What are Omeprazole alternative drugs

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 the following classes of drugs which are available as omeprazole alternative drugs:

PPIs (esomeprazole and pantoprazole)
H2 receptor antagonists (ranitidine)
Antacids

Omeprazole belongs to a group of medication called proton pump inhibitors (PPIs). PPIs are the most effective group of medications which suppress the production of acid in the stomach.

All of the above alternative drugs are either available as general sale list medication (GSL) or/and pharmacy only medication (P). GSL medicines can be sold in any shop or supermarket, P medicines, on the other hand, can only be purchased from the pharmacy.

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).

Omeprazole 20mg and 40mg (tablets or capsules) is not available over the counter and can only be obtained on prescription.

Omeprazole alternative drugs

Nexium Control (Esomeprazole 20mg tablets) as an alternative

Nexium Control is the closest omeprazole alternative available over the counter. In fact, both drugs have the same chemical structure. Nexium Control tables are available as GSL medication.

Pantoloc Control (Pantoprazole 20mg tablets) as an alternative

Pantoprazole is another PPI used to relieve heartburn symptoms. Pantoloc Control is a pharmacy only 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).

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 can considerably be cheaper than PPIS. Ranitidine is classified as GSL or P medicine depending on the pack size of the product. Ranitidine can also be effective omeprazole alternative in management of heartburn symptoms.

However, PPIs are superior (more effective) in the treatment of GORD symptoms (Sigterman et al, 2013) than ranitidine.

Some of you may ask: why?

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 of the pathways 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.

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Antacids as over the counter alternatives to omeprazole

Antacid are least effective as compared to two other groups of drugs discussed so far. There are number of antacid products available on the market. Antacid come in form of chewable tablets and liquid.

Antacid 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.

Conclusion

Omeprazole and other PPIs such as esomeprazole and pantoprazole can be purchased without a prescription.

Esomeprazole and pantoprazole belong to the same group of medication as omeprazole and have similar effectiveness in the management of heartburn. Patients need to remember that use of over the counter PPIs is limited for up to 4 weeks (read product information leaflet for the exact product licensing).

Lifestyle changes such as weigh loss can reduce episodes of heartburn.

Anyone experiencing symptoms of heartburn for longer than 3 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 NHS website for more info, always read the product information leaflet.

References:

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

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