Pantoprazole or omeprazole which is better reviews. Omeprazole or pantoprazole: sharp points of discussion. Benefits of Proton Pump Inhibitors

Introduction

The mechanism of action of pantoprazole is the same as that of other drugs from the group of proton pump inhibitors.

Pantoprazole is the first of the "proton pump" inhibitors, which is available for both oral and intravenous use.

In the US, the main indication for pantoprazole is the treatment of erosive esophagitis associated with gastroesophageal reflux disease (1,2).

Pharmacology

Like other proton pump inhibitors, pantoprazole inhibits ATPase only during hydrochloric acid secretion. Inhibitors of the "proton pump" bind to H+, K+-ATPase and irreversibly block the transport of hydrogen ions.

Pharmacokinetics

Pantoprazole unstable to acid, so it is available in enteric-coated tablets. Pantoprazole is characterized by rapid absorption and its maximum concentration is reached approximately 2.5 hours after a single or repeated dose per os. Pantoprazole undergoes little first-pass metabolism. Its absolute bioavailability is about 77%. The drug can be taken regardless of food intake or antacids. The volume of distribution is approximately 11.0-23.6 liters, and the percentage of protein binding is about 98%. In the liver, pantoprazole undergoes extensive metabolism with the participation of the cytochrome P-450 system. Pantoprazole does not accumulate in the body and repeated doses of the drug during the day do not affect its pharmacokinetics. There is no need for a special selection of the dose of pantoprazole in elderly patients or in patients with renal insufficiency, as well as with moderate hepatic insufficiency. The half-life of pantoprazole in patients with severe liver cirrhosis is increased to 7-9 hours (6). Data on the pharmacokinetics of pantoprazole in persons under 18 years of age have not yet been published (1).

Indications

Intravenous administration of pantoprazole is indicated for the short-term (7-10 days) treatment of GERD in patients who cannot take tablet forms of the drug.

Additional studies are currently underway to evaluate the effectiveness of intravenous forms of pantoprazole in the treatment of Zollinger-Ellison syndrome, in the prevention of stress ulcers (in patients in intensive care units), as well as in the prevention of aspiration pneumonia in patients undergoing elective surgical interventions.

Clinical Efficiency

Erosive esophagitis in GERD

Comparative studies of the clinical efficacy of pantoprazole, histamine H2 receptor antagonists and omeprazole in patients with grade II or III reflux esophagitis (according to the Savary-Miller scale) were conducted (table 1). As a result of these studies, pantoprazole was found to be more effective than H2 receptor antagonists in terms of ulcer healing and symptom control (10,11).

Tab. 1. Placebo-controlled studies of the efficacy of pantoprazole in erosive esophagitis associated with GERD

GERD - gastroesophageal reflex disease;

PANT - pantoprazole;

P - randomized;

OMP - omeprazole;

MC - multicenter.

In another comparative clinical study, emphasis was placed on studying the pharmacodynamic features of pantoprazole and omeprazole in healthy volunteers. Pantoprazole 40 mg daily has been shown to provide a faster onset of effect and greater suppression of gastric secretion than omeprazole 20 mg daily (14). However, so far it has not been possible to show that these pharmacodynamic differences are significantly reflected in the results of comparative studies of the effectiveness of these drugs in the treatment of esophagitis.

A clinical study by Van Rensburg et al (15) compared the clinical efficacy and tolerability of pantoprazole at daily doses of 40 mg and 80 mg. It was found that after 4 weeks of treatment, complete healing was recorded in 78% and 72% of patients, respectively, and after 8 weeks - in 95% and 94% of patients (p>0.05). These results correlate with those of a well-designed pharmacodynamic study conducted in healthy volunteers, which showed that a daily dose of pantoprazole of 40 mg was as effective as daily doses of 80 and 120 mg (16).

More than 90% of patients with erosive esophagitis heal with short-term proton pump inhibitor therapy, but maintenance therapy is needed to prevent recurrence (17).

In a specially conducted multicenter clinical study, which lasted for a year, the preventive efficacy and safety of maintenance therapy was studied using pantoprazole 40 mg per day. A study was conducted on those patients who managed to achieve healing of reflux esophagitis with omeprazole or pantoprazole therapy (18). Endoscopy data showed recurrence rates of 2% and 6% at 6 and 12 months, respectively. In 24% of patients, side effects were noted, most often diarrhea, nausea, vomiting and dizziness.

In a prospective, randomized, multicenter study, the results of long-term maintenance therapy with pantoprazole 40 mg or 20 mg once a day for 12 months were studied. The study was conducted on 396 patients who achieved complete healing of grade II and III esophagitis (19). According to endoscopies, relapses after six months of treatment with 40 mg or 20 mg of pantoprazole per day occurred in 7% versus 16%, and after 12 months in 19% versus 29%. The authors conclude that the administration of pantoprazole at a daily dose of 20 mg is effective and safe for maintenance therapy in patients who managed to stop the acute period of reflux esophagitis.

Peptic ulcer of the duodenum

Savarino et al. conducted a prospective, randomized, multicenter study of 64 patients with duodenal ulcer. In this study, a 24-hour assessment of gastric acidity and the degree of scarring of ulcers was carried out. Before starting a 2-week course of therapy with pantoprazole (20 mg once a day, 40 mg once a day and 40 mg twice a day), and after its completion, all patients underwent endoscopic examination and monitoring of pH in the stomach cavity. Ulcer healing was achieved in 94%, 88% and 95%, respectively. Daily pH monitoring allowed to reveal a dose-dependent effect, while it turned out that taking 40 mg of pantoprazole twice a day is more effective than taking 40 mg of pantoprazole once a day (p<0.01) и 20 мг один раз в сутки (р<0.001). Вместе с тем, полученные данные нуждаются в уточнении, так как было исследовано относительно небольшое количество больных. Кроме того, практически все обследованные пациенты были носителями Н.pylori.

Stomach ulcer

Helicobacter pylori infection

Randomized clinical trials have been conducted comparing the clinical efficacy of omeprazole and pantoprazole when used as one of the components in the combination therapy of H. pylori infection (29). Antibacterial therapy was the same in all cases and consisted of amoxicillin 1 g twice daily and clarithromycin 500 mg twice daily for ten days. The dose of omeprazole was 20 mg twice daily; the dose of pantoprazole is 40 mg once a day or 40 mg twice a day. At the end of the 10-day course of treatment, patients did not receive any therapy except for antacids, if they were needed. The effectiveness of treatment was assessed by the degree of eradication of H. pylori and the degree of healing of ulcers after 4 weeks and 6 months after completion of the course of therapy (Table 4).

