In today’s post, I will contrast the two most popular proton pump inhibitors (PPIs) prescribed in the UK. Not only lansoprazole and omeprazole are the two most common PPI, but they are also one of the most popular prescribed drugs in the UK. I will review the essential facts to highlight the similarity and difference between each medication. Lansoprazole vs omeprazole – post summary:
- Lansoprazole vs omeprazole: drug classification
- Lansoprazole vs omeprazole: mechanism of action
- Lansoprazole vs omeprazole: common side effects
- Availability of different forms of both drugs
- Over the counter Availability of Lansoprazole and Omeprazole
- Lansoprazole vs omeprazole: which one is more popular in the NHS
- Lansoprazole vs omeprazole: cost difference
- Lansoprazole vs Omeprazole vs Ranitidine
Lansoprazole vs omeprazole: drug classification
Both Lansoprazole and Omeprazole belong to a group of drugs called Proton Pump Inhibitors (PPIs). PPIs are the most effective drug in stopping the production of stomach acid. PPIs, therefore, are used in the treatment of the following conditions:
- Gastric (stomach) ulcers
- Eradication of stomach and peptic ulcers
- Prevention of stomach and peptic ulcers
- Prevention of gastric, peptic ulcers caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs).
- Treatment Zollinger–Ellison syndrome
- Treatment of Gastro-oesophageal reflux disease (GORD)
Verdict: both lansoprazole and omeprazole have the same licensed use as listed above.
Lansoprazole vs omeprazole: mechanism of action
Stomach acid production can be stimulated by three different chemicals (hormones); however, there is only one way for the acid to leave the cells (where it was produced) into the stomach. A proton pumps action the last stage of stomach acid production.
At the name suggest proton pump inhibitors stop proton pumps, consequently reducing stomach acid and help with symptoms of indigestion and heartburn. Because they act on the last stage of stomach acid production, PPIs are the most effective class of ‘anti-acid’ drugs as compared to the h2-receptor antagonist (ranitidine) or antacid drugs, which only neutralise the stomach acid.
Verdict: both lansoprazole and omeprazole have the same mechanism of action.
Lansoprazole vs Omeprazole: common side effects
PPIs, as a class of drugs, have some common side effects (SE). The table below compares common side effects for Lansoprazole and Omeprazole:
|Nervous system||Headache, dizziness||Headache|
|Gastrointestinal SE||Nausea, diarrhoea, stomach pain, constipation, vomiting, flatulence, dry mouth or throat,||Abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting|
|Liver||Increased liver enzymes|
|Skin||itching, rash||uncommon side effect|
*eMC (2020);**eMC (2019)
From the list of common side effect, it appears that omeprazole has a smaller number of common side effects. However, liver and skin side effects are also listed in the product information for omeprazole, but as uncommon side effects.
Long term use of PPIs has been associated with reduced calcium absorption, which can increase the risk of fractures, mainly when used in high doses in elderly population for at least over a year (NICE, 2020).
Verdict: patients taking lansoprazole and omeprazole may experience similar side effects.
Availability of different forms of Lansoprazole and Omeprazole
The most common forms for lansoprazole and omeprazole drugs are capsules; however, both drugs are available in different forms in the UK.
Both lansoprazole and omeprazole come in different strengths; for example, the most prescribed form of omeprazole is omeprazole 20mg capsules (‘standard’ dose for an adult). Lansoprazole is commonly prescribed as lansoprazole 30mg capsules (‘standard’ dose for an adult).
The ‘strength’ of drugs prescribed is not interchangeable between different medicines. Lansoprazole 30mg capsules are not necessary ‘better’ or more effective than 20mg of omeprazole, simply because it has more of the active ingredient.
The potency and effectiveness of the drug is a more complicated matter, beyond the scope of this post. When looking at the ‘strength’ of the same medicine, it can be suggested that for example, omeprazole 20mg is ‘stronger’ or more effective than omeprazole 10mg.
Over the counter availability (OTC) of lansoprazole and omeprazole
Omeprazole can be purchased over the counter, without a prescription. Both omeprazole 10g and 20mg tablets are available as pharmacy-only medications, for example, Boots Acid Reflux 10 mg and 20mg Gastro-Resistant Tablets. Less known is Pyrocalm Control 20mg Gastro-Resistant Tablets (omeprazole 20mg tablets), which are general sale item available for self-selection in pharmacies and supermarkets.
Lansoprazole is not available over the counter and comes only as a prescription-only medication.
Verdict: in the UK, omeprazole is available over the counter without a prescription. Although lansoprazole is not available as OTC medication, there is a number of PPIs alternative to omeprazole and lansoprazole, which are commonly available of the shelf.[amazon box=”B00MA5RMIQ” image_alt=”Nexium Control (esomeprazole) – a popular PPI available without presciption” linl_title=”Buy esomeprazole on Amazon.co.uk”]
Lansoprazole vs omeprazole: which one is more popular in the NHS
The graph below shows prescribing information from August 2015 until June 2020 for five PPIs available in the UK. Omeprazole and lansoprazole are clearly the most prescribed PPIs with Omeprazole being the most commonly prescribed in the UK. A considerable gap in prescribing can be observed between lansoprazole and omeprazole and 3rd most popular PPIs – esomeprazole.
