Nexium prefered for esophagitis?

[MdBrndPhrmcst]

Hi everyone

The HMO outpt center I'm working for has omeprazole as its prefered PPI. We are currently switching everyone from nexium to omeprazole. Which is fine, however one of the Primary Care MD's said she thought that for pts who has/had esophagitis they need to be on nexium. She said that all the GI docs are pretty adament about the pts being on Nexium for esophagitis. Have you guys heard anything about this? Is ther better outcomes or more data for this indication with nexium? are there some cases where one PPI is better than the others (not counting drug interactions). I'm wondering if this is just drug reps doing their jobs real well.

Thanks in advance

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[Priapism321]

Hi everyone

The HMO outpt center I'm working for has omeprazole as its prefered PPI. We are currently switching everyone from nexium to omeprazole. Which is fine, however one of the Primary Care MD's said she thought that for pts who has/had esophagitis they need to be on nexium. She said that all the GI docs are pretty adament about the pts being on Nexium for esophagitis. Have you guys heard anything about this? Is ther better outcomes or more data for this indication with nexium? are there some cases where one PPI is better than the others (not counting drug interactions). I'm wondering if this is just drug reps doing their jobs real well.

Thanks in advance

It was the same drug the last time I took a medicinal chemistry course; I doubt there is any real literature other than the garbage science the rep brought in with the pens and food. I would probably wipe my rear with the glossy reprints a rep brought in before I ever thought of using them as "educational" materials.

 

[WVUPharm2007]

I concur with priapism. Said physician is talking crazy talk. All PPIs are created equal. Seriously. Protonix, Prevacid, Nexium, whatever...

 

[Megas]

Nexium does have the coolest pens, and I like catered food, but if you look at head-to-head trials for erosive esophagitis ("package insert"), Nexium 40 mg was compared to 20 mg omeprazole in info the reps will show for healing rates that demonstrate a superior healing rate with Nexium, mind you that's 40 mg Nexium versus 20 mg omeprazole. Reps will breeze past the data where Nexium 20 mg was equivalent to omperazole 20 mg while trying to distract you with small talk and food, and they won't even discuss a comparison of 40 mg Nexium to 40 mg omeprazole (cause there was probably no difference). A PPI is a PPI.

 

[Old Timer]

Nexium does have the coolest pens, and I like catered food, but if you look at head-to-head trials for erosive esophagitis ("package insert"), Nexium 40 mg was compared to 20 mg omeprazole in info the reps will show for healing rates that demonstrate a superior healing rate with Nexium, mind you that's 40 mg Nexium versus 20 mg omeprazole. Reps will breeze past the data where Nexium 20 mg was equivalent to omperazole 20 mg while trying to distract you with small talk and food, and they won't even discuss a comparison of 40 mg Nexium to 40 mg omeprazole (cause there was probably no difference). A PPI is a PPI.

I read somewhere, just don't ask me where that Nexium was all of 3% more effective than ompeprazole and I don't remember if the dosages were comparable. What it means is except for individual human variation, which after 26 years of practice I can attest to its reality, they are all the same...

 

[npage148]

some rep was giving me a line that Aciphex was faster acting than the others. I think She was telling me it was something to do with its lipophilicity but I really don't remember if that was it

 

[Megas]

I read somewhere, just don't ask me where that Nexium was all of 3% more effective than ompeprazole and I don't remember if the dosages were comparable. What it means is except for individual human variation, which after 26 years of practice I can attest to its reality, they are all the same...

Was it the package insert? Sometimes I think I'm the only person who actually reads them...anyway, if it was then it was b/c the dosages were not comparable. Thank you for the 26-year insight!

 

[Old Timer]

Was it the package insert? Sometimes I think I'm the only person who actually reads them...anyway, if it was then it was b/c the dosages were not comparable. Thank you for the 26-year insight!

The main thing I have learned is there is individual patient variation. There are patients who will fail on one PPI and respond to another and there is no other explanation that I can come up with.

 

[Megas]

The main thing I have learned is there is individual patient variation. There are patients who will fail on one PPI and respond to another and there is no other explanation that I can come up with.

Wild, I never heard that before (in my three whole weeks as a licensed pharmacist). So if one PPI doesn't work try another one?

 

[Quiksilver]

Wild, I never heard that before (in my three whole weeks as a licensed pharmacist). So if one PPI doesn't work try another one?

you got it. this is common from what i see. and from personal experience i started on protonix because i got samples from my doc, i took a prilosec one day instead and the relief didn't even touch it for me.

 

[Aznfarmerboi]

you got it. this is common from what i see. and from personal experience i started on protonix because i got samples from my doc, i took a prilosec one day instead and the relief didn't even touch it for me.

Were the doses equivalent?

 

[Glycerin]

Wild, I never heard that before (in my three whole weeks as a licensed pharmacist). So if one PPI doesn't work try another one?

Could be a pharmacogenomic factor..drug metabolism variants an' all.

 

[Quiksilver]

Were the doses equivalent?

What I took:
omeprazole 20 mg
pantoprazole 40 mg

Here was a summary of a meta analysis saying basically what everyone else has been saying. There is no significance between various brands.
http://www.jfponline.com/pages.asp?aid=3715&UID=

sorry i can't find the entire article but there you go.

all other variables remain the same. I didn't take them with food or within 2 hours after food. I took them all with a glass of water

 

[patmcd]

What I took:
omeprazole 20 mg
pantoprazole 40 mg

Here was a summary of a meta analysis saying basically what everyone else has been saying. There is no significance between various brands.
http://www.jfponline.com/pages.asp?aid=3715&UID=

sorry i can't find the entire article but there you go.

all other variables remain the same. I didn't take them with food or within 2 hours after food. I took them all with a glass of water

I actually experienced the same thing. I tried Protonix for GERD without success, but Nexium worked like a champ.

 

[Megas]

I actually experienced the same thing. I tried Protonix for GERD without success, but Nexium worked like a champ.

So Nexium did work better for you? Jeez, are they all the same or not?

 

[Quiksilver]

they all work the same, statistically looking over a large population they have the same effectiveness. The difference lies when you look at Patient A vs Patient B. its all about inter-patient variability. This could be for a lot of reasons and i haven't taken pharmacodynamics yet but somthing as simple as genetics can be the best explanation