Tab. 4. Comparative evaluation of the effectiveness of pantoprazole and omeprazole when they are used in a three-component protocol

OMP 40 = omeprazole 20 mg twice daily;

PANT 40 = pantoprazole 40 mg once daily;

PANT 80 = pantoprazole 40 mg twice a day.

In another study, it was shown that combination therapy, including a high dose of pantoprazole, lasting 7 days allows for the eradication of H. pylori in 93% (30).

In a slightly smaller, prospective, randomized trial in 50 patients with peptic ulcer disease or non-ulcerative dyspepsia who were diagnosed with H. pylori, it was found that the clinical efficacy of 40 mg of pantoprazole when taken once a day was equivalent to 40 mg of omeprazole at taking once a day. However, both drugs were given for a week in combination with clarithromycin 50 mg twice daily and metronidazole 500 mg twice daily (31). Eradication of H. pylori was achieved in 100% of patients who received pantoprazole and in 88% of patients who received omeprazole (p = 0.235).

Other treatment options using pantoprazole have also been explored. In particular, the combination of pantoprazole (40 mg daily), clarithromycin (500 mg twice daily) and metronidazole (500 mg three times daily) was found to be more effective than the combination of pantoprazole (40 mg daily) and cparithromycin (500 mg three times a day) (32). At the same time, patients continued to receive treatment with pantoprazole 40 mg per day for two weeks after completing the course of antibiotic therapy. The effectiveness of a course of triple therapy in terms of H. pylori eradication was 95%, while the effectiveness of a course of two-component therapy was 60% (p<0.001).

In addition, a comparative evaluation of the effectiveness of pantoprazole and ranitidine was carried out when used as part of combination therapy for the eradication of H. pylori. It was found that the percentage of H. pylori eradication was higher in those patients who received pantoprazole. The percentage of ervdication and the percentage of healing of ulcers were 82.5% and 100% (when taking 40 mg of pantoprazole once a day in a combination of 500 mg of clarithromycin twice a day); 94.8% and 100% (when taking pantoprazole 40 mg once a day in combination with clarithromycin 500 mg twice a day and amoxicillin 1 g twice a day); 67.6% and 96% (when taking 120 bismuth sucitrate three times a day in combination with 150 mg of roxithromycin twice a day and 250 mg of metronidazole twice a day and 300 mg of ranitidine at bedtime (37). Thus, it was found that the three-component protocol, which included the use of pantoprazole, was significantly more effective in terms of eradication of the infection than the other two protocols studied.

Zollinger-Ellison Syndrome

Acute gastrointestinal bleeding

Side effects and drug toxicity

As pantoprazole became more widespread, side effects such as anaphylaxis, angioedema, pancreatitis, and dermatological reactions were reported.

drug interaction

Dosing regimen

Dose adjustment is not required in elderly patients, as well as in patients with renal insufficiency or with moderate hepatic insufficiency. In addition, there is no need to adjust the dose of pantoprazole in patients on hemodialysis (43).

Pantoprazole extended-release tablets should be swallowed whole, with or without food or antacids. In most clinical studies, pantoprazole was administered before meals.

Tablet forms of pantonrazole

Intravenous forms of nantonrazop

Special remarks

Tab. 2. Placebo-controlled clinical trials of the efficacy of pantoprazole in duodenal ulcer

PANT - pantoprazole;

OMP - omeprazole;

RAS - ranitidine;

P - randomized;

MC - multicenter.

Table 3. Placebo-controlled trial of pantoprazole in acute gastric ulcers

PANT - pantoprazole;

RAS - ranitidine;

P - randomized;

MC - multicenter;

OMP - omeprazole.

Tab. 5. Most common side effects of pantoprazole

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Antiulcer drug pantoprazole: pharmacodynamics, pharmacokinetics and clinical results
Medical News SUN Pharmaceutical Industries Ltd. Information bulletin for doctors. June 2006

The pharmaceutical market is growing by leaps and bounds. Every year, new drugs and analogues of existing ones appear. The number of gastroenterological drugs is also constantly growing, proton pump inhibitors (PPIs) are no exception. Omeprazole, which has long been sold under a variety of trade names, has many analogues, including pantoprazole.

What are the similarities:

• indications (as a rule, these are diseases caused by the aggressive action of acid on the walls of the stomach, intestines and esophagus, the fight against Helicobacter in combination with other drugs.)
• contraindications (primarily pregnancy, lactation and childhood, hypersensitivity)
• side effects and precautions

You can easily find a complete list of indications, side effects and contraindications in online reference books or instructions for drugs.

The drug Omeprazole

What is the difference between Pantoprazole and Omeprazole?

There are not many differences between these drugs. The main difference between Pantoprazole and Omeprazole is its greater bioavailability, but at the same time its antisecretory activity is lower than that of omeprazole. Also, the use of pantoprazole is more appropriate if simultaneous treatment with drugs such as citalopram (antidepressant) and clopidogrel (antiplatelet agent) is necessary. It can be added that omeprazole has been used in medicine for much longer.

Which is more profitable: Pantoprazole or Omeprazole?

And here the difference between Omeprazole and Pantoprazole is already more significant.
The price range of Omeprazole and its analogues sold under other trade names (Omez, Ultop, Helicid, Losek, Gastrozol and others) varies from 30 to 200 rubles. The cost of Pantroazole and preparations based on it (Nolpaza, Controloc) starts from 200 rubles and above.

It is important to remember that this article is purely informative in nature, the decision in choosing in the first place should be within the competence of your attending physician.

20.01.2017

Gastroesophageal reflux disease (GERD) is the most common acid-dependent disease, and the frequency of its detection continues to grow worldwide (G. R. Lockeet al., 1997; S. Bor et al., 2005). The key goal of managing GERD is to maintain an intragastric pH >4. The most effective in the treatment of reflux esophagitis are proton pump inhibitors (PPIs) (J. Dent et al., 1999; P. O. Katzet al., 2013).

One of the most widely used and sensitive methods for assessing acid-suppressive action is 24-hour monitoring of intragastric pH (S. Shi, U. Klotz, 2008). At the same time, the main parameters characterizing the effectiveness of PPIs are considered to be the average pH value over 24 hours, the average time (in percentage terms) pH > 4, and the rate of onset of an adequate acid-suppressive effect after taking the first dose (N. J. Bellet al., 1992 ).

