contrast to occasional heartburn, RD can bedangerous. I it isnt treated, over time, the acid reu
can iname or erode the lining o the esophagus, a
condition called esophagitis. You may sense it as a
chronic soreness in your lower throat and/or chest.
ost cases o esophagitis are relatively mild. But i
let untreated, it can result in bleeding, scarring, and a
narrowing o the esophagus. This can make eating and
swallowing oods painul and dicult. People who have
uncontrolled RD or years also have a higher risk o
cancer o the esophagus, though this cancer is rare.
Between a third and hal o the people with RD will
have some damage to their esophagus, although its
usually mild. But doctors cant tell who is going to
develop that damage and who will not, or how severe it
might be. As a result, i you are diagnosed with RD,
your doctor will almost certainly prescribe a PPI. All
o these drugs greatly reduce the amount o acid your
stomach produces, making the reuing stomach
contents less erosive. That allows the esophagus to heal.
I you are diagnosed with RD, your doctor mayalso recommend that you undergo a procedure called
an upper endoscopy. The procedure uses a lighted
eible tube, put down the throat, to look inside the
esophagus. Your doctor will then look or damage to
your esophagus. He or she may also take a sample o
tissue to test or cancer.
PPIs dont cure RD; they treat the symptoms. Not a
lot is known about how people with RD do over the
long-term. But it appears that some have RD or lie
while or most, the condition occurs only sometimes orresolves on its own.
I you are diagnosed with RD and are given a
prescription or a PPI, talk with your doctor about how
long you should take the medicine. Ater a ew months,
you may be able to stop taking it without any problems.
I your symptoms return, you can oten start takingthe medicine again. any doctors and pharmacists
think that PPIs are overused to treat people who have
heartburn but do not have signs o esophagitis.
A small number o people who have severe symptoms
and/or are prone to severe damage to their esophagus
may need to take a PPI every day or years. People
diagnosed with RD should have dietary counseling
to determine which oods may worsen their symptoms.
Quitting smoking is also recommended. And i you are
overweight, research has shown that losing weight canreduce heartburn and RD.
PPIs are also used to treat peptic ulcers, erosions in
the lining o the stomach or upper intestinal tract.
These ulcers are caused primarily by a bacterial
inection with an organism called Helicobacter pylori.
PPI drug treatment alone does not eliminate the
inection; you need antibiotics or that. The benet o
using PPIs is that they enable the ulcers to heal by
reducing stomach acid. That treatment has virtuallyeliminated the need or ulcer surgery ecept or those
in whom bleeding is unstoppable.
PPIs are also now commonly prescribed to help
prevent or treat erosions in the stomach lining in
people who take nonsteroidal anti-inammatory drugs
(NSAIDs), such as ibuproen (Advil and generics) or
naproen (Aleve and generics), or corticosteroids such
as prednisone to treat arthritis or pain. Studies have
ound that they help by reducing stomach acid and
allowing the ulcers to heal. People who take NSAIDsregularly or pain, arthritis, or other reasons should
talk with their doctor about taking a PPI as well to
protect their stomach.
In this report, we only evaluate PPIs or treating
heartburn and RD.
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Chsinapp
ourBestBuypicks
All PPIs are highly eective at reducing stomach acid,relieving heartburn, and thereby helping to heal damage
to the esophagus caused by RD. The overall evidence
rom research that compared the drugs with each
other shows them to be very similar, with no PPI any
better than any other. Some studies have indicated that
esomeprazole (Neium) may have a slight advantage,
but the drug was administered at a higher dose in these
trials (we discuss this in more detail on page 13).
As you can see in Table 1, below, i you take a PPI
you have a 65 to 77 percent chance o completesymptom relie ater our weeks. You have a 77 to 90
percent chance that any damage that occurred to your
esophagus will be healed ater eight weeks. And the
majority o people who are advised to remain on a PPI
to prevent relapses dont usually eperience one. Someresearch indicates pantoprazole and rabeprazole provide
better symptom relie and healing o esophagitis at eight
weeks, and that esomeprazole provides better esophagus
healing (inammation has gone away) over 6 months.
