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 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 Helicobacter pylori (H pylori) eradication therapy, as in tables 2 and 3 below.

Table 1 Proton pump inhibitor doses relating to evidence synthesis and recommendations in the original guideline (CG17; 2004)
Proton pump inhibitor Full or standard dose Low dose (on-demand dose) Double dose

Esomeprazole

20 mg once a day

Not available

40 mg once a day

Lansoprazole

30 mg once a day

15 mg once a day

30 mg twice a day

Off-label dose for GORD

Omeprazole

20 mg once a day

10 mg once a day

Off-label dose for GORD

40 mg once a day

Pantoprazole

40 mg once a day

20 mg once a day

40 mg twice a day

Off-label dose for GORD

Rabeprazole

20 mg once a day

10 mg once a day

20 mg twice a day

Off-label dose for GORD

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.

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

Table 2 Proton pump inhibitor 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 mg once a day

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

20 mg once a day

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

40 mg twice a day

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

Lansoprazole

30 mg once a day

15 mg once a day

30 mg twice a day

(Off-label dose for gastro-oesophageal reflux disease.)

Omeprazole

40 mg once a day

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

20 mg once a day

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

40 mg twice a day

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

Pantoprazole

40 mg once a day

20 mg once a day

40 mg twice a day

(Off-label dose for gastro-oesophageal reflux disease.)

Rabeprazole

20 mg once a day

10 mg once a day

20 mg twice a day

(Off-label dose for gastro-oesophageal reflux disease)

Table 3 Proton pump inhibitor doses for H pylori eradication therapy in this guideline update (2014)
Proton pump inhibitor Dose

Esomeprazole

20 mg

Lansoprazole

30 mg

Omeprazole

20 to 40 mg

Pantoprazole

40 mg

Rabeprazole

20 mg