Proton pump inhibitors: better acid suppression when taken before a meal than without a meal

  title={Proton pump inhibitors: better acid suppression when taken before a meal than without a meal},
  author={Jan Gunnar Hatlebakk and P. O. Katz and Luciana Camacho-Lobato and Donald O. Castell},
  journal={Alimentary Pharmacology \& Therapeutics},
Proton pump inhibitors including omeprazole and lansoprazole inhibit gastric acid secretion by selectively and non‐competitively inactivating the H+, K+ ATPase molecules of the parietal cell, but possibly only those that are actively secreting acid. This might imply that stimulation of acid secretion by a meal is necessary for optimal inhibition of gastric secretion. 

The effect of once daily omeprazole and succinic acid (VECAM) vs once daily omeprazole on 24‐h intragastric pH

To compare the effect of once daily bedtime dosing of V ECAM 40 and VECAM 20 without food vs OMP 20 mg administered before breakfast on gastric acidity, a comparison study is conducted on rats fed a single dose of omeprazole/VECAM combination.

Optimising Acid Inhibition Treatment

Oral ‘potent’ acid inhibition (refractory gastro-oesophageal reflux disease, and perhaps Barrett’s oesophagus), available data suggest that the pharmacological and clinical profiles of esomeprazole are slightly better.

Control of gastric acid secretion in health and disease.

The physiology and pathophysiology of acid secretion as well as evidence regarding its inhibition in the management of acid-related clinical conditions are reviewed.

Management of heartburn not responding to proton pump inhibitors

Patients with gastro-oesophageal reflux disease (GORD) who are not responding to proton pump inhibitors (PPIs) given once daily are very common, and diagnostic evaluation of patients with GORD who have failed PPI treatment may include an upper endoscopy, pH testing and oesophageAL impedance with pH monitoring.

Nocturnal acid breakthrough on proton pump inhibitor therapy: To treat or not to treat

Opinion statementNocturnal acid breakthrough is misunderstood and infrequently requires treatment in everyday practice. There are important subgroups of patients in whom esophageal reflux occurs in

The pharmacology and clinical relevance of proton pump inhibitors

The pharmacology of PPIs, the principles of optimal dosing, nocturnal gastric acid breakthrough and its clinical importance, and a treatment approach to gastroesophageal reflux disease using these agents are reviewed.

Histamine receptor antagonists, proton pump inhibitors and their combination in the treatment of gastro-oesophageal reflux disease.

The majority of patients with gastro-oesophageal reflux disease can be effectively managed with carefully titrated doses of proton pump inhibitors, but a small number will continue to show difficulty in the management of their disease, principally because of inadequate nocturnal acid control.

Proton Pump Inhibitors in the Management of GERD

Awareness of new concerns regarding potential side effects of PPIs when used long-term require careful thought as GERD is a chronic disease with most needing some form of medical treatment over time.

PPIs Are Better Taken Before Meals

Despite morning dosing recommendations for proton-pump inhibitors (PPIs), there is considerable inter- and intrapatient variation as to when these



Effect of omeprazole--a gastric proton pump inhibitor--on pentagastrin stimulated acid secretion in man.

The effect of oral omeprazole on pentagastrin stimulated gastric acid secretion was studied in 11 healthy subjects and the inhibitory effect stabilising after three days at a predose inhibition of about 30% and a postdose inhibition ofAbout 80%.

Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily

On chronic intake of omeprazole, most healthy volunteers and patients still have nocturnal acid breakthrough (NAB), defined as night‐time periods with gastric pH < 4.0 lasting for longer than 1 h.

The effect of food and antacids on lansoprazole absorption and disposition.

This study showed that lansoprazole must be administered in fasting state and not simultaneously with antacids, and that the effect was more pronounced in male subjects.

Appropriate acid suppression for the management of gastro-oesophageal reflux disease.

Preliminary meta-analysis shows that the healing rate of erosive oesophagitis at 8 weeks by antisecretory agents is directly related to the duration of suppression of gastric acid secretion achieved over a 24-hour period.

Antisecretory effect of three premeal doses of cimetidine 400 mg versus a single morning dose of omeprazole 20 mg: pathophysiological implications for duodenal ulcer treatment.

The greater effectiveness of omeprazole was confirmed by its longer-lasting antisecretory action, insofar as the drug increased gastric pH above 3.0 units for about 21 h, whereas the daytime cimetidine regimen maintained this threshold for 7.30 h over the circadian cycle.

Optimal dosing of omeprazole 40 mg daily: effects on gastric and esophageal pH and serum gastrin in healthy controls.

Divided dosing of omeprazole 20 mg b.i.d. provides superior gastric acid suppression to either once a day regimen of omEPrazole 40 mg in most individuals.

Omeprazole (20 mg) daily given in the morning or evening: a comparison of effects on gastric acidity, and plasma gastrin and omeprazole concentration

There was a large inter‐individual variability of intragastric acidity in response to omeprazole, which was reflected both in the plasma gastrin and in the area under the plasma omepazole concentration–time curve.

Decreased Oral Bioavailability of Lansoprazole in Healthy Volunteers when Given with a Standardised Breakfast

Lansoprazole should not be taken concomitantly with food, as the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) were decreased and the time to reach Cmax (tmax) was doubled when lansopazole was coadministered with breakfast.

Bioavailability of Omeprazole as Enteric Coated (EC) Granules in Conjunction with Food on the First and Seventh Days of Treatment

The time for appearance of omeprazole in plasma seemed to be prolonged when the EC granule formulation was given after food intake, and the total amount of drug absorbed was not affected.