The gures in Table 1, below, are compiled rom many
studies, so they do not reect a direct comparison o
the PPI drugs as i the drugs were evaluated against
each other in a single study. The gures are presented
here to illustrate the general eectiveness o the class
o PPIs. The dierences between the drugs should notbe taken as an indication that one drug is stronger or
weaker, or better or worse, than any other. That is one
reason we give you the ranges o response as well as
the averages.
able1.generalEectienesspps1
genericameAnd
sepera
Brandame SmtmRelieat
4Weeks,Aerae
percentae
patients(Rane)
EshaealHealin
at8Weeks,Aerae
percentae
patients(Rane)
Relase
preentin,
percentae
patients
Delansoprazole 30 mg Deilant NA2 NA2 75
Delansoprazole 60 mg Deilant NA2 86(82-89) 83
someprazole 20 mg Neium NA2 87 (84-91) 87
someprazole 40 mg Neium 73(65-82) 90(88-92) 93
ansoprazole 30 mg Prevacid 70(61-80) 86 (83-90) 91
Omeprazole 20 mg Prilosec 65 (54-76) 85 (81-88) 86-92
Pantoprazole 20 mg Protoni 77(70-84) 77(65-88) 55-86
Pantoprazole 40 mg Protoni 72(62-83) 89(86-92) 78
Rabeprazole 20 mg AcipHe 69(52-86) 82(76-89) 89
1. ectiveness data presented or PPI dosage strengths that have been studied to date. Data are rom individualstudies included in DRPs analysis o the PPIs. Ranges given reect ndings rom multiple studies.
2. NA=Data not available.
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Chsinapp
ourBestBuypicks
Doctors have no way o gauging how a person willrespond to a PPI or i they will respond to one better
than another. The gures we present indicate that most
people can epect to get relie rom taking any PPI.
But its not uncommon or some people to respond
better to one PPI than another. As a result, your doctor
may recommend that you try another PPI i the one
you try initially does not appear to work ater about si
weeks. Or your doctor may prescribe a higher dose o
the PPI beore switching you to another one.
ppsSideEectsandSaet
PPI drugs can cause both minor and serious side
eects, but studies have not ound any signicant
dierences between the PPIs in the side eects they
cause or their saety proles. inor side eects
include headache and diarrhea. About one to three
percent o people stop taking a PPI because they
cannot tolerate the side eects. In light o the potential
risks, the fDA advises doctors and patients to only use
PPIs when necessary and to limit them to the lowestdose or the shortest period required or relie, or that
is appropriate or your condition.
One serious side eect o PPIs includes being
susceptible to certain inections since there is a
decreased production o stomach acid, which normally
helps protect against inections by killing bacteria and
viruses. Specically, taking PPIs can increase the risk
o community-acquired pneumonia, particularly within
the rst month o use. They can also increase the risk
o inection with a bacterium called Clostridium difcile,which can cause disabling diarrhea and high ever and
can lead to more serious intestinal conditions.
You may be at higher risk or inection i you have
asthma, lung disease, decreased immunity (because
o HIV or AIDS, or eample), or are older. People 65
and older are already advised to get vaccinated against
pneumonia and to get a u shot every year. Takinga PPI on a regular basis may be another important
reason to get both vaccines.
In addition, several studies have ound that some
people who took PPIs had a higher risk o hip
ractures, and one study ound an increased risk o
wrist and orearm ractures. The drugs can potentially
interere with the absorption o calcium, which can
lead to weakened bones. The bone ractures occurred
mostly in patients older than 50 who either took high
doses or PPI or stayed on them or one year or longeraccording to an fDA review.
In addition, when taken or longer than a year, PPIs
can lower blood levels o magnesium. Although many
patients dont have symptoms when their magnesium
levels are low, it can be a serious condition leading
to muscle spasms, irregular heartbeat, and seizures.
I you might be on a PPI or a long time or i you are
taking digoin, a diuretic, or any other medication that
can lower your magnesium, your doctor should order
blood tests to monitor your magnesium levels.
runteractinCncerns
PPIs are known to interact with other medicines and
dietary supplements in ways that can be dangerous.
In some cases, your doctor may recommend that you
take a specic PPI because o evidence that it is less
likely to interact with another drug you are taking.
People oten take a PPI to decrease stomach irritationand bleeding that can occur with a blood-thinning
drug called clopidogrel (Plavi or generic)oten
prescribed or patients ater heart attacks, strokes,
stent placements, and other heart problems. But i
you take Plavi, you should be cautious about taking a
PPI, particularly esomeprazole or omeprazole because
they can reduce Plavis protective eect, which could
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10
increase the risk o another heart attack. This issueis important to discuss with your doctor i you take
clopidogrel. Our medical advisers recommend that
people who take Plavi should skip PPIs unless other
treatments have not been adequate.