Cytochrome P450 2C19 (CYP2C19) genotypes and Helicobacter pylori (H. pylori) infection can have a significant impact on the ability of PPIs to reduce stomach acid. In patients with low activity of CYP2C19, the so-called slow metabolizers, the acid-lowering effect of PPIs is more pronounced than in patients with high activity of this enzyme, that is, "fast metabolizers" (E. J. Dickson, R. C. Stuart, 2003) . The frequency of the CYP2C19 genotype with high CYP2C19 activity in different populations can reach 20% (Z. Desta et al., 2002; A. Celebi et al., 2009).
Given the significance of the problem, in recent years a number of studies have been conducted on the comparative assessment of the effect of various PPIs on intragastric pH; however, most of these studies compared only two drugs.
The aim of this study was to evaluate the effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg, and pantoprazole 40 mg on intragastric pH >4 and 24-hour pH in patients with GERD who are "rapid metabolizers" according to the CYP2C19 genotype and negative for H. pylori.

Materials and methods
The study included H. pylori-negative patients aged ≥18 years with GERD accompanied by heartburn and/or regurgitation occurring at least once a week for the last 6 months. Exclusion criteria: gastric sphincter obstruction, hiatal hernia >2 cm, active peptic ulcer, cancer of the upper gastrointestinal tract, history of gastrointestinal surgery, motility disorders (systemic sclerosis, achalasia, etc.), atrophic gastritis, so-called alarm symptoms in regarding malignant neoplasms (hematemesis, dysphagia, odynophagia, melena), pregnancy or lactation.
Before treatment, all patients underwent a complete physical examination, esophagogastroduodenoscopy, a urea breath test to exclude H. pylori infection, and determination of the CYP2C19 mutation status. The study included patients with wild (non-mutated) CYP2C19 genotype; patients with homo- or heterozygous CYP2C19 mutations were excluded from participation.
PPIs, histamine H2 receptor antagonists, prokinetics, and antispasmodics were not allowed 2 weeks before the start of the study. Patients could use antacids to control symptoms until the day before starting therapy.
Patients were randomized into 4 groups to receive esomeprazole 40 mg (enteric-coated tablet), rabeprazole 20 mg (enteric-coated tablet), lansoprazole 30 mg (micropellet capsule), or pantoprazole 40 mg (enteric-coated tablet) qd 30 min before standard breakfast.
A 24-hour measurement of the pH of the esophagus and stomach was carried out using an Orion pH meter and two electrodes placed intranasally 5 cm above and 10 cm below the lower esophageal sphincter.
During the 6 days of the study, all meals were standardized; breakfast, lunch and dinner were served at 9:30, 13:00 and 19:00 respectively. Patients were not allowed to consume alcohol, acidic or alkaline drinks.

results
The study included 56 patients - 14 patients in each group. Due to protocol deviation, 7 people were excluded, so 49 patients were included in the final analysis.
According to the initial clinical and demographic characteristics, the groups did not differ statistically (Table). Before treatment, the time to 24-hour intragastric pH >4 for esomeprazole, rabeprazole, lansoprazole, and pantoprazole was 2.4% (95% CI 0.3-14.3), 7.4% (0.9-11 .3), 2.8% (0.4-15.5) and 6.4% (0.7-14.9), respectively, without significant differences between the groups (p>0.05). On the 1st day of treatment, the corresponding figures were 56% (21-87), 58% (31-83), 57% (33-91) and 27% (5-77), on the 5th day - 68% ( 36-90), 63% (22-82), 65% (35-99) and 61% (35-98). In terms of intragastric pH time >4, esomeprazole, rabeprazole and lansoprazole were statistically significantly superior to pantoprazole on day 1, but the difference between the groups leveled off on day 5.
Mean 24-hour intragastric pH for esomeprazole, rabeprazole, lansoprazole and pantoprazole on day 1 was 4.2 (1.4-5.9), 4.4 (2.0-5.1), 4.1 ( 2.7-5.2) and 2.1 (1.0-6.0), on the 5th day - 4.5 (2.5-6.2), 4.6 (2.2-5 .5), 4.4 (2.8-6.0) and 4.4 (2.3-5.6), respectively. According to this indicator, esomeprazole, rabeprazole and lansoprazole were significantly better than pantoprazole on the 1st day.
The time required to reach an intragastric pH >4 after the first dose was 3, 4, and 6 hours for esomeprazole, lansoprazole, and rabeprazole, respectively. In the pantoprazole group, the pH reached 3 2 hours after ingestion, but then did not change until the 6th hour.
The mean intragastric pH for esomeprazole, rabeprazole, lansoprazole and pantoprazole 3 hours after the first dose was 4±0.5; 2.6±0.6; 3±0.5 and 2.9±0.7; after 4 hours - 4.1±0.6; 3.2±0.5; 4±0.5 and 2.9±0.6; after 6 hours - 4.8±0.6; 4±0.5; 4.3±0.7 and 3.2±0.7, respectively. Esomeprazole was statistically significantly superior to rabeprazole, lansoprazole, and pantoprazole after 3 hours (p<0,05), а также пантопразол через 4 и 6 ч после приема (р<0,05).
Regarding the time needed to reach a pH >4 after the first dose, esomeprazole showed the fastest effect, followed by lansoprazole, rabeprazole and pantoprazole in increasing order of time. The hourly pH values ​​achieved in the 4 treatment groups are shown in the figure.

Discussion
The results of the study showed that in patients with GERD who are not infected with H. pylori and belong to the type of so-called fast metabolizers, esomeprazole, rabeprazole and lansoprazole significantly outperform pantoprazole in terms of intragastric pH > 4 on the 1st day of treatment, while esomeprazole proved to be better than all other PPIs in terms of the rate of onset of adequate acid suppression. These data are broadly consistent with those observed in other studies.
So, scientists from Sweden compared esomeprazole 40 mg with lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg and rabeprazole 20 mg. Esomeprazole outperformed all other PPIs in mean intragastric pH time >4 on days 1 and 5 of treatment (K. Rohss et al., 2004)
In a study by K.Miner et al. (2003) in H. pylori-negative patients with GERD, esomeprazole 40 mg/day on the 5th day of therapy in terms of intragastric pH was statistically significantly better than lansoprazole 30 mg/day, pantoprazole 40 mg/day, rabeprazole 20 mg/day and omeprazole 20 mg/day
N. G.Hunfeld et al. (2012) found that esomeprazole 40 mg provided better efficacy and faster acid suppression than rabeprazole 20 mg.
According to in vitro studies, the slower onset of action of pantoprazole compared to that of other PPIs may be due to two factors: pantoprazole's lower pKa1 and pKa2 values ​​and its preferential metabolism by CYP2C19.

conclusions
The present study demonstrated that in non-H. pylori-infected "rapid metabolisers" GERD patients, pantoprazole was a less potent PPI than esomeprazole, lansoprazole, and rabeprazole on day 1 of treatment. On the 5th day of therapy, this difference disappears. With regard to the time required to increase intragastric pH >4 after the first dose, esomeprazole has the fastest effect, followed by lansoprazole and rabeprazole.
The results obtained may be of practical importance in the choice of PPI prescribed on an “on demand” basis for the treatment of patients with GERD.

