Heartburn Support - Nexium/Prilosec question

Author

Nexium/Prilosec question

dkarlinsey@gmail.com

2006-07-19, 4:22 pm

I have a question regarding medication for GERD/Gastritis. It would be
nice if there was a pharmacist or Dr to answer this question as it is
somewhat scientific.

Basically, how does nexium compare to prilosec as far as dosage, how
important is it to take medicine at the same time everyday, and does it
matter if you take your pills at the same time or split them up?

I did some reading at some people say 20mg of prilosec equals 10mg of
nexium because prilosec is a racemic mixture with S and R isomers while
nexium is just the S isomer (which is supposed to be the active
ingredient) so 20mg of prilosec only has 10mg of active ingredient. But
the usual prescribed dosages are usually the same...???

http://www.ti.ubc.ca/pages/letter45.htm
http://www.everything2.com/index.pl?node_id=1317964

Also, it is unclear to me whether the R isomer is completely inactive
or only partially effective. If it is partially effective then that
means 20mg of prilosec is actually slighty more effect than 10mg of
nexium. But if the R isomer causes side effects, then it may be better
to take nexium to reduce the risk of side effects.

And does it matter whether you take 40mg in the morning or 20mg * day?

Howard McCollister

2006-07-19, 9:22 pm

<dkarlinsey@gmail.com> wrote in message
news:1153320504.266904.81110@h48g2000cwc.googlegroups.com...
>I have a question regarding medication for GERD/Gastritis. It would be
> nice if there was a pharmacist or Dr to answer this question as it is
> somewhat scientific.
>
> Basically, how does nexium compare to prilosec as far as dosage, how
> important is it to take medicine at the same time everyday, and does it
> matter if you take your pills at the same time or split them up?
>
> I did some reading at some people say 20mg of prilosec equals 10mg of
> nexium because prilosec is a racemic mixture with S and R isomers while
> nexium is just the S isomer (which is supposed to be the active
> ingredient) so 20mg of prilosec only has 10mg of active ingredient. But
> the usual prescribed dosages are usually the same...???
>
> http://www.ti.ubc.ca/pages/letter45.htm
> http://www.everything2.com/index.pl?node_id=1317964
>
> Also, it is unclear to me whether the R isomer is completely inactive
> or only partially effective. If it is partially effective then that
> means 20mg of prilosec is actually slighty more effect than 10mg of
> nexium. But if the R isomer causes side effects, then it may be better
> to take nexium to reduce the risk of side effects.
>
> And does it matter whether you take 40mg in the morning or 20mg * day?
>

I suspect that Nexium is primarily a ploy by AstraZeneca to get around the
patent expiration on Prilosec. I consider Nexium 40 mg to be equivalent to
Prilosec 20 mg twice a day. I prescribe the two interchangably, as well as
Aciphex, Protonix, or Prevacid - whichever of those drugs the patient's
insurance will cover. I have not found any of those drugs to be
substantially more effective than any of the others.

HMc

leushinoguy@gmail.com

2006-07-31, 4:25 pm

Is there something "healing" in Protonix that is not present in
Prilosec? I tolerate Prilosec but recently my doctor prescribed
Protonix after a throat scope. Evidently there was some damage to the
lower esophagus but there is no way to tell whether this was new or old
damage (i.e. before my taking Prilosec over the counter... about two
years now.. once a day). After a week with Protonix, I find I have
increased burping (and sometimes I wonder if those burps are acidy),
headaches and some soreness in my side. I experienced none of this with
Prilosec but admittedly I was only using 10 mg once a day compared to
the Protonix's 40 mg.

I'll be speaking with my doctor when he returns in a week's time but
meanwhile could someone answer the question. I'd greatly appreciate an
answer.

Howard McCollister wrote:
> <dkarlinsey@gmail.com> wrote in message
> news:1153320504.266904.81110@h48g2000cwc.googlegroups.com...
>
>
> I suspect that Nexium is primarily a ploy by AstraZeneca to get around the
> patent expiration on Prilosec. I consider Nexium 40 mg to be equivalent to
> Prilosec 20 mg twice a day. I prescribe the two interchangably, as well as
> Aciphex, Protonix, or Prevacid - whichever of those drugs the patient's
> insurance will cover. I have not found any of those drugs to be
> substantially more effective than any of the others.
>
> HMc

Howard McCollister

2006-07-31, 4:25 pm

<leushinoguy@gmail.com> wrote in message
news:1154375535.890644.217630@75g2000cwc.googlegroups.com...
> Is there something "healing" in Protonix that is not present in
> Prilosec? I tolerate Prilosec but recently my doctor prescribed
> Protonix after a throat scope. Evidently there was some damage to the
> lower esophagus but there is no way to tell whether this was new or old
> damage (i.e. before my taking Prilosec over the counter... about two
> years now.. once a day). After a week with Protonix, I find I have
> increased burping (and sometimes I wonder if those burps are acidy),
> headaches and some soreness in my side. I experienced none of this with
> Prilosec but admittedly I was only using 10 mg once a day compared to
> the Protonix's 40 mg.
>

No, all of the various PPI's are generally equivalent, although there is
individual variability in a peoples' response to medication.

