Part II. Drug treatment of gastritis and gastroduodenitis. Reduced activity of the acid-peptic factor

Updated: 04/23/2021 15:13:42

Expert: Abramova Tsilya

Proton pump inhibitors confidently occupy a leading position among drugs for the treatment of diseases of the digestive tract. They help with gastritis and peptic ulcers - they reduce the formation of hydrochloric acid, prevent the appearance of ulcers, and prevent the progression and relapse of the disease. In combination with other medications, they improve the patient’s condition - relieve pain, heartburn, nausea and other symptoms.

Nolpaza and Omez are proton pump inhibitors. They belong to the same group of drugs, but differ in composition. Various active components determine differences in the action of drugs. Read the article for a detailed review of each drug.

Important to remember! Proton pump inhibitors are not intended for self-medication. Drugs in this group are prescribed by a gastroenterologist only after a complete examination of the patient and an accurate diagnosis.

What's inside: composition and form of release of drugs

Omez and Nolpaza belong to the same group of drugs. These are proton pump inhibitors (PPIs), or H+-K+-ATPases, known anti-ulcer drugs. Used in complex therapy of gastric and duodenal ulcers, gastritis with increased secretion of gastric juice.

Detailed characteristics of the drugs are presented in the table.

Comparison of addiction between Nolpaza and Omeprazole

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “o syndrome” in Nolpaza is quite similar to the similar values ​​in Omeprazole. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Nolpaza has a fairly low “syndrome” value, just like Omeprazole.

How do proton pump inhibitors work?

Omez and Nolpaza have the same mechanism of action. They block H+-K+-ATPase, the enzyme responsible for the synthesis of hydrochloric acid in the stomach. Proton pump inhibitors are prodrugs. Entering the blood, they are converted into an active form only in the secretory tubules of the parietal cells of the stomach - where enzyme molecules protrude into the lumen.

Important details:

1. Proton pump inhibitors block the production of hydrochloric acid for a long time. The effect of the drug lasts longer than it actually remains in the blood.
2. Proton pump inhibitors are quickly destroyed in the acidic environment of the stomach. If the drug is directly sent into hydrochloric acid, it will not reach the desired enzyme. Therefore, a protective enteric tablet coating is used to deliver the medication to the parietal cells of the stomach. Sometimes the active substance is placed in a capsule.
3. Clinical studies show that omeprazole (Omez) is more quickly converted into the active form in the parietal cells of the stomach than pantoprazole (Nolpaza). This means that omeprazole also binds to proton pumps more quickly and blocks the production of hydrochloric acid.
4. Scientists say: the slow transformation of pantoprazole also has a positive effect. It binds to a large number of proton pump components. In the future, this should lead to a stronger effect of Nolpaza, but in practice, experts do not find confirmation of this theory. Professor S. Yu. Serebrova says that this fact has no practical significance. Any modern PPI almost irreversibly blocks the synthesis of the enzyme, and the synthesis of hydrochloric acid is restored only after the formation of new proton pumps in the cells of the stomach.

Nolpaza and Omez, despite the common mechanism of action, have different pharmacokinetics: they are absorbed and excreted from the body differently. Scientists have discovered the key differences between the drugs:

1. Pantoprazole (Nolpaza) has higher bioavailability - 77% versus 35% for omeprazole (Omez). The higher this indicator, the more active substance is absorbed in the body.
2. The high bioavailability of Nolpaza does not imply a reduction in dosage. Clinical studies show that 40 mg pantoprazole is comparable in effectiveness to 20 mg omeprazole.
3. Nolpaza reaches maximum concentration in the blood after 2-3 hours, Omez - after 0.5-3.5 hours.
4. The half-life of the drugs varies slightly: 0.6-1.5 hours for omeprazole and 0.9-1.2 hours for pantoprozole.

Features of pharmacokinetics must be taken into account when using the drug, however, these facts cannot be the only argument in favor of any drug.

Description of the drug Omez

The active ingredient of the drug is omeprazole. The drug is available in the form of capsules and lyophysilate powder, which is used to prepare an infusion solution. Omez refers to drugs that are used to treat peptic ulcers and gastroesophageal reflux disease. Pharmacotherapeutic group: proton pump inhibitors.

The active component is a mixture of two enantiomers that help reduce the secretion of gastric acidity due to the targeted action of the drug. The parietal cells of the stomach contain a proton pump, its inhibition helps control the suppression of gastric acid secretion.

