PPIs & Indigestion 💊
Reference guide for PPIs and indigestion medications. Drug table with omeprazole, pantoprazole, lansoprazole, Gaviscon, famotidine, dosing, and prescribing for dyspepsia and GORD on the ward.
💡 Ward approach
- Mild dyspepsia / reflux: alginate (Gaviscon) after meals and at bedtime; antacid (Rennie) for quick prn relief.
- Persistent symptoms or oesophagitis: PPI od; omeprazole 20 mg is typical first-line (preferably before food). If nil by mouth: esomeprazole 20 mg IV od for symptomatic reflux or 40 mg if oesophagitis; pantoprazole 40 mg IV od, then switch to PO when tolerated (IV pantoprazole licensed ≤7 days).
- NSAID or steroid cover: omeprazole 20 mg od while on regular NSAIDs or high-dose steroids (see linked topics).
- Review need for ongoing PPI at discharge; many inpatients can step down to PRN alginate/antacid.
⚠️ Cautions
- Hospital-acquired diarrhoea: PPIs are a risk factor for C. difficile; review if loose stools develop.
- Prolonged PPI use: hypomagnesaemia, B₁₂ deficiency, fracture risk.
- Alginates/antacids: separate from other oral drugs by ~2 hours where absorption matters.
- Do not mask alarm features: dysphagia, weight loss, GI bleeding, anaemia, persistent vomiting need senior review.
🚨 When to escalate
- Haematemesis, melaena, syncope, or haemodynamic instability → resuscitate and see Upper GI bleed.
- Dysphagia, persistent vomiting, or iron-deficiency anaemia → urgent gastroenterology review.
- Refractory symptoms despite adequate PPI trial; consider H. pylori testing, endoscopy, or alternative diagnosis.
PPIs & indigestion medications
Antacids, alginates, H₂ blockers, and proton pump inhibitors
| Drug | Class | Dose | Route | Frequency | Indication | Notes |
|---|---|---|---|---|---|---|
| Gaviscon Advance | Alginate | 5–10 ml | PO | After meals & nocte | Reflux, dyspepsia | Forms raft on gastric contents; separate from other meds by ~2 h; sodium load |
| Rennie Peppermint | Antacid | 1–2 tablets | PO | prn | Quick heartburn relief | Ca²⁺/Mg²⁺; max 11 tabs/day; not for under 18s; review if >7 days |
| Famotidine (Clonmel 20 mg) | H₂ blocker | 20 mg | PO | BD | Mild reflux oesophagitis | Prescription H₂ blocker; weaker than PPI; 40 mg products are for ulcer disease only |
| Esomeprazole (Nexium) | PPI | 20 mg (symptomatic) / 40 mg (oesophagitis) | PO / IV | OD (PO with or without food) | GORD, oesophagitis, NPO reflux | IV Nexium 20–40 mg od when nil by mouth; switch to PO ASAP |
| Omeprazole (Losec) | PPI | 20 mg (40 mg if severe) | PO | OD (preferably before food, am) | GORD, dyspepsia, ulcer prophylaxis | C. diff, hypomagnesaemia with prolonged use; check interactions (e.g. clopidogrel; local practice varies) |
| Lansoprazole (Zoton) | PPI | 15–30 mg | PO | ≥30 min before food (am) | GORD, dyspepsia | Orodispersible tablet available; similar cautions to other PPIs |
| Pantoprazole (Protium) | PPI | 40 mg | PO / IV | 1 h before food (PO) | GORD, oesophagitis, NPO ulcer/reflux | IV 40 mg od when oral not possible (max 7 days); fewer CYP interactions; stress ulcer prophylaxis off-label |
Gaviscon Advance
AlginateDose:5–10 ml
Route:PO
Frequency: After meals & nocte
Indication: Reflux, dyspepsia
Notes: Forms raft on gastric contents; separate from other meds by ~2 h; sodium load
Rennie Peppermint
AntacidDose:1–2 tablets
Route:PO
Frequency: prn
Indication: Quick heartburn relief
Notes: Ca²⁺/Mg²⁺; max 11 tabs/day; not for under 18s; review if >7 days
Famotidine (Clonmel 20 mg)
H₂ blockerDose:20 mg
Route:PO
Frequency: BD
Indication: Mild reflux oesophagitis
Notes: Prescription H₂ blocker; weaker than PPI; 40 mg products are for ulcer disease only
Esomeprazole (Nexium)
PPIDose:20 mg (symptomatic) / 40 mg (oesophagitis)
Route:PO / IV
Frequency: OD (PO with or without food)
Indication: GORD, oesophagitis, NPO reflux
Notes: IV Nexium 20–40 mg od when nil by mouth; switch to PO ASAP
Omeprazole (Losec)
PPIDose:20 mg (40 mg if severe)
Route:PO
Frequency: OD (preferably before food, am)
Indication: GORD, dyspepsia, ulcer prophylaxis
Notes: C. diff, hypomagnesaemia with prolonged use; check interactions (e.g. clopidogrel; local practice varies)
Lansoprazole (Zoton)
PPIDose:15–30 mg
Route:PO
Frequency: ≥30 min before food (am)
Indication: GORD, dyspepsia
Notes: Orodispersible tablet available; similar cautions to other PPIs
Pantoprazole (Protium)
PPIDose:40 mg
Route:PO / IV
Frequency: 1 h before food (PO)
Indication: GORD, oesophagitis, NPO ulcer/reflux
Notes: IV 40 mg od when oral not possible (max 7 days); fewer CYP interactions; stress ulcer prophylaxis off-label
Educational reference only. Medical disclaimer