Omeprazole is one of the most commonly prescribed drugs in the UK, mainly used for the treatment of gastro-oesophageal reflux disease (GORD) with symptoms of the heartburn caused by stomach acid, which rises from the stomach into the oesophagus (the tube that connects your mouth and stomach). In this post, I will discuss different Omeprazole alternative drugs available for the public to buy and as prescription-only medications.
Omeprazole: drug classification
Omeprazole belongs to a group of medication called proton pump inhibitors (PPIs). PPIs are the most effective group of drugs that suppress the production of acid in the stomach.
Omeprazole alternative drugs are either available as general sale list medication (GSL), pharmacy-only medication (P) or as Prescription Only Medication (POM). GSL medicines can be sold in any shop or supermarket, P medicines, on the other hand, can only be purchased from the pharmacy. POM drugs are prescribed by a doctor or another qualified prescriber.
Is Omeprazole available over the counter without prescription?
Omeprazole can be purchased over the counter without a prescription. Omeprazole 10mg tablets are classified as P medicine.
Pharmacy chains such as Boots and Lloyds sell their own branded version of Omeprazole named ‘Boots Acid Reflux tablets’ and ‘Heartburn relief’ (Lloyds Pharmacy). In 2019 a new product containing Omeprazole was launched. Pyrocalm Control is licensed as GSL medicine. Each gastro-resistant tablet of Pyrocalm Control contains 20mg of Omeprazole.
Omeprazole 20mg is widely prescribed in the UK. Omeprazole 40mg tablets or capsules can only be obtained on prescription.
Omeprazole alternative drugs: Over the counter alternatives
1. Nexium Control (Esomeprazole 20mg tablets)
Nexium Control is the closest Omeprazole alternative available over the counter, without a prescription. Nexium Control tables are widely available as GSL medication. Most supermarkets and some corner shops sell Nexium Control. Nexium control can also be purchased online (both tablets and capsules). You can read much more about Nexium Control in my separate post: Nexium Control review. Is Nexium the best PPI?
2. Pantoloc Control (Pantoprazole 20mg tablets) as an alternative
Pantoprazole is another PPI used to relieve heartburn symptoms. Pantoloc Control is a P medicine, which can only be purchased from the pharmacy.
Short term use of Pantoprazole in the treatment of gastro-oesophageal reflux disease demonstrated similar effectiveness to other PPIs such as Omeprazole and Esomeprazole (Dias, 2009).
3. Ranitidine as Omeprazole alternative
We are now moving away from PPIs. Ranitidine belongs to a group of medication called H2 receptor antagonists (H2 receptor blockers). H2 receptor antagonists differ from PPIs in chemistry and work in a different way to suppress acid production.
Available as a generic or branded as Zantac, ranitidine 75mg tablets are considerably cheaper than PPIs and available without a prescription. Most pharmacies and larger supermarkets stock Ranitidine. Ranitidine is effective in the management of heartburn and indigestion symptoms; however, PPIs are superior (more effective) in the treatment of GORD symptoms (Sigterman et al., 2013) than Ranitidine. Read more: Ranitidine vs Omeprazole: which drug is better?
In recent months most Ranitidine 75mg products including Zantac, most supermarket own labeled versions and POM Ranitidine were subject to a number of recalls due to possible contamination with N-Nitrosodimethylamine (NDMA), which is classified as ‘probable human carcinogen‘. This is a global issue with a number of Ranitidine products in the USA containing above the acceptable daily intake of NDMA. In the UK investigation is being conducted by The Medicines and Healthcare Regulatory Agency (MHRA). This means the supply of Ranitidine products will be disrupted in coming months. Learn more about Ranitidine and cancer link in my separate post.
Some of you may ask: why PPIs are more effective than H2-receptor antagonist?
The difference in effectiveness comes from different mechanisms of action of PPIs and H2 receptor antagonists. In plain language, H2 receptor antagonists suppress acid production by blocking only one pathway of acid production. PPIs, on the other hand, block proton pump, which plays a role in the final part of acid secretion. This mechanism of action makes them more effective than H2 receptor antagonists.
4. Antacids as over the counter Omeprazole alternative
Antacids are least effective as compared to two other groups of drugs discussed so far. There is a number of antacid products available on the market. Antacids come in different forms, for example, as chewable tablets and most popularly as a liquid formulation.