HMc

leushinoguy@gmail.com

2006-08-01, 2:24 am

Wow! Thanks for such a speedy response. Okay.. could I trouble you for
a bit more information? My surgeon is unfortunately away for the week
and his receptionist told me to contact my own physician. He
essentially said to revert to the Prilosec until the surgeon returned.
I've not yet done that because I'm concerned that I might be adversely
affecting the condition of my esophagus. After all... why did he
prescribe Protonix in the first place? Evidently my condition is not
"that" bad but if not treated it "could" develop into a more serious
state. While the headaches finally stopped today, I still have chest
discomfort and mild aching in the backs of my legs. Not sure if either
is connected with Protonix.

My question to you again: Are you certain there is no special healing
property in Protonix as opposed to Prilosec? My own physician told me
to take one and if that did not do the trick, take another. They're
over the counter (10 mg) and the Protonix is a 40 mg tablet so even
with two Prilosec I would still not be getting the same dosage. Is it
wise to just drop it or should I carry on for another week with the
above symtoms? In other words, will things improve with time? It's been
a week now?

Thanks.

Howard McCollister wrote:
> <leushinoguy@gmail.com> wrote in message
> news:1154375535.890644.217630@75g2000cwc.googlegroups.com...
>
> No, all of the various PPI's are generally equivalent, although there is
> individual variability in a peoples' response to medication.
>
> HMc

Howard McCollister

2006-08-01, 8:24 am

<leushinoguy@gmail.com> wrote in message
news:1154408804.214696.185180@h48g2000cwc.googlegroups.com...
> Wow! Thanks for such a speedy response. Okay.. could I trouble you for
> a bit more information? My surgeon is unfortunately away for the week
> and his receptionist told me to contact my own physician. He
> essentially said to revert to the Prilosec until the surgeon returned.
> I've not yet done that because I'm concerned that I might be adversely
> affecting the condition of my esophagus. After all... why did he
> prescribe Protonix in the first place? Evidently my condition is not
> "that" bad but if not treated it "could" develop into a more serious
> state. While the headaches finally stopped today, I still have chest
> discomfort and mild aching in the backs of my legs. Not sure if either
> is connected with Protonix.
>
> My question to you again: Are you certain there is no special healing
> property in Protonix as opposed to Prilosec? My own physician told me
> to take one and if that did not do the trick, take another. They're
> over the counter (10 mg) and the Protonix is a 40 mg tablet so even
> with two Prilosec I would still not be getting the same dosage. Is it
> wise to just drop it or should I carry on for another week with the
> above symtoms? In other words, will things improve with time? It's been
> a week now?
>
> Thanks.
>

Yes, I'm certain.

As to dosages, they are not necessarily equivalent. 20 mg Protonix is not
necessarily the same as 20 mg Prilosec.

HMc

leushino

2006-08-01, 4:36 pm

Howard, thanks for the response. If I understand you correctly, you are
saying that both medications do the same thing: block the production of
acid in the stomach thereby assisting in the healing of the esophagus
since it is not irritated as often. Protonix may or may not be more
effective with some people than with others... it is something that
needs to be tested. Is this correct?

Also, you never addressed the second part of my question. Will the side
effects I'm currently having with the medication subside or time (or...
perhaps more correctly, do they "usually" subside over time)? I've been
on it for a full week now and the headaches are still present but not as
acute as the first five days. What I'm trying to determine is whether to
"tough it out" a bit longer... say two weeks.

Thanks.

Howard McCollister wrote:
> <leushinoguy@gmail.com> wrote in message
> news:1154408804.214696.185180@h48g2000cwc.googlegroups.com...
>
>
> Yes, I'm certain.
>
> As to dosages, they are not necessarily equivalent. 20 mg Protonix is not
> necessarily the same as 20 mg Prilosec.
>
> HMc
>
>

Howard McCollister

2006-08-01, 4:36 pm

"leushino" <leushinonospam@myway.com> wrote in message
news:ovJzg.43$Ek1.24@fe03.lga...
> Howard, thanks for the response. If I understand you correctly, you are
> saying that both medications do the same thing: block the production of
> acid in the stomach thereby assisting in the healing of the esophagus
> since it is not irritated as often. Protonix may or may not be more
> effective with some people than with others... it is something that needs
> to be tested. Is this correct?
>
> Also, you never addressed the second part of my question. Will the side
> effects I'm currently having with the medication subside or time (or...
> perhaps more correctly, do they "usually" subside over time)? I've been on
> it for a full week now and the headaches are still present but not as
> acute as the first five days. What I'm trying to determine is whether to
> "tough it out" a bit longer... say two weeks.
>

Yes. If one PPI doesn't work satisfactorily, a doctor would be likely to
prescribe a different one.

Side effects from this (and other) medications tend to be individualized, so
there's no way of predicting what side effects will occur, nor how they
behave, in any one particular patient. Sometimes medication side effects go
away, sometimes they don't, sometimes they get worse. If they are still
bothersome after a couple of weeks, IMHO it's unlikely they will go away.

HMc