I you take Plavi and require a medication to treat
your heartburn, RD, or gastric ulcer and your
symptoms arent severe, another option may be an
older class o drugs called H2 blockers, which includes
nizatidine (Aid, Aid AR), amotidine (Pepcid, Pepcid
AC), and ranitidine (Zantac, Zantac 75, Zantac 150). Allare available as low-cost generics. You could also try
an antacid. These drugs have not been associated with
reducing the protective eects o Plavi. You should
also talk to your doctor about having periodic blood
counts or monitoring o your stools in order to detect
gastrointestinal bleeding you may not be aware o
(black, tarry stools can be a sign o this, or eample).
The main drugs to be concerned about potentially
interacting with PPIs are:
Clopidogrel (Plavi and generic), and potentially
other anti-clotting medication, used to prevent
clots ater a heart attack, stroke, and/or stent
placement
Blood thinners, such as wararin (Coumadin
and generics)
Anti-aniety drugs known as benzodiazepines,
such as diazepam (Valium and generics)
Antibiotics
Phenytoin (Dilantin and generics), used to
treat epilepsy
Disuluram (Antabuse and generic), used to
treat alcoholism
Atazanavir (Reyataz) and nelnavir (Viracept),
used to treat HIV/AIDS
Another concern is whether PPIsare sae to take during pregnancy,
because pregnant women are prone to
heartburn and RD. Unortunately,
theres not enough evidence to draw a
rm conclusion about this.
One study ound no increased risk o rates o preterm
birth, miscarriage, ectopic pregnancy, or stillbirth in
women who took PPIs while pregnant, compared to
those who did not. But this study had several limitations
so more studies would be needed to conrm there is no
risk beore a denitive conclusion can be made.
finally, studies indicate that about three percent o
Caucasians and Arican-Americans and 17 to 25 percent
o Asian-Americans have less than average amounts o
the enzymes that break down PPIs in the body. for these
groups o people, less than the usual dose o a PPI might
work just as well to relieve symptoms, though the usual
doses are considered to be sae. Testing to determine a
persons level o this enzyme is not necessary.
CstandourBestBuypicks
While the seven PPIs evaluated in this report do not
dier in eectiveness or saety, they do dier in price.
The average monthly cost ranges rom less than $20
to more than $400 (See Table 2 on page 11.). Taking
the evidence or eectiveness, saety, cost, and otheractors into account, i you need a PPI, we have chosen
the ollowing as Consumer Reports Best Buy Drugs:
eneric omeprazole OTC
eneric lansoprazole OTC
Chsinapp
ourBestBuypicks
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11
able2.ppCstCmarisn
genericame Brand
ameArequenc
seBAerae
nthlCstC
Delansoprazole 30 mg sustained-release tablets Deilant One per day $188
Delansoprazole 60 mg sustained-release tablets Deilant One per day $183
someprazole 20 mg capsules Neium One per day $240
someprazole 40 mg capsules Neium One per day $234
ansoprazole 20 mg delayed-release tablets (nonprescription) Prevacid 24HR One per day $24D
ansoprazole 20 mg delayed-release tablets (nonprescription) eneric One per day $17D
ansoprazole 15 mg delayed-release capsules Prevacid One per day $265
ansoprazole 15 mg delayed-release capsules eneric One per day $119
ansoprazole 15 mg delayed-release dissolvable tablets Prevacid One per day $285
ansoprazole 15 mg delayed-release dissolvable tablets eneric One per day $161
ansoprazole 30 mg delayed-release capsules Prevacid One per day $275
ansoprazole 30 mg delayed-release capsules eneric One per day $107
ansoprazole 30 mg delayed-release dissolvable tablets Prevacid One per day $265
ansoprazole 30 mg delayed-release dissolvable tablets eneric One per day $163
Omeprazole 20 mg tablets (nonprescription) Prilosec OTC One per day $22D
Omeprazole 20 mg tablets (nonprescription) eneric One per day $17D
Omeprazole 10 mg delayed-release capsules Prilosec One per day $211
Omeprazole 10 mg delayed-release capsules eneric One per day $64
Omeprazole 20 mg delayed-release capsules Prilosec One per day $236
Omeprazole 20 mg delayed-release capsules eneric One per day $58
Omeprazole 40 mg delayed-release capsules Prilosec One per day $374
Omeprazole 40 mg delayed-release capsules eneric One per day $134
Chsinapp
ourBestBuypicks
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Uig t Pt PUP iibit t tt: tbU d tc cid flUxCm p B B D
12
these are proven menes avaae whou a
presrpon. for mos peope, hey are as eeve ashe more epensve presrpon aernaves. ess
han $1 a ay, ener omeprazoe tc an ener
ansoprazoe tc os one-enh he pre o severa o
he presrpon aernaves, a major savns or hose
who nee a PPi.
