aswander

I highly recommend staying away from Prilosec OTC. Here's the lowdown:

Most OTC products are called H-2 inhibitors. These are the previous generation of acid-reducers and the principle ingredient, Ranitidine, is found in many preparations like Tagamet and Xantac. These are great drugs for occasional heartburn, but typically, they simply fail to be strong enough to treat the misery called LPR. Occasionnally, they will be used at a mega-dose level to treat someone with chronic hearburn who has problems with side effects from PPIs. But the mega-dose level is 300 mg of Ranitidine, and at that dosage, most people actually get Ranitidine by prescription from the pharmacy because it's cheaper this way, and more controlled.

Prilosec OTC is the only acid-reducer available over-the-counter from the newer generation of acid reducers called PPIs (proton-pump inhibitors). PPIs are much stronger and more effective at reducing acid. The first PPI, Prilosec, came off of patent in 2003, so in addition to having a generic version of Prilosec available now by prescription, the makers of Prilosec (Astrazeneca) got permission from the FDA to sell the drug OTC, just as Ranitidine had originally been prescription-only and then gone OTC. HOWEVER, Prilosec actually decided to liscense out the name "Prilosec OTC" (note that the "OTC" part makes it different than "Prilosec") to another company to manufacture it. So in addition to the dosage in each Prilosec OTC pill being lower than the dosage in a prescription Prilosec pill, my experience with Prilosec OTC suggested that the medication is not very effective, because doubling, than quadrupling, and finally taking 8x the recommended OTC dose only made my symptoms come back in strange permutations. Yet I can take prescription grade Prilosec and be fine. When I confronted my doctor on this issue, she spoke up and told me that many of her patients had tried the OTC and it had failed for them as well - and she was the one who tipped me off about the different manufacturer. She thinks something funny is going on with that drug and says to stick to the prescription -grade PPIs.

On the positive side, Prilosec OTC may be useful for some people with a little heartburn a few times a week, but it is very ineffective for LPR.

That said, you have a number of choices at the pharmacy counter, by prescription and the key thing to remember is that you need a double dose of whatever medication that you choose. That means a double dose of the maximum strength pill of whatever medication you get a prescription for. Your doctor will write something like "Nexium 40 mg BID". The BID means 2x daily.

Prilosec is still available and is the original PPI. Nexium is the most recently launched PPI. I'm on Nexium and love it. I know that Prilosec and Zegrid also work for me and I know that Protonix does not work for me.

The list:

Nexium
Aciphex
Prevacid
Prilosec
Protonix
Zegrid (a new formulation of Prilosec combined with the active ingredient in Tums, so I've been told)


Protonix doesn't have a great rep for treating LPR on this board. If you want to start out with the "cadillac" of PPIs, go for the Nexium. If you want to start out with the cheapest drug, get the generic version of prescription Prilosec.

I take my 2 pills together which works nicely. But other people split them up, 1 in the morning 1 at night.

You just need to find out what works for you. You might get instant relief, or you might need to experiment with the different PPIs and timing of the dosages until you find the method that works best for you. Everyone is different.

What works for me is Nexium, 2 doses in the morning (for a total of 80 mg of medication), and a Zegrid at bedtime if necessary.

PPIs will wear off after 11-16 hours. So if you take them in the morning, you may feel some symptoms come back at the end of the day. That's when a dose of Zegrid is nice, and other people sometimes take 150 or 300 mg of generic Ranitidine at that time.

I have also found that I can take 2 Zegrid in place of my 2 Nexium if I'm out of Nexium. Same thing for Prilosec.

My recovery from LPR is an A+ provided that I stick to the medication. When I stop taking it, my symptoms come back because the mediation does not cure the fundamental problem - the weak upper esophogous. I can go for 2-3 days without taking the medication, but my symptoms start coming back consistently. and by the 3rd day, I'm hacking away. It's just not worth it for me.

Hope that helps.

Anyone here on Aciphex or Prevacid that wants to give her an opinion?