Drug Status Key

  • Preferred
  • On Formulary
  • Specialist Initiation
  • Shared Care
  • Hospital Only
  • Under Review
  • New on System

1.3.5 Proton pump inhibitors

CAUTION: Proton Pump Inhibitors may relieve or mask the symptoms from a malignant gastric ulcer and may even induce the healing of a lesion and therefore delay diagnosis.

Where a PPI is indicated the LOWEST EFFECTIVE DOSE should be prescribed.

Indication Omeprazole (O) / Lansoprazole (L) (capsules)

Treatment of Gastro-oesophageal reflux disease

O: 20mg daily for 4-8 weeks,
L: 30mg daily for 4-8 weeks,
If symptoms recur step down to lowest dose needed to control symptoms. Discuss use on an as-needed basis

Treatment of Gastro-oesophageal reflux disease - severe oesophagitis

O: 40mg daily for 8 weeks,
L: 30mg daily for 8 weeks,
Long term maintenance as above

Failure of treatment:
Try a different PPI as above or:
O: 40mg twice a day,
L: 30mg twice a day

Maintenance:
O: 40mg daily
L: 30mg daily

Uninvestigated dyspepsia

O: 20mg daily for 4 weeks
L: 30mg daily for 4 weeks
If symptoms recur step down to lowest dose needed to control symptoms. Discuss use on an as-needed basis

Duodenal Ulcer

O: 20mg daily for 4 weeks
Maintenance of recurrent ulcers 20mg daily
L: 30mg daily for 4 weeks; maintenance 15mg daily

Gastric Ulcer

O: 20mg daily for 8 weeks
L: 30mg daily for 8 weeks

Zollinger-Ellison Syndrome
O: 20-120mg daily
L: 60 – 120mg daily

NSAID associated ulcers

O: 20mg daily for 4 weeks, continue for further 4 weeks if not fully healed.
L: 30mg daily for 4 weeks, continued for further 4 weeks if not fully healed. Prophylaxis 15-30mg daily

NSAID Protection

O: 20mg daily
L: 15-30mg daily


PPIs are not indicated for use in:

  • Non-specific abdominal symptoms such as bloating or flatulence
  • Right or left quadrant abdominal discomfort / pain
  • Lower abdominal discomfort / pain

MHRA Drug Safety Update – Interaction between the use of clopidogrel and PPI’s – April 2010

In light of the most recent evidence, the previous advice on the concomitant use of clopidogrel with proton pump inhibitors has now been modified. Use of either omeprazole or esomeprazole with clopidogrel should be discouraged. The current evidence does not support extending this advice to other PPIs.

Omeprazole injection indicated in acute GI bleed (confirmed by endoscopy or frank haematemesis, life threatening GI bleed, bleeding varices). NBM is not an indication for use of the injection.

Orodispersible and dispersible tablets should only be used in children where dosing requires it and in adults with swallowing difficulties

Please note, sample information has been entered into Chapters 1 and 2 only and although fairly clinically accurate, it is not guaranteed. The information was entered during April and May 2017 and drugs will have subsequently been randomly added during telephone demonstrations.

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Pack Price
14 capsule
28 capsule £0.84
56 capsule
Pack Price
28 tablet £2.10
Pack Price
14 capsule
28 capsule £1.11
56 capsule
7 capsule
Pack Price
14 tablet
28 tablet £3.42
7 tablet
Pack Price
28 tablet £7.75
30 tablet
56 tablet
Pack Price
28 tablet £11.60
30 tablet
56 tablet
Pack Price
14 capsule
28 capsule £0.91
Pack Price
28 capsule
7 capsule £0.75
Pack Price
1 vial

Also known as Nexium

Pack Price
14 tablet
28 tablet £0.95
7 tablet
Pack Price
14 tablet
28 tablet £1.12
Pack Price
28 tablet (2 x 14 tablets) £18.50
Pack Price
28 tablet (2 x 14 tablets) £25.19
Pack Price
14 tablet (2 x 7 tablets) £7.49
7 tablet £4.37