houh Zeer tc aso oss aou he same as
he oher over-he-ouner PPisaou $20 or a
monhs suppywe an ye reommen eause
he avaae sues on Zeer no mee he
rera or nuson n he sen anayss haorms he ass o hs Best Buy Drugs repor, so we
on know how ompares n erms o eeveness
an saey.
ur hoe o hese over-he-ouner menes
presens wo quesons, however. the rs s: do younee o vs a oor you sar akn one o hem
or hearurn an hnk you may have gd? the
answer s yes. buyn hese rus o reeve oasona
hearurn requres no na physan vs, savn you
ha roue an epense. bu you have perssen
hearurnwe a week or severa weeksor you
have soreness n your hroa or hes, you shou see
a oor as soon as posse, even as you onnue
o ake he over-he-ouner PPis or any oher
nonpresrpon a reuer. ememer, gd an
e anerous an you an anose yourse.
Choosing a ppI
ur Best Buypicks
able 2. ppI Cost Coarison (continued)
eneric ae Brand
aeAFrequency
of seBAverage
monthly CostC
Panoprazoe 20 m eaye-reease aes Proon ne per ay $254
Panoprazoe 20 m eaye-reease aes gener ne per ay $70
Panoprazoe 40 m eaye-reease aes Proon ne per ay $232
Panoprazoe 40 m eaye-reease aes gener ne per ay $66
aeprazoe 20 m aes pe ne per ay $355
. gener naes ru so y ener name. mon PPis, omeprazoe, omeprazoe/soumaronae, ansoprazoe, an panoprazoe are avaae as ener rus.
b. s ypay presre.c. onhy os rees naonwe rea averae pres or pr 2013, roune o he neares oar. inormaon was erve
y Consumer Reports Best Buy Drugs rom aa prove y oure eahare nays, in., whh s no nvoven our anayss or reommenaons. verae monhy os s ase on reommene osae o one p ay.
d. Pres or hese meaons were oane y consumer epors sere shoppers a ve major han pharmaes(cV, e , tare, Wareens, an Wamar) an oa supermarkes aross he U.. n January 2013. the presrom he varous sores were averae o ye per-p pres, whh were hen onvere no a monhy pre.
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13
The second question involves your healthinsurance status. Insurers do not typically pay or
nonprescription medicines. So i you have insurance
and your doctor says you need a PPI, he or she may
be inclined to prescribe one rather than tell you to
buy one o the over-the-counter PPIs. Beore that
happens, you should nd out rom your health plan
i it covers over-the-counter PPIs. Some insurers
do, and others may provide coverage under certain
circumstances. I this is the case, youll save money
by starting your treatment with one o the drugs that
doesnt require a prescription.
I your health plan does not oer coverage o an over-
the-counter PPI, you can:
Consult with your doctor to choose the PPI that
has the lowest out-o-pocket cost under your
insurance plan. eneric prescription omeprazole,
or eample, may be available or a copayment o
$5 to $10 a month.
Pay or an over-the-counter PPI instead o out o
your own pocket.
ither way, your monthly cost will be relatively low, and
the dierence in cost between the two choices may be
quite small. Choosing nonprescription omeprazole OTC
or generic lansoprazole OTC oers the convenience o
purchasing more without a doctors prescription. And
i your symptoms ease or disappear, you may not need
to visit the doctor again.
I you do not have health insurance or prescription
drug coverage, or you must pay a sizable portion odrug costs out-o-pocket, nonprescription omeprazole
or lansoprazole are the clear drugs o choice. These
will save you substantial amounts o money.
I you have RD and have moderate to severesymptoms or esophagitis, you may need a higher dose
o a PPI. I you take nonprescription omeprazole or
lansoprazole, you could take one to two 20 mg tablets
daily at a cost o around $17 to $34 a month.
In that contet, the makers o Neium have promoted it
heavily as the superior drug to treat people with RD
and esophagitis. The gures we present in Table 1 show
that, on average, Neium may have a slight advantage
over several o the other PPIs or such use. However, the
justication or such a claim seems marginal at best.Neium is usually prescribed at a dose o 40 mg, which
studies have ound to be more potent than, say, 20 mg
o generic omeprazole or Prilosec OTC. Other studies
have ound Neium 40 mg to be equivalent to Protoni
at 40 mg and Prevacid 30 mg. In addition, one key
study ound that people with RD without esophagitis
did just as well with generic omeprazole at 20 mg as
with Neium at 20 mg or 40 mg.