The article is printed in abbreviated form.
The bibliography is under revision.

Celebi A., Aydin D., Kocaman O. et al. Comparison of the effects
of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg,
and pantoprazole 40 mg on intragastric pH in extensive metabolizer patients with gastroesophageal reflux disease. Turk J Gastroenterol 2016; 27:408-414.

Translated from English. Alexey Tereshchenko

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I want to quickly take an effective medicine.

But Omeprazole, how to take it to restore the function of the gastrointestinal tract and intestines, who is indicated and contraindicated, what side effects does it have and can it be replaced with other analogues? It is worth considering in more detail.

Release form composition and packaging

Omeprazole is a fairly well-known drug.

Produced by many Russian companies under the brands:

• akrikhin;
• teva;
• avva rus;
• astrafarm;
• sandoz;
• richter;
• promed;
• staff.

The drug acts on the enzyme in the stomach as part of hydrochloric acid, inhibits secretion, accelerates the exchange of hydrogen ions in the mucus of the epithelium, thereby blocking the production of hydrochloric acid.

As a result, the level, secretion of digestive juice decreases.

Taking into account the intake of doses, the effectiveness of the drug is observed for one 1-1.5 days.

Release form of the drug- hard capsules (10, 20, 40 mg). Packing - cell, contour. Pack - cardboard or polymer cans (10, 20 mg).

Composed of:

• active ingredient - omeprazole;
• auxiliary elements: sodium lauryl sulfate, purified water, dye e129, glycerin, gelatin, nipagin, mannitol, sugar, titanium dioxide, talc, methacrylic acid.

Pharmacological action, pharmacokinetics

Omeprazole has an inhibitory and antiulcer effect, inhibits the activity of the enzyme adenosine triphosphate H + K.

The metabolite, when it enters an acidic environment, already after 4-5 minutes, begins to transform into sulfenamide, entering into active interaction with phosphates, blocking the phase.

This drug is a highly selective drug for conversion into an active metabolite in an acidic environment.

In relation to parietal cells, the drug is not absorbed, but quickly suppresses the secretion of hydrochloric acid irritants and the production of pepsin, leading to a decrease in the total volume of contents in the stomach.

Omeprazole in capsules with a thin shell contains microgranules, the release of which already 1 hour after application leads to the achievement of the maximum therapeutic effect. Preservation lasts up to 1 day.

A single dose of omeprazole is sufficient so that the suppression of the secretion of hydrochloric acid was carried out to the maximum for the whole day. Secretory activity will be restored after 5-6 days if you stop taking Omeprazole.

The pharmacokinetics of the drug is as follows:

• bioavailability - 40%, but an increase in people in old age is possible;
• absorption is high;
• lipophilicity - high at the time of entry into contact with albumin and glycoproteins (proteins) in blood plasma;
• the elimination period is 0.5 hours and a little more up to 3 hours for liver diseases.

Metabolism occurs in the liver cells in the form of 6 inactive metabolites. Up to 80% of the drug is excreted by the kidneys, up to 40% - by bile. The rate of elimination of the drug may be reduced in elderly people with chronic renal failure.

Indications for use

The main effect of the drug is the suppression of the synthesis of hydrochloric acid, the elimination of excessive secretion against the background of food intake.

Main indications:

With these diseases, there is an excessive production of gastric juice, which inevitably destroys the mucous membrane, forming erosion and ulcers.

Omeprazole in tablets is prescribed for any pathology of the gastrointestinal tract, which led to an increase in the production of gastric juice, an increase in the concentration of organic acids.

The drug contributes to:

• decrease in acidity in the stomach;
• suppression of Helicobacter pylori bacteria;
• improvement of general well-being;
• elimination of pain, dyspepsia.

The most common appointment is peptic ulcer against the background of increased acidity in the stomach. The use of omeprazole capsules will help with heartburn, although in cases of relapse it should be taken under the supervision of a doctor.

The effect on heartburn after taking the drug is observed after 3-4 days, and the primary relief - after 1 day.

Portability of Omeprazole is excellent. The risks of side effects are minimal.

Intravenous administration of the drug in injections is possible in the treatment of:

• reflux esophagitis;
• peptic ulcer and 12 duodenal ulcer.

Omeprazole eliminates dyspepsia well and can be used for a long time - up to 0.5 years. Doctors recommend taking the drug in case of discomfort after eating, alcohol poisoning to relieve pain, burning, and other discomfort.

Contraindications for use

The use of Omeprazole is excluded when:

• pancreatitis;
• individual intolerance;
• pregnancy, which can negatively affect the formation of the digestive tract in the baby, cause disorders.

It is forbidden to give the drug to children under 5 years of age with a body weight of not more than 20 kg due to difficulty swallowing capsules.

In some cases, it is possible to prescribe together with antibiotics during complex therapy by opening the capsules, mixing with a liquid (yogurt, water).

The drug can be given to a child, but it is extremely important to keep the situation under control and it is better to consult a doctor first.

Side effects

Rarely, but omeprazole causes side effects

• insomnia;
• hallucinations;
• dizziness;
• muscle weakness;
• myalgia;
• increased sweating;
• itching on the skin up to anaphylactic shock.

With uncontrolled use, constipation, dry mouth, nausea, and vomiting may occur.

Instructions for use

The use of the drug is aimed at reducing the production of gastric juice secretion, therefore, in some cases, the use may become inappropriate.

Only on the basis of the diagnosis, general well-being and existing symptoms, the dosages prescribed by the attending physician, the course of application (before or after meals) will depend.

It is advisable to first consult with a gastroenterologist about the rules for using the drug.

For example, during an exacerbation, it is treated by taking 20 mg immediately before meals in the morning 1 time per day. The capsule must be swallowed whole with water.