Verdict: Omeprazole is more commonly prescribed than lansoprazole.
Is lansoprazole better than omeprazole?
There is no date to suggest than lansoprazole is better than omeprazole and vice versa. National guidelines on gastro-oesophageal reflux disease (GERD) and dyspepsia (NICE) does not favour any of the PPIs. Omeprazole became most prescribed PPI, perhaps because of cost-effectiveness (low price & effectiveness of the treatment). Lansoprazole is not far off in terms of popularity. All PPIs are effective in preventing gastro-oesophageal reflux disease (Horn, 2000).
Verdict: all PPIs have similar efficacy when used in the treatment of acid-related conditions.
Drug interactions for omeprazole and lansoprazole
Both drugs have the potential for interactions with other medicines. Both lansoprazole and omeprazole are metabolised (converted into the active form) in the liver although by different enzymes (chemicals). Omeprazole offers a greater potential for interactions with other drugs, whereas interactions are possibly less significant with lansoprazole.
Lansoprazole, therefore, may be a drug of choice when interactions with other drugs are of concern. For example, in cardiovascular patients who take clopidogrel (an antiplatelet medication), lansoprazole is usually a preferred drug as omeprazole has shown to interact with this drug (Strand et al, 2017).
Pantoprazole and rabeprazole (two other PPIs) have less potential for drug interactions and compared to lansoprazole and omeprazole (Horn, 2000).
To learn more about specific interactions which are possible with PPI therapy, read product information leaflet or speak to a pharmacist.
Verdict: Lansoprazole has less potential for drug interactions.
What is the cost difference between lansoprazole and omeprazole?
The following table represents prices for Lansoprazole and Omeprazole capsules, the most commonly prescribed form of both drugs.
|Omeprazole 10mg capsules|
|Omeprazole 20mg capsules|
|Lansoprazole 15mg capsules|
|Lansoprazole 30mg capsules|
Source: AHH Branch Stock Code List. October 2020.
The above prices are only relevant to private patients. Patients who get drugs prescribed on NHS, pay a standard prescription fee (£9.15, October 20’) or get medication for free if they are exempt from paying.
Patients who get a private prescription need to pay for the supply of the drug (cost of the drug +any mark cost set by a pharmacy). In the above case, the cost of private prescription for omeprazole or lansoprazole may be significantly lower than the NHS prescription charge. Some pharmacies, however, have a minimum prescription charge, which can be £5 or more.
Tesco pharmacy has one of the lowest minimum charges for private prescriptions, set at £2. Low minimum charge means that patients can get a supply of 28 of omeprazole or lansoprazole capsules for around £2.
Learn more about private prescriptions.
Verdict: lansoprazole and omeprazole are similar in price (trade price of prescribed drugs).
Lansoprazole vs omeprazole vs ranitidine
I touched a little bit on the differences between various anti-acid medicines at the beginning of the post. Both lansoprazole and omeprazole are classified as PPIs.
Ranitidine, on the other hand, belongs to a group of drugs called h2-receptor antagonists. As discussed earlier, stomach acid production can be triggered in three different ways. Ranitidine stops only one pathway of stomach acid production. The h2-receptor antagonist can be useful in reducing stomach acid production; however, PPIs such as omeprazole or lansoprazole are more effective.
In 2019 and 2020, ranitidine was subject to a number of recalls due to the potential of being carcinogenic. As a result, ranitidine is the subject of an ongoing investigation into its safety. Ranitidine alternative drugs include mainly PPIs.
Verdict: PPIs such as omeprazole and lansoprazole are more effective in the management of acid-related conditions than H2 receptor antagonist such as ranitidine.
PPIs are effective in the management of gastro-oesophageal reflux disease. Overall, both omeprazole and lansoprazole are similar in terms of side effect profile, efficacy, cost and have proven to have a very favourable safety profile (Ito & Jensen, 2010).
eMC (2020). SmPC: Omeprazole 20 mg Gastro-Resistant Capsules, Hard. Available at: https://www.medicines.org.uk/emc/product/10340/smpc Accessed 0n 08/10/2020
eMC (2020). SmPC: Lansoprazole 15mg Gastro-resistant Capsules. Available at: https://www.medicines.org.uk/emc/product/4164/smpc Accessed on 08/10/2020
Horn J. The proton-pump inhibitors: similarities and differences. Clin Ther. 2000 Mar;22(3):266-80; discussion 265. doi: 10.1016/S0149-2918(00)80032-6. PMID: 10963283. Available at: https://doi.org/10.1016/s0149-2918(00)80032-6 Accessed on 09/10/2020
Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010 Dec;12(6):448-57. doi: 10.1007/s11894-010-0141-0. PMID: 20882439; PMCID: PMC2974811. Available at: https://doi.org/10.1007/s11894-010-0141-0 Accessed on 09/10/2020
NICE (2020). Proton Pump Inhibitors. Available at: https://bnf.nice.org.uk/drug-class/proton-pump-inhibitors-2.html Accessed on 09/10/2020
Strand DS, Kim D, Peura DA. 25 Years of Proton Pump Inhibitors: A Comprehensive Review. Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502 Available at: https://dx.doi.org/10.5009%2Fgnl15502 Accessed on 08/10/2020