However, i you have been diagnosed with esophagitis,
you might want to consider Neium, pantoprazole(Protoni and generic), or rabeprazole (AcipHe)
because, as we previously noted, some research
suggests they provide better healing rom that
condition. None are available over-the-counter, so
they are all more epensive than our Best Buy picks.
And because there are no generic ormulations o
Neium and AcipHe, they are both substantially more
epensive than generic pantoprazole.
Chsinapp
ourBestBuypicks
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14
Its important or you to know that theinormation we present here is not meant to
substitute or a doctors judgment. But we
hope it will help you and your doctor arrive
at a decision about which PPI and dose is
best or you, i one is warranted at all, and
which gives you the most value or your
health-care dollar.
1.entincstturdctr.Bear in mind that many people are reluctant todiscuss the cost o medicines with their doctor, and
that studies have ound that doctors do not routinely
take price into account when prescribing medicines.
Unless you bring it up, your doctor may assume that
cost is not a actor or you.
2.Askabutldermedicatins.
any people (including physicians) thinkthat newer drugs are better. While thats a natural
assumption to make, its not always true. Studies
consistently nd that many older medicines are as good
as, and in some cases better than, newer medicines.
Think o them as tried and true, particularly when it
comes to their saety record. Newer drugs have not yet
met the test o time, and unepected problems can and
do crop up once they hit the market. O course, some
newer prescription drugs are indeed more eective
and saer. Talk with your doctor about newer vs. older
medicines, including generic drugs.
3.Cnsiderenericdrus.Prescription medicines go generic when acompanys patents on them have lapsed, usually ater
about 12 to 15 years. At that point, other companies
can make and sell the drugs. enerics are much less
epensive than newer brand-name medicines, but theyare not lesser quality drugs. Indeed, most generics
remain useul medicines even many years ater rst
being marketed. That is why more than 75 percent o all
prescriptions in the U.S. today are written or generics.
4.Keeu-t-daterecrds.Another important issue to talk with yourdoctor about is keeping a record o the drugs you take.
There are several reasons or this:
first, i you see several doctors, each may not be
aware o medicines the others have prescribed.
Second, since people dier in their response to
medications, its common or doctors today to
prescribe several medicines beore nding one that
works well or best.
Third, many people take several prescription
medications, nonprescription drugs, and dietary
supplements at the same time. They can interact
in ways that can either reduce the benet you get
rom the drug or be dangerous.
fourth, the names o prescription drugsboth
generic and brandare oten hard to pronounce
and remember.
for all these reasons, its important to keep a written
list o all the drugs and supplements you take and
periodically review it with your doctors.
5.Knwtheacts.finally, always be sure that you understandthe dose o the medicine being prescribed and howmany pills you are epected to take each day. Your
doctor should tell you this inormation. When you
ll a prescription at a pharmacy, or i you get it by
mail, check to see that the dose and the number o
pills per day on the bottle match the amounts your
doctor told you.
5 istalkinWithyurctr
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15
Our evaluation is based primarily on an independentscientic review o the studies and research literature
on PPIs. A team o physicians and researchers at the
Oregon Health & Science University vidence-Based
Practice Center conducted the analysis as part o the
Drug ectiveness Review Project, or DRP. DRP is
a rst-o-its-kind multi-state initiative to evaluate the
comparative eectiveness and saety o hundreds o
prescription drugs.
A synopsis o DRPs analysis o the PPIs is the basis
or this report. A consultant to Consumer ReportsBest Buy Drugs is also a member o the Oregon-based
research team, which has no nancial interest in any
pharmaceutical company or product. The ull DRP
review o PPIs is available at http://derp.ohsu.edu/
about/nal-document-display.cm. (This is a long and
technical document written or physicians.)
To supplement the DRP analysis, a member o DRP
also conducted an updated search or relevant studies
that have been published since the publication o the
DRP report.
cept where noted, the prices in this report or PPIs
are national averages based on sales o prescription
drugs in retail outlets. They reect the retail price
paid or a months supply o each drug in April 2013
and were obtained rom a healthcare inormation
company that tracks the sales o prescription drugs
in the U.S. for Prilosec OTC, Prevacid 24HR, and
their generic counterparts, prices were obtained by
Consumer Reports secret shoppers at ve major chain
pharmacies (CVS, Rite Aid, Target, Walgreens, andWalmart) and local supermarkets across the U.S. in
January 2013. The average price or Zegerid OTC is
based on prices at ve online pharmacy stores (CVS,
Rite Aid, Target, Walgreens, and Walmart) in ay 2013.
