Appendix A: Dosage information on proton pump inhibitors

Appendix A: Dosage information on proton pump inhibitors

In 2004, when the original guideline was developed (CG17), doses of proton pump inhibitors (PPIs) were based on the British National Formulary (BNF) at the time, as in table 1 below.

During the update of this guideline (2014), the Guideline Development Group (GDG) has further defined the PPI doses specifically for severe oesophagitis and H pylori eradication therapy, as in tables 2 and 3 below.

Table 1 PPI doses relating to evidence synthesis and recommendations in the original guideline (CG17; 2004)

Proton pump inhibitor

Full/standard dose

Low dose (on-demand dose)

Double dose

Esomeprazole

20 mg1 once a day

Not available

40 mg3 once a day

Lansoprazole

30 mg once a day

15 mg once a day

30 mg2 twice a day

Omeprazole

20 mg once a day

10 mg2 once a day

40 mg once a day

Pantoprazole

40 mg once a day

20 mg once a day

40 mg2 twice a day

Rabeprazole

20 mg once a day

10 mg once a day

20 mg2 twice a day

1 Lower than the licensed starting dose for esomeprazole in gastro-oesophageal reflux disease (GORD), which is 40 mg, but considered to be dose-equivalent to other PPI. When undertaking meta-analysis of dose-related effects, NICE classed esomeprazole 20 mg as a full-dose equivalent to omeprazole 20 mg.

2 Off-label dose for GORD.

3 40 mg is recommended as a double dose of esomeprazole because the 20‑mg dose is considered equivalent to omeprazole 20 mg.

Table 2 PPI doses for severe oesophagitis in this guideline update (2014)

Proton pump inhibitor

Full/standard dose

Low dose (on‑demand dose)

High/double dose

Esomeprazole

40 mg1 once a day

20 mg1 once a day

40 mg1 twice a day

Lansoprazole

30 mg once a day

15 mg once a day

30 mg2 twice a day

Omeprazole

40 mg1 once a day)

20 mg1 once a day)

40 mg1 twice a day

Pantoprazole

40 mg once a day

20 mg once a day

40 mg2 twice a day

Rabeprazole

20 mg once a day

10 mg once a day

20 mg2 twice a day

1 Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17.

2 Off-label dose for gastro-oesophageal reflux disease.

Table 3 PPI doses for H pylori eradication therapy in this guideline update (2014)

Proton pump inhibitor

Dose

Esomeprazole

20 mg

Lansoprazole

30 mg

Omeprazole

20–40 mg

Pantoprazole

40 mg

Rabeprazole

20 mg

  • National Institute for Health and Care Excellence (NICE)