Often a drug is prescribed for the prevention of stomach ulcers. To avoid possible exacerbations, the permissible dosage is 20 mg per day.

The main purpose of the drug is to neutralize unpleasant symptoms., normalize the production of hydrochloric acid. If, after the course of treatment, the problem does not go away, then it is possible to increase the dosage, but with the permission of the doctor.

The drug is often prescribed for heartburn, but it is permissible to use it only in an emergency and at a dose of no more than 10 mg per day, the duration of the treatment course is 2 weeks. It is important to understand that the drug can lead to a cumulative effect.

If taken without the permission of a doctor in order to get rid of heartburn, then the use should not be more than 5 days in a row. In the future, it is advisable to visit a doctor, undergo an examination to correct subsequent therapy.

Overdose

If you neglect the doctor's prescriptions, violate the rules for taking and dosing the drug, then there may be an intolerance to the components of the drug and cases of overdose with side effects:

• muscle weakness;
• myalgia;
• headache;
• rash, redness, itching on the skin;
• failure of liver function;
• depression;
• stress;
• increased sweating;
• deviations in the composition of the blood;
• atrophic gastritis

If you take the drug in acceptable doses with an increased level of acidity, then an overdose is extremely rare.

Only when the dose is exceeded over 60 mg per day, drowsiness, fever throughout the body, confusion, tachycardia, dryness of the mucous membrane in the nose and mouth, difficulty breathing, visual impairment may occur.

Omeprazole is rapidly absorbed into the blood within 1 hour and dialysis is already becoming ineffective. Although, with confusion and poor health, of course, one cannot do without an urgent appeal to specialists.

Interaction with other drugs

Features of co-administration of Omeprazole with other drugs:

Alcohol compatibility

The proton pump inhibitor in the composition of Omeprazole contributes to the rapid suppression of the secretion of gastric juice, if you read the instructions for use, then the possible danger in combination with alcoholic beverages is not indicated.

This means that joint application is possible.

However, if you take an analogue of Nexium, then the manifestation of side effects is possible:

• diarrhea;
• depression;
• allergy;
• overexcitation;
• nausea, vomiting;
• possible development of hepatitis with excessive imbalance of liver function.

Omeprazole can adversely affect the liver. And if combined together with strong drinks, then there may be an excessive burden on the body, stress with regular long-term use of alcohol.

And, in particular, with the use of Omeprazole, fatty hepatosis is ensured and even doctors say this, and the patient may be completely unaware of the disease and only random examinations can confirm the diagnosis.

Use during pregnancy and lactation

Following the instructions for use, omeprazole is contraindicated in women during pregnancy, regardless of the trimester.

The main component of the drug quickly crosses the placenta, has a negative effect on the development and condition of the fetus, also during breastfeeding.

Despite the lack of studies, it is not recommended to take the drug.

Exclusively in case of acute vital necessity and only with the permission of the attending physician

Application in childhood

According to the instructions, the use of Omeprazole in children under 5 years of age is prohibited. Only if a tumor is detected in the pancreas is it possible to prescribe the drug, but taking into account the weight of the child and under the supervision of a specialist.

Application is possible only with a mass of more than 10 kg.

Indications:

• heartburn;
• reflux esophagitis;
• Zollinger-Ellison syndrome.

The use of omeprazole in children is indicated from the age of 4 for a comprehensive treatment course in the detection of peptic ulcer. Permissible doses - 5 mg per day with a weight of up to 10 kg, 10 mg - with a weight of up to 20 kg, 20 mg with a weight of over 20 kg.

The use of the drug is possible only in cases where the intended benefit is much higher than the possible risks from the therapy.

Use for liver and kidney dysfunction

If you take Omeprazole for diseases of the kidneys (liver), then the results of a blood test may be distorted, a decrease in the concentration of gastrin in the blood plasma.

Failure of the liver should be the reason for reducing the dose - 20 mg.

Application for the elderly

If in elderly patients there is a failure of liver function, then dose adjustment of omeprazole is not carried out. Pharmacokinetics will not change as dialysis is carried out in chronic kidney disease.

If there is a violation of liver function, then the dose should not be more than 20 mg per day.

special instructions

The reaction of the body may be inadequate to any substance, in particular the components of Omeprazole.

The drug should be used with caution in case of:

Possible side effects: bloating, upset stool, nausea, vomiting.

Vacation from pharmacies

The medicine is dispensed strictly according to the prescriptions of doctors.

Storage conditions and shelf life

Price

The approximate cost of Omeprazole in Russia starts from 28 rub. for package number 10 and from 50 rub. for packing No. 230. Lyophilisate price - from 235 rub.

Analogues

A number of analogues contain the same active substance and all of them are proton pump inhibitors. They may well replace Omeprazole, suppress the level of gastric secretion and the release of pepsin. These are inexpensive drugs, but give quick results.

Analogues from Russian manufacturers or close substitutes are distinguished by high popularity among patients:

1. Ultop with the active substance - Omeprazole as an antiulcer agent for inhibiting the activity of ATP-ase in the cells of the stomach, blocking the production of hydrochloric acid, the concentration of basal secretion. Indicated for use in gastric ulcer, Zollinger-Ellison syndrome, non-ulcer dyspepsia, gastroesophageal reflux. Price 148-337 rubles.
2. , as a means to eliminate disorders of the gastrointestinal tract, the active ingredient, a derivative of benzimidazole. The main purpose is the treatment of reflux disease, the elimination of unpleasant signs of heartburn, acid reflux, pain when swallowing. Price - 110-170 rubles for 30 capsules with a pack of 10.20 mg.
3. Ortanol with active omeprazole, an antiulcer inhibitor for the treatment of gastric ulcers, systemic mastocytosis, polyendocrine adenomatosis, uninfected duodenal ulcer. Price - 107-112 rub.(10 mg, 20 mg).
4. Omepradex, to suppress gastric secretion and block hydrochloric acid. It is indicated for gastroesophageal disease, hypersecretory condition, peptic ulcer of the stomach, non-ulcer dyspepsia. Price - 120-135 rub.
5. Gastrosol- anti-ulcer proton pump inhibitor with the active ingredient - omeprazole to reduce the level of basal, stimulated secretion regardless of the stimulus, blocking the production of hydrochloric acid. Price for 14 capsules - 80 rub., 28 capsules - 130 rub.
6. , antiulcer for the treatment of stomach ulcers, 12 duodenal ulcers. Perhaps the appointment in combination with antibiotics. Average price in Moscow - 110-180 rub.
7. Gasek from Switzerland to suppress the secretion of hydrochloric acid. Available in capsules, vials. Reduces acid production, is considered highly effective, versatile and affordable. Cost in Ukraine - 180 hryvnia.
8. omephez with the appointment of reflux esophagitis, polyendocrine adenomatosis, mastocytosis, systemic NSAID gastropathy, hypersecretory conditions. Active substitutes Omeprazole Shtpda, Omeprazole Akri. Price - 20-57 rub.
9. with active omeprazole. An antiulcer drug with a release form - a lyophilisate for the preparation of infusion solutions. Suppresses the secretion of hydrochloric acid, inhibits the proton pump of parietal cells in the stomach, reduces the production of secretion. Significant cost, within 1800 rub.
10. Omitox, proton pump to block the synthesis of hydrochloric acid. It treats peptic ulcer of the stomach and duodenum, restores secretory activity completely after 3-5 days. Price 87-92 rub.
11. Promez- active substance (omeprazole). Rapid absorption from the gastrointestinal tract is observed after 1 hour. Bioavailability - up to 40%, plasma protein binding - 90%. Indicated for use in reflux esophagitis, ulcers with Helicobacter pylori, erosive lesions of the duodenum. Price - 20-57 rub.
12. Crosacid- ATPase inhibitor to block the secretion of hydrochloric acid. Treats peptic ulcer caused by Helicobacter pylori, increases the sensitivity of bacteria to antibiotics. This is an antimicrobial agent with an appointment for stomach ulcers, Zollinger-Ellison syndrome, reflux esophagitis. Price - 98 rub.
13. to reduce the secretion of the gastric glands with the active substance - Rabeprazole, to suppress the secretion of basal secretion juice, regardless of the stimulus that caused it. Price - 330 rub .
14. - a hypoacid medication with the active ingredient - Pantoprazole (a derivative of benzimidazole) to block the hydrophilic secretion of hydrogen chloride in the stomach, to suppress the stimulated basal production of hydrochloric acid. Shown orally. Price - 120 rub.(20 mg), per pack of 14 180 rub.
15. Rabeprazole- antiulcer agent with complete absorption after 3 hours. They are prescribed for stomach ulcers, gastritis, relapses of peptic ulcers caused by Helicobacter pylori, gastroesophageal disease. Price in Moscow - 200 rub. for 20 mg.
16. De-nol- antiulcer, gastroprotective, antibacterial composition. Refers to the adsorbent. Promotes the formation of a protective film on the gastric mucosa, the formation of special compounds to cover damaged areas. It becomes a barrier to the mucosa, stimulates acid synthesis, reduces the activity of gastric pepsin, and has an antimicrobial effect. It is prescribed for chronic gastritis, gastroduodenitis, duodenal ulcer. Price - 570 rub. for 56 pieces, 250 rub. for 112 pcs.

Omez and Omeprazole - which is better?

The active substance of the drugs is the same. Omez is much more expensive, but according to user reviews, it is more effective, well eliminates the symptoms of acid-dependent diseases, perfectly penetrates the gastrointestinal mucosa, and is absorbed into the blood.

After 1 hour, the elimination of unpleasant symptoms in the stomach is observed.

Pantoprazole and Omeprazole - which is better?

Omeprazole perfectly treats diseases associated with increased production of gastric secretions. Pantoprazole, as an analogue, is more affordable. Although antisecretory activity, the therapeutic effect is more reduced, in particular in the treatment of peptic ulcers of the stomach, esophagitis.

If you choose between 2 drugs, then you should give preference to Omeprazole, since it can be used in combination with drugs: Clopidogrel, Citalopram.

Which is better - Nolpaza or Omeprazole?

The composition of the active substance is Rabeprazole, but the effectiveness when compared with Omeprazole is the same. According to patient reviews, Nolpaza is a safer drug, since it has the maximum number of side effects.

The use of omeprazole is effective in excess gastric juice in order to eliminate gastritis, heartburn to relieve unpleasant symptoms.

But with low acidity, it is unreasonable to use the drug, which can only lead to an aggravation of the course of the disease due to excessive suppression of the production of gastric juice.

Omeprazole is considered a gastroprotective drug, well eliminates the symptoms of heartburn. In other cases, it is unreasonable to apply. It may be worth giving preference to other effective and popular generic analogues.

The drug eliminates problems with the stomach, prevents the development of complications, the re-emergence of unpleasant symptoms.

This is a modern antisecretory remedy that allows you to quickly cope with the inflammatory course in the upper gastrointestinal tract, suppress hydrochloric acid or reduce its activation.

Omeprazole is an excellent level of the impact of Helicobacter pylori microorganisms on the gastrointestinal tract, leading to gastritis, peptic ulcer. The medicine perfectly improves well-being and reduces the likelihood of side effects later.

Only a specialist can adjust the therapy taking into account the severity of the pathology, the patient's condition. It is possible to increase the dosage, for example, when Zollinger-Ellison syndrome is detected, up to 60-120 mg 2 times a day. But with liver diseases, it is not recommended to exceed the dosage of more than 20 mg per day.

This drug has generics with identical chemical compounds, although prices vary significantly.

Given the reviews, Omeprazole's tolerability is good. Patients claim that it is advisable to use it for various disorders in the digestive tract. Moreover, omeprazole capsules well eliminate heartburn immediately after the first application, treat gastritis and ulcers.

However, side effects are possible. It is necessary to use the drug strictly according to the instructions, do not neglect therapeutic doses, and it is best to first consult a doctor before use.

There is sometimes inaccurate information on the Internet on this issue, so let's take a closer look.

Omeprazole and rabeprazole refer to proton pump inhibitors(IPP). Synonym - proton pump blockers. These are drugs that suppress the secretion of hydrochloric acid (HCl) in the stomach, so they are classified as antisecretory agents and are used to treat hyperacidity of the stomach. Proton pump inhibitors (proton pump blockers) reduce secretion hydrogen ions(H + , or proton) parietal (parietal) cells of the stomach. The secretion mechanism consists in the entry of an extracellular potassium ion (K +) into the cell in exchange for the removal of a hydrogen ion (H +) to the outside.

Classification and characteristics

Currently applied 3 groups drugs that reduce acidity in the stomach:

1. proton pump inhibitors- are the most powerful antisecretory agents that suppress the formation of hydrochloric acid in the stomach. Are taken 1-2 times a day;
2. H 2 blockers(read "ash-two") - have low antisecretory efficiency and therefore can be prescribed only in mild cases. Taken 2 times a day. Block histamine (H 2 -) receptors of parietal cells of the gastric mucosa. H 2 blockers include ranitidine and famotidine.