Consumer Reports Best Buy Drugs selected theBest Buy Drugs using the ollowing criteria. The drug
(and dose) had to:
Be in the top tier o eectiveness among the PPIs.
Have a saety record similar to or better than
other PPIs.
Have an average monthly cost lower than other
PPIs meeting the rst two criteria.
The Consumers Reports Best Buy Drugs methodology
is described in more detail in the methods section at
www.CRBestBuyDrugs.org.
HwWepickedthe
BestBuypps
http://derp.ohsu.edu/about/final-document-display.cfmhttp://derp.ohsu.edu/about/final-document-display.cfmhttp://derp.ohsu.edu/about/final-document-display.cfmhttp://derp.ohsu.edu/about/final-document-display.cfmhttp://derp.ohsu.edu/about/final-document-display.cfm -
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16
This copyrighted report can be downloaded
ree, reprinted, and disseminated or individual
noncommercial use without permission romConsumers Union or Consumer Reports magazine
as long as it is clearly attributed to Consumer
Reports Best Buy Drugs. We encourage its wide
dissemination as well or the purpose o inorming
consumers. But Consumers Union does not authorize
the use o its name or materials or commercial,
marketing, or promotional purposes. Any organization
interested in broader distribution o this report should
email [email protected]. Consumer Reports BestBuy Drugs is a trademarked property o Consumers
Union. All quotes rom the material should cite
Consumer Reports Best Buy Drugs as the source.
2013 Consumers Union o U.S., Inc.
Consumer Reports is an independent and nonprot
organization whose mission since 1936 has been to
provide consumers with unbiased inormation ongoods and services and to create a air marketplace.
Its website is www.ConsumerReports.org.
Consumer Reports Best Buy Drugs is a public-
education project administered by Consumers Union.
These materials were made possible by the state
Attorney eneral Consumer and Prescriber ducation
rant Program, which is unded by a multistate
settlement o consumer-raud claims regarding the
marketing o the prescription drug Neurontin.
The ngelberg foundation provided a major grant to
und the creation o the project rom 2004 to 2007.
Additional initial unding came rom the National
ibrary o edicine, part o the National Institutes o
Health. A more detailed eplanation o the project is
available at www.CRBestBuyDrugs.org.
We ollowed a rigorous editorial process to ensure that
the inormation in this report and on the Consumer
Reports Best Buy Drugs website is accurate anddescribes generally accepted clinical practices. I we
nd an error or are alerted to one, we will correct it
as quickly as possible. But Consumer Reports and its
authors, editors, publishers, licensers, and suppliers
cannot be responsible or medical errors or omissions,
or any consequences rom the use o the inormation
on this site. Please reer to our user agreement at
www.CRBestBuyDrugs.org or urther inormation.
Consumer Reports Best Buy Drugs should not be
viewed as a substitute or a consultation with amedical or health proessional. This report and the
inormation on www.CRBestBuyDrugs.org are provided
to enhance your communication with your doctor
rather than to replace it.
SharinthisRert
Abuts
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disease: a randomized, double-blind comparative trial - theANCIPAT study. uropean Journal o astroenterology &Hepatology. arch 2007;19(3):205-211.
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18. Hellstrom, P.., et al., The choice o proton pump inhibitor: doesit matter? Pharmacology & Toicology, 2004;94 (3):106-11.
19. Holtmann, ., et al., A randomized, double-blind, comparativestudy o standard-dose rabeprazole and high-dose omeprazolein gastroesophageal reu disease. Alimentary Pharmacology& Therapeutics. 2002;16(3):479-85.
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34. Schmitt C., ightdale C.J., Hwang C., Hamelin B. A multicenter,randomized, double-blind, 8-week comparative trial o standarddoses o esomeprazole (40 mg) and omeprazole (20 mg) orthe treatment o erosive esophagitis. Digestive Diseases &Sciences. ay 2006;51(5):844-850.
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38. Van Pinteren, B. et al., Short-term treatment with protonpump inhibitors, H2-receptor antagonists and prokinetics orgastroesophageal reu disease-like symptoms and endoscopynegative reu disease. Cochrane Database o SystematicReviews. (4):CD002095, 2001.
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Reerences
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