Proton pump inhibitors (Formulary)

MHRA advice: Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus (September 2015)
MHRA advice: Proton pump inhibitors in long-term use: reports of hypomagnesaemia (December 2014)

Guidance: Management of acute upper GI bleed.

Patient information: Medicines to reduce stomach acid (proton pump inhibitors).

Important: Supplementary notes

Prescribing tips:

Review continued PPI prescribing annually: Algorithm for the review of patients on proton pump inhibitors.
Base the choice of formulation on appropriateness for the patient and cost; for maintenance therapy lansoprazole 15mg once daily is more effective than omeprazole 10mg once daily.

Interactions:

PPIs have the potential to interact with a range of drugs. See BNF for details.
NB PPIs have been observed to react with warfarin; this occurs unpredictably and infrequently therefore close monitoring is required. There is no evidence that any of the proton pump inhibitors is safer in this respect.

Co-prescribing

See guidance: Antiplatelet and NSAID.

Clostridioides difficile:

Careful consideration needs to be given to the use of PPIs in vulnerable groups.
Proton pump inhibitors are associated with an increased risk of Clostridioides difficile infection similar to that with antibiotic therapy, particularly in those aged 65 and over.

Fracture risk:

There is an association between long-term high-dose proton pump inhibitors and increased fracture risk.

LANSOPRAZOLE - (First line)

Important: Therapy notes

Lansoprazole orodispersible tablets are preferred first-line in those with swallowing difficulties as they are licensed for use in tube feeding and are lower cost than omeprazole dispersible tablets.
See Instructions for the administration of lansoprazole orodispersible tablets via an enteral feeding tube.
For maintenance therapy lansoprazole 15mg once daily is more effective than omeprazole 10mg once daily.

Important: Formulation and dosage details

Formulation:

Capsules 15mg, 30mg

Dosage:

Treatment, 30mg once daily for 4 to 8 weeks.
Maintenance dose, 15mg once daily.

Important: Formulation and dosage details

Formulation:

Orodispersible tablets 15mg, 30mg

Dosage:

Treatment, 30mg once daily for 4 to 8 weeks.
Maintenance dose, 15mg once daily.

OMEPRAZOLE

Important: Therapy notes

Omeprazole suspension is not recommended for use in NHS Highland.
For the use of omeprazole solution (specialist recommendation only) see the NHS Highland unlicensed and off-label medicines list (intranet access required).
Omeprazole is the PPI of choice for use in Obstetrics.

Important: Formulation and dosage details

Formulation:

Capsules 10mg, 20mg

Dosage:

In adults, by mouth, treatment, 20mg once daily for 4 to 8 weeks, in severe cases increase to 40mg once daily; maintenance dose, 20mg once daily. In children, refer to BNF for Children.

Proton pump inhibitors (Formulary)

Important: Supplementary notes

LANSOPRAZOLE - (First line)

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Dosage:

Important: Formulation and dosage details

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Dosage:

OMEPRAZOLE

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Dosage:

Important: Formulation and dosage details

Formulation:

Dosage:

Important: Formulation and dosage details

Formulation:

Important: Formulation and dosage details

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Editorial Information