   For reference: H1 blockers are used against allergies ( loratadine, diphenhydramine, cetirizine and etc.).

3. antacids(in translation " against acid"") - means based on magnesium or aluminum compounds, which quickly neutralize (bind) hydrochloric acid in the stomach. These include almagel, phosphalugel, maalox and others. They act quickly, but for a short time (within 1 hour), so they have to be taken often - 1.5-2 hours after eating and at bedtime. Although antacids reduce acidity in the stomach, they simultaneously increase the secretion of hydrochloric acid by the mechanism negative feedback, because the body tries to return the pH (acidity level, it can be from 0 to 14; below 7 - acidic, above 7 - alkaline, exactly 7 - neutral) to the previous values ​​(normal pH in the stomach is 1.5-2).

To proton pump inhibitors relate:

• (trade names - omez, losek, ultop);
• (trade names - nexium, emanera);
• lansoprazole(trade names - lancid, lanzoptol);
• pantoprazole(trade names - nolpaza, control, sanpraz);
• rabeprazole(trade names - Pariet, Noflux, Ontime, Zulbex, Hairabezol).

Price comparison

Omeprazole is several times cheaper than rabeprazole.

The price of generics (analogues) of 20 mg 30 capsules in Moscow on February 14, 2015 is from 30 to 200 rubles. For a month of treatment, you need 2 packs.

The price of the original drug Pariet (rabeprazole) 20 mg 28 tab. - 3600 rub. For a month of treatment, 1 pack is needed.
(analogues) of rabeprazole are much cheaper:

• Ontime 20 mg 20 tab. - 1100 rubles.
• Zulbeks 20 mg 28 tab. - 1200 rub.
• Hairabezol 20 mg 15 tab. - 550 rubles.

In this way, cost of treatment per month is about 200 rubles (40 mg / day), rabeprazole using hairabezole- about 1150 rubles. (20 mg/day).

Differences between omeprazole and esomeprazole

It is an S-stereoisomer (left-handed optical isomer ), which differs from the dextrorotatory isomer in the same way that a left hand and a right hand or a left and right shoe differ. It turned out that the R-shape much stronger (than the S-form) is destroyed when passing through the liver and therefore does not reach the parietal cells of the stomach. Omeprazole is a mixture of these two stereoisomers.

According to the literature, has significant advantages over , however, is more expensive. taken at the same dosage as .

Price trade names is:

• Nexium 40 mg 28 tab. - 3000 rub.
• Emanera 20 mg 28 tab. - 500 rubles. (for a month you need 2 packs).

Benefits of rabeprazole over other PPIs

1. Effect rabeprazole starts within 1 hour after ingestion and lasts 24 hours. The drug acts in a wider pH range (0.8-4.9).
2. Dosage rabeprazole is 2 times lower compared to omeprazole, which gives better tolerability of the drug and fewer side effects. For example, in one study, side effects ( headache, dizziness, diarrhea, nausea, skin rash) were noted at 2% during treatment rabeprazole and at 15% during treatment .
3. Admission rabeprazole into the blood from the intestines (bioavailability) does not depend on the time of the meal.
4. Rabeprazole more reliable inhibits the secretion of hydrochloric acid, because its destruction in the liver does not depend on the genetic diversity of variants of the cytochrome P450 enzyme. Thus, it is possible to better predict the effect of the drug in different patients. Rabeprazole less than other drugs affects the metabolism (destruction) of other drugs.
5. After discontinuation rabeprazole no rebound syndrome(cancellations), i.e. there is no compensatory sharp increase in the level of acidity in the stomach. The secretion of hydrochloric acid is restored slowly (within 5-7 days).

Indications for taking proton pump inhibitors

• gastroesophageal reflux disease (reflux of acidic stomach contents into the esophagus),
• pathological hypersecretion of hydrochloric acid (including Zollinger-Ellison syndrome),
• in complex treatment, it is used to eradicate (eliminate) Helicobacter pylori infection (Helicobacter pylori), which causes ulcers and chronic gastritis.

Note. All proton pump inhibitors break down in an acidic environment, therefore, are available in the form of capsules or enteric tablets, which swallowed whole(cannot be chewed).

conclusions

Briefly: rabeprazole ≅ esomeprazole > omeprazole, lansoprazole, pantoprazole.

Detail: rabeprazole It has several advantages before other proton pump inhibitors and is comparable in effectiveness only with , however, treatment rabeprazole cost 5 times more than and slightly more expensive than .

According to the literature, the effectiveness of Helicobacter pylori eradication does not depend on the choice of a specific proton pump inhibitor (any one is possible), while in the treatment gastroesophageal reflux disease most authors recommend rabeprazole.

Analogy with antihypertensive drugs

Among proton pump inhibitors 3 drugs stand out:

• (basic drug with side effects),
• (an improved preparation based on the S-stereoisomer of omeprazole),
• rabeprazole(the safest).

Similar ratios are available among those used to treat arterial hypertension:

• amlodipine(with side effects)
• levamlodipine(improved preparation based on the S-stereoisomer with minimal side effects),
• lercanidipine(most secure).

Read also:

7 comments to the article “Which is better - omeprazole or rabeprazole? Benefits of rabeprazole»

Hairabezol Benefits:
Hairabezol is recommended for CHILDREN from 12 years old!!!
Shelf life of Hayrabezol is 3 years.
Unique Braille packaging.
Hayrabezol is not dependent on food intake.

My story is this: the doctor prescribed Ultop for me. After a single application, there were serious side effects: a sharp headache; blushed and began to see badly in one eye; palpitations and fever. I told the doctor about this, but she does not believe me - she says there can be no such consequences from the ultop and appointed Omez-insta. I come home, I decided to read, and it turns out to be the same ultop, only under a different name!