Omeprazole is a weak base that is able to concentrate and convert into the active form in the acidic environment of intracellular tubules located in parietal cells. Its main function is to inhibit the enzyme H+K+-ATPase, which is an acid pump.

When administered orally, 20 mg omeprazole in patients suffering from duodenal ulcers can maintain gastric pH ≥3 for 17-24 hours.

Due to a decrease in acid secretion and a decrease in intragastric acidity, depending on the dose used, omeprazole effectively reduces and/or normalizes the acid exposure of the esophagus in patients suffering from gastroesophageal reflux disease.

The use of Omez is advisable for:

Assessing the effectiveness of drugs

Professor S. Yu. Serebrova conducted a comparative analysis of two proton pump inhibitors - omeprazole and pantoprazole (Omez and Nolpaza). The results were published in the journal "Attending Physician".

Important aspects:

1. According to a meta-analysis, which systematizes the results of the use of PPIs in different categories of patients, we can conclude: pantoprazole is a less active drug compared to omeprazole.
2. Clinical studies prove the same therapeutic effectiveness of pantoprazole and omeprazole in the treatment of peptic ulcers and reflux esophagitis.
3. The Cochrane Library database also contains references to proton pump inhibitors. The analysis shows that drugs in this group effectively cope with the manifestations of functional dyspepsia and reliably suppress the secretion of gastric juice. PPIs have also proven themselves in the treatment of peptic ulcers.

Comparison of the effectiveness of Nolpaza and Omeprazole

Nolpaza is more effective than Omeprazole - this means that the ability of the drug substance to provide the maximum possible effect is different.
For example, if the therapeutic effect of Nolpaza is more pronounced, then with Omeprazole it is impossible to achieve this effect even in large doses.

Also, the speed of therapy is an indicator of the speed of the therapeutic action; Nolpaza and Omeprazole are also different, as is bioavailability - the amount of a drug reaching the site of its action in the body. The higher the bioavailability, the less it will be lost during absorption and use by the body.

Application diagram

Proton pump inhibitors are prescribed in the following situations:

1. peptic ulcer of the stomach and duodenum - comprehensive treatment and prevention of relapses;
2. gastroesophageal reflux disease;
3. other conditions associated with excessive production of hydrochloric acid: stress gastric ulcers, systemic mastocytosis, etc.;
4. eradication of Helicobacter pylori in peptic ulcer disease.

The treatment regimen is determined by the doctor, taking into account the patient’s age and the severity of his condition. The course of treatment lasts 4-8 weeks. Typically, proton pump inhibitors are prescribed half an hour before meals.

Comparison of side effects of Nolpaza and Omeprazole

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Nolpaza has almost the same level of adverse events as Omeprazole. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Nolpaza are similar to Omeprazole: how quickly the body recovers after taking it and whether it recovers at all.

Precautionary measures

Omez and Nolpaza have similar adverse reactions. The most common symptoms that occur are:

1. decreased blood cell levels – anemia, leukopenia, thrombocytopenia;
2. hypersensitivity reactions: allergic rash, angioedema;
3. insomnia or increased excitability;
4. headache, dizziness, drowsiness;
5. visual and hearing impairment;
6. bronchospasm;
7. abdominal pain, stool disturbance, flatulence;
8. excessive sweating;
9. peripheral edema.

If undesirable reactions occur, you should stop taking the drug and consult a doctor.

During pregnancy and breastfeeding, only Omez is approved for use. Nolpaza is not prescribed in these situations.

What is better to buy, Nolpaza or Omez

If we compare these two drugs, then:

1. Omez promotes a more active reduction in the acidity of gastric juice, and Nolpaza has a milder effect, without having a parallel effect on the gastric mucosa.
2. With long-term use of Omez, the likelihood of side effects such as nausea, dizziness and dry mouth increases.
3. Omez is a fast-acting drug, and Nolpaza is used systematically to restore gastrointestinal functions.
4. The price for Nolpaza is higher than for Omez.

conclusions

Let's summarize:

1. Omez and Nolzpaza are effective and relatively safe drugs from the group of proton pump inhibitors. They are used in the treatment of gastric and duodenal ulcers, functional dyspepsia and other similar conditions.
2. Proton pump inhibitors suppress the production of stomach acid. The effect of the drug is long-lasting and persists even after it is removed from the body.
3. Nolpaza has greater bioavailability, but less antisecretory activity. The therapeutic efficacy, according to clinical studies, is the same for the drugs.

