NICE guidance - proton pump inhibitors in dyspepsia
Last reviewed 07/2021
PPI doses relating to management of dyspepsia, oesophagitis and peptic ulcer disease
| PPI | Full/Standard dose | Low dose (on demand dose) | Double dose |
| Esomeprazole | 20 mg* once a day | Not available | 40 mg*** once a day |
| Lansoprazole | 30mg once a day | 15mg per day | 30 mg** twice a day |
| Omeprazole | 20 mg once a day | 10mg* per day | 40 mg once a day |
| Pantoprazole | 40 mg once a day | 20mg per day | 40mg twice a day |
| Rabeprazole | 20mg once a day | 10mg per day | 20mg twice a day |
- * lower than the licensed starting dose for esomeprazole in GORD, which is 40 mg, but considered to be dose-equivalent to other PPIs. When undertaking meta-analysis of doserelated effects, NICE classed esomeprazole 20 mg as a full-dose equivalent to omeprazole 20 mg
- **off-label dose for GORD
- ***40 mg is recommended as a double dose of esomeprazole because the 20-mg dose is considered equivalent to omeprazole 20 mg.
PPI doses for severe oesophagitis
| PPI | Full/Standard dose | Low dose (on demand dose) | Double dose/High dose |
| Esomeprazole | 40 mg* once a day | 20mg* once a day | 40 mg* twice a day |
| Lansoprazole | 30mg once a day | 15mg per day | 30 mg** twice a day |
| Omeprazole | 40 mg* once a day | 20mg* per day | 40 mg* twice a day |
| Pantoprazole | 40 mg once a day | 20mg per day | 40mg** twice a day |
| Rabeprazole | 20mg once a day | 10mg per day | 20mg** twice a day |
- *dose, specifically for severe oesophagitis
- ** Off-label dose for GORD.
PPI doses for H pylori eradication therapy
| PPI | Dose (twice daily) |
| Esomeprazole | 20mg |
| Lansoprazole | 30mg |
| Omeprazole | 20-40mg |
| Pantoprazole | 40mg |
| Rabeprazole | 20mg |
Reference:
NICE guidance - management of dyspepsia in adults in primary care (summary section)