In general, thanks to you, I have become enlightened and I will look for a normal substitute without a terrible side effect. I wish I could find a good gastroenterologist now ... (((

1. 4 years ago, she treated gastritis with an ultop, apparently, it did not help, because erosion of the stomach was discovered already this year. Zulbex was prescribed. I almost went to the other world with 2 tablets: an hour after taking the drug on the first day, my throat hurt and a cough began, my appetite disappeared, in the morning on the second day there was pain in the lower abdomen, as with cystitis. I decided to take another pill. again, an hour after the intake, the temperature rose sharply to 38.5, the lower back ached, the head did not understand anything at all, aches all over the body, everything inside rumbled. I read in the side effects later that Zulbex quite often causes flu-like diseases and infections of the genitourinary system. and it's still the safest drug, you mean??? this was not the case with Ultope, dry mouth and loss of appetite at most. by the way, perhaps the dosage of 20 mg is too large for me, because. my weight is 39 kg

   Unfortunately, Zulbex (rabeprazole), despite its merits, is not as safe as it initially seemed. On the other hand, Ultop (omeprazole) is also capable of causing general fatigue, general weakness, weight gain, and fever. These effects are described in the instructions for the drug. As for the dosage, 10 or 20 mg of rabeprazole per day is usually used (no more than 20 mg). So rabeprazole is not right for you, you need to go back to omeprazole or try esomeprazole.

2. Thanks for the comment. I read, but the doctor prescribed them to me, while he said that the drug was well tolerated and that it helped very well. And you do not tell me how long it takes for it to be completely eliminated from the body? today I didn’t take pills anymore, but the temperature is still around 37.3, the pain in the lower back is gone, the throat hurts less, there is no such weakness anymore, the appetite has returned. The last time I took the drug was 24 hours ago. I remembered about the ultop that my hair began to fall out from it very much (this is also written in the instructions).

   By itself, rabeprazole is excreted from the body quite quickly, after a day only traces remain, but the effect of the drug lasts about a day. Most likely, in 4-5 days, the side effects will completely disappear. As a replacement, you can either try esomeprazole, or switch to H 2 blockers, but they block the secretion of hydrochloric acid much weaker.

3. Hello! I read Jeanne's review and was a little delighted :) in the spring I had erosive gastritis, they prescribed pariet - there was a strong weakness on it, they replaced it with a nolpaza - I got very sick in the solar plexus area and blurred vision. Droppers were replaced with Nexium. At first there was a feeling of cold and shocking, then a feeling that sand was coming from the kidneys, on the 2nd day my throat ached and the temperature was 37, a couple of days then it still rose, sores on the palate. I found this in my notes - they asked me to carry such a diary.

   Gradually, the side effects disappeared, the drug was canceled, but the diet was observed all summer, because a small error caused a burning sensation in the area of ​​\u200b\u200bthe left shoulder blade. A week ago, I started to burn again often in the shoulder blade, against the background of 1 night cast (apparently provoked by sports on an empty stomach). Then the right side got very sick and weakness began. I tried to help Seta with Iberogast, Chinese teas, but I had to resort to medicines. I started drinking Nexium yesterday - in the evening, body aches and weakness. Today I have no strength all day, terrible weakness, I can hardly walk. The throat hurt again and the temperature rose to 37-37.5. At first I thought that I was sick, but there are no other signs of the disease and rinsing does not help. In the spring, it seemed to me that there were not so many side effects, at least there was not such a strong weakness. What drug can be replaced? What can you say about famotidine? About its side effects?

   Pariet (rabeprazole), Nolpaza (pantoprazole), Nexium (esomeprazole) belong to the group of proton pump blockers and can cause similar side effects: fever and flu-like syndrome. H2-blockers (famotidine, ranitidine, roxatidine, nizatidine) cause fever less often, so you should try them. They have other side effects, but chances are you won't have any or only a small amount. See website for specific side effects. rlsnet.ru Try first those H2 blockers that suit the price. In general, H2 blockers are weaker than proton pump blockers. Just do not use cimetidine, it is an outdated drug with a large number of adverse reactions.

4. What is the safest analogue of rabeprozole (pariet, noflux, ontime, zulbex, hairabezol)?

   In theory, all analogues should be equivalent. The branded drug (reference, the first to enter the market) is Pariet. In general, it is believed that the best drugs are European, American and Israeli manufacturers. But keep in mind that fakes are sometimes sold in Russia. Therefore, you can use any analogue (generic) if it helps you and does not cause side effects.

5. I have been sick since 1994. I have a fixed catarrhal hernia of the esophageal opening of the diaphragm, catarrhal reflux esophagitis, erosion of the antrum of the stomach, superficial gastroduodenitis. Previously, there was a stomach ulcer and a scar was found in the duodenum 12. Regularly treated at the place of residence. Including constantly (almost every day) she took Omeprazole, which helped slightly and for a short time (sometimes I had to take several tablets at a time to relieve severe heartburn). Heartburn almost never stops. Around the same time, I developed vasomotor rhinitis. There was nothing to breathe. By appointment I spray hormonal sprays. Almost no help. Over the past 4-5 years, she has gained a lot of weight (from 46 to 56-58 sizes). Hair will soon be gone. Over the past two years, she began to choke. There was an attack of suffocation such that I was blue-violet. For some reason, the therapist prescribed a penicillin-containing antibiotic, to which I always have a terrible allergic reaction like Quincke's edema (I warned). For a long time she treated allergies with pills and droppers with hormonal drugs (in a hospital). The last year has become more and more suffocating. Hemoglobin dropped to 88, protein to 72-73. Now I am being treated by a hematologist: anemia of moderate severity, anemic heart. (I am forced to take sorbifer. The hematologist categorically forbade Maltofer, he does not cure). The gastroenterologist has now appointed Pariet. I doubted the need to take such an expensive drug. But I read the information on your website about the effectiveness of drugs and the complications from them, I realized that perhaps only he could help me. And all the complications in the form of severe shortness of breath, bronchospasm, weight gain, hair loss, blurred vision (she began to see poorly both with and without glasses), she became very weak and much more, you can’t describe everything, from Omeprazole. I didn’t even imagine that Omeprazole could do more harm than good, and be simply dangerous to health, it seemed to me so reliable and, importantly, cheap.

   Will I ever be able to breathe normally now, will my vision be restored, will my weight return to normal, ...? (Allergy tests are negative, I can't get a referral to a pulmonologist). Can anyone professionally answer me, give me some advice on how to deal with this?

   Rabeprazole and omeprazole are from the same group, so their side effects are similar. Don't expect a radical improvement.

   Asthma and vasomotor rhinitis are most likely associated with reflux of acid from the esophagus into the bronchi. This is a typical complication.

   Why omeprazole does not help well is not entirely clear. For verification, daily pH-metry should be done.

   However, I am sure that omeprazole works, and the real cause of your problems is a hiatal hernia. The only option to eliminate it (and then life, most likely, will begin to improve) is surgery. Your situation is somewhat neglected, so you will need preparation before the operation (hemoglobin increase, etc.). However, you need to be operated on, because it will only get worse.