The final choice of drug remains with the doctor and depends on the specific clinical situation.

Comparison of safety of Nolpaza and Omeprazole

The safety of a drug includes many factors.

At the same time, it is higher for Nolpaza than for Omeprazole. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Nolpaza, as well as Omeprazole, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Nolpaza has fewer risks when used than Omeprazole.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Nolpaza and Omeprazole.

Comparison of ease of use of Nolpaza and Omeprazole

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Nolpaza is approximately the same as Omeprazole. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-04 13:43:46

Differences between Nolpaza and Omeprazole

To understand what the difference is between the drugs and how they are interchangeable, let’s consider them from the point of view of their main characteristics:

The price is produced in Slovenia, the cost of the package is approximately 200-600 rubles , depending on the dosage and the number of tablets in the pack. "Omeprazole" is produced in Russia, Serbia and Israel, its price ranges from 30-150 rubles .

Active ingredient

Studies have shown that the intensity of the acticeretory effect of the proton pump inhibitor omeprazole exceeds that of pantoprazole. The time to achieve maximum effect for pantoprazole is almost three times longer than for omeprazole.

Release form

Omeprazole is available in a single form - gelatin-coated capsules. Nolpaza is available in the form of film-coated tablets.

How long does it take for the effect of taking the drug to appear?

The effect of Omeprazole begins, depending on the characteristics of the body, about half an hour to an hour after administration. Nolpaze takes about two hours to reach its maximum concentration in the blood plasma.

Contraindications

The list of contraindications for prescribing Omeprazole is not too wide and includes intolerance to the components of the drug, childhood, pregnancy and breastfeeding (treatment is possible, but it is necessary to switch the baby to formula). Contraindications to taking Nolpaza are:

• intolerance to the components of the drug;
• age under 18 years;
• dyspepsia (neurotic genesis);
• malignant formations in the gastrointestinal tract;
• simultaneous administration with the drug "Atazanavir".

Interaction with other drugs

As the history of observations of patients treated with Omeprazole shows, long-term use of 20 mg per day did not have a significant effect on most drugs.

However, it is undesirable to take the drug simultaneously with those drugs, the absorption of which directly depends on the pH value. In this case, Omeprazole will reduce their effectiveness. “Nolpaza” has an absolutely similar effect. It can be taken simultaneously with the following drugs without any risk:

• Cardiovascular drugs (Digoxin, Nifedipine, Metoprolol);
• Antibiotics for the treatment of the digestive system (“Amoxicillin”, “clarithromycin”);
• Oral contraceptives;
• Non-steroidal anti-inflammatory drugs;
• Drugs for the treatment of the endocrine system (“Glibenclamide”, “Levothyroxine sodium”);
• Anxiolytics (“Diazepam”);
• Antielliptic drugs (“Carbamazepine” and “Phenytoin”);
• Immunosuppressants (Cyclosporin, Tacrolimus).

Side effects

The list of possible side effects looks quite impressive, but almost all of them occurred in isolated cases, in seriously ill patients, while taking potent drugs.

Disorders of the digestive system (stool, nausea, pain, gas formation) are relatively common. Much less often you can observe such reactions as sleep disturbances, vertigo, ringing in the ears, swelling of the extremities, and allergic skin rashes.

As for Nolpaza, about ten percent of drug prescriptions result in headaches, abdominal pain, constipation, diarrhea, and gas. Much less frequently, in approximately every hundredth patient, the following occurred:

• increased drowsiness;
• insomnia;
• blurred vision;
• dizziness;
• allergic skin reactions;
• weakness;

Overdose

Cases of Omeprazole overdose have been observed quite rarely, with the following symptoms: confusion, blurred vision, dry mouth, headaches, nausea, arrhythmia. The instructions for use of Nolpaza indicate that no cases of overdose in humans have been identified. However, in both cases, symptomatic treatment is recommended, since hemodialysis is not effective.

Concluding all of the above, it can be noted that the difference between the two drugs, although it exists, is not too significant. "Omeprazole" and "Nolpaza" differ quite greatly in price, and also differ in the active substance in the composition. Moreover, the mechanism of their work in the body is completely identical.

Omeprazole was released onto the market much earlier, its effect on the body has been studied much better. At the same time, there have been no cases of overdose of Nolpaza; side effects from its use are also less common.