Antacids provide fast, short term relief from symptoms of heartburn by neutralising acid in the stomach. Antacid can be purchased from the pharmacy and other outlets.
Omeprazole alternative drugs: prescription-only medications (POM)
1. Proton Pump Inhibitors:
The following PPIs are available as prescription-only medication:
- Lansoprazole: most commonly prescribed as Lansoprazole 15mg or 30mg capsules. Lansoprazole is also available as 15mg and 30mg orodispersible tablets (as generic ‘cheaper’ form) and as a branded product called ZotonFasTab. Orodispersible tablets are placed on the tongue and allow to disperses in the mouth, releasing gastro-resistant microgranules that are swallowed with the saliva (eMC, 2019).
- Esomeprazole: another Omeprazole alternative that is available as gastro-resistant capsules and tablets (20mg and 40mg) produced generically and under different brands such as Nexium. Nexium is also available as Nexium 10 mg gastro-resistant granules for oral suspension. Esomeprazole granules are mixed with water to produce a suspension.
- Pantoprazole: less popular Pantoprazole is available as a prescription-only medication inf form of 20mg and 40mg gastro-resistant tablets.
- Rabeprazole: last PPI available as Omeprazole alternative is Rabeprazole. Rabeprazole is the least commonly prescribed PPI in the UK. Rabeprazole is available in the form of 10mg and 10mg gastro-resistant tablets.
- Omeprazole liquid: for those with swallowing difficulties or babies and toddlers, Omeprazole can be specially made into Omeprazole liquid. Learn more about Omeprazole liquid in the post: Omeprazole liquid: indications, special form, cost & availability.
2. H2 receptor antagonist: Ranitidine
Ranitidine is available in the form of 150mg and 300mg tablets. Additionally, Ranitidine can be prescribed in the form of oral solution, available as Ranitidine 150mg/10ml oral solution, and as branded product Zantac Syrup ( 150mg of Ranitidine per 10ml). Oral solution of Ranitidine is prescribed for babies (young population) or patients with swallowing difficulties.
Other H2 blockers available on prescription include:
The above drugs are not commonly prescribed in the UK.
Lifestyle changes such as weight loss can reduce episodes of heartburn. Other lifestyle modifications to consider include:
- avoid foods that cause acid reflux
- reduce alcohol consumption
- reduce coffee consumption
- stop smoking
Anyone experiencing symptoms of heartburn for longer than three weeks should consult their GP. Patients should be aware of other symptoms needed GP referral, such as weight loss (for no reason), frequent episodes of feeling sick (NHS, 2017), and other symptoms. Visit the NHS website for more info, always read the product information leaflet.
Omeprazole alternative drugs: FAQ
Is Zantac the same as Omeprazole?
Zantac belongs to a group of drugs called H2 receptor antagonists and Omeprazole to Proton Pump Inhibitors (PPIs). PPIs are more effective in reduction of stomach acid production.
Is it better to take Ranitidine or Omeprazole?
Omeprazole is more effective in reduction of stomach acid than Ranitidine, however ranitidine is associated with less common side effects as compared to Omeprazole.
Can I stop taking Omeprazole suddenly?
Some patients may be able to stop Omeprazole suddenly, however this depends on the indicated use and the duration of treatment. Speak to your prescriber before stopping Omeprazole.
What can I use in place of antacids?
Drugs used instead of antacid include Ranitdine a H2 receptor antagonist; Proton Pump Inhibitors (PPIs) such as Omeprazole and Esomeprazole. H2 antagonist and PPIs are more effective in reduction of stomach acid production.
- Dias, L.M. Clin. Drug Investig. (2009) 29(Suppl 2): 3. https://doi.org/10.2165/1153121-S0-000000000-00000 Accessed on 05/06/2019
- eMC (2019). Summary Product Characteristics: ZotonFasTab. Available at: https://www.medicines.org.uk/emc/product/1714/smpc Accessed on 30/12/2019
- NHS (2017). Heartburn and acid reflux. Available at: https://www.nhs.uk/conditions/heartburn-and-acid-reflux/ Accessed on 05/06/2019
- Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME (2013). Short‐term treatment with proton pump inhibitors, H2‐receptor antagonists and prokinetics for gastro‐oesophageal reflux disease‐like symptoms and endoscopy negative reflux disease. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD002095. DOI: 10.1002/14651858.CD002095.pub5. Available at: https://doi.org/10.1002/14651858.CD002095.pub5 Accessed on 05/06/2019