Omeprazole is one of the most commonly prescribed drugs in the UK, mainly used for the treatment of gastro-oesophageal reflux disease (GORD) with symptoms such as heartburn caused by stomach acid, which rises from the stomach into the oesophagus (the tube that connects your mouth and stomach). In this post, I will discuss different Omeprazole alternative drugs available for the public to buy and options for prescription-only medications. Additionally, the following will be reviewed:
- classification of omeprazole
- classification of omeprazole alternative drugs
- licensed use of omeprazole and omeprazole alternative drugs
- availability of omeprazole over the counter, and finally
- options for omeprazole alternative drugs available without a prescription and on prescription
Omeprazole and alternatives: drug classification
Omeprazole belongs to a group of medication called proton pump inhibitors (PPIs). PPIs are the most effective group of drugs that suppress the production of acid in the stomach. Omeprazole alternative drugs, discussed in this post, belong to one of the following class:
- proton pump inhibitors (PPIs)
- H2-receptor antagonists (H2-blockers)
Omeprazole alternative drugs are available as:
- general sale list medicines (GSL),
- pharmacy-only medicines (P) or
- prescription-only medication (POM)
GSL medicines can be sold in any shop or supermarket. P medicines, on the other hand, can only be purchased from the pharmacy under the supervision of a pharmacist, this includes online pharmacies. POM drugs can only be prescribed by a doctor or another qualified prescriber.
Is Omeprazole available over the counter without prescription?
Omeprazole can be purchased over the counter without a prescription. Omeprazole 10mg tablets are classified as P medicine.
Pharmacy chains such as Boots and Lloyds sell their own branded version of Omeprazole named ‘Boots Acid Reflux tablets’ and ‘Heartburn relief’ (Lloyds Pharmacy). In 2019 a new product containing Omeprazole was launched. Pyrocalm Control is licensed as GSL medicine. Each gastro-resistant tablet of Pyrocalm Control contains 20mg of omeprazole.
Omeprazole 20mg is widely prescribed in the UK. Omeprazole 40mg tablets or capsules can only be obtained on prescription.
Omeprazole alternative drugs: over the counter alternatives
1. Nexium Control as omeprazole alternative drug
Nexium Control is the closest omeprazole alternative available over the counter, without a prescription. Nexium Control belongs to the same class of drugs as omeprazole – proton pump inhibitors. Nexium Control comes in two different pack sizes: 7 and 14 tablets.
Nexium Control: active ingredient
Each Nexium Control tablet or capsule contains 20mg of esomeprazole.
Nexium Control where to buy it?
Nexium Control tables are widely available as GSL medication. Most supermarkets and some corner shops sell Nexium Control. Nexium Control can also be purchased online, for example, both tablets and capsules are available on Amazon.co.uk.
Nexium Control recommended dosage
The recommended dose for Nexium Control is one tablet per day (daily dose: 20mg of esomeprazole).
You can read more about Nexium Control in my separate post: Nexium Control review. Is Nexium the best PPI?
2. Guardium Acid Reflux Control as omeprazole alternative treatment
Guardium Acid Reflux Control is the latest addition of acid reflux medication available without a prescription. Similarly to Nexium Control, Guardium Acid Reflux Control contains esomeprazole as an active ingredient.
Guardium Acid Reflux Control: active ingredient
Each Guardium Acid Reflux Control tablet contains 20mg of esomeprazole.
Guardium Acid Reflux Control where to buy?
Guardium Acid Reflux Control can be purchased from conventional or online pharmacies. Different websites including Amazon.co.uk also sell this product. Two pack sizes are available to: pack of 7 and 14 tablets. Guardium Acid Reflux Control is a GSL medication therefore it can be sold in any shop or supermarket.
Guardium Acid Reflux Control recommended dose
- Guardium Acid Reflux Control is licensed for adults over 18 years of age.
- The recommended dose is one tablet per day (daily dose: 20 mg esomeprazole)
3. Pantoloc Control as an alternative option
Pantoprazole is another PPI used to relieve heartburn symptoms. Pantoloc Control is a P medicine, which can only be purchased from the pharmacy. Pantoloc Control is available in two different pack sizes: 7 and 14 tablets. Short term use of pantoprazole in the treatment of gastro-oesophageal reflux disease demonstrated similar effectiveness to other PPIs such as omeprazole and esomeprazole (Dias, 2009).
Pantoloc Control: active ingredient
Each Pantoloc Control tablet contains 20mg of pantoprazole.
Pantoloc Control where to buy it?
Not all pharmacies stock Pantoloc Control, however, some will be able to order this medication on an individual basis for collection from a pharmacy, the same or next day.
Pantoloc Control recommended dose
The recommended daily dose is one tablet per day (daily dose: 20 mg pantoprazole).
We are now moving away from PPIs. Ranitidine belongs to a group of medication called H2 receptor antagonists (H2 receptor blockers). H2 receptor antagonists differ from PPIs in chemistry and work in a different way to suppress acid production. Ranitidine is effective in the management of heartburn and indigestion symptoms; however, PPIs are superior (more effective) in the treatment of GORD symptoms (Sigterman et al., 2013) than ranitidine. Read more: Ranitidine vs Omeprazole: which drug is better?
Ranitidine is available under different brand names, including most known: Zantac. Supermarkets and chain pharmacies sell their own ‘versions’ of ranitidine. Each over the counter ranitidine product contains 75mg of ranitidine per tablet. Ranitidine is considerably cheaper than PPIs available over the counter.
Where to buy ranitidine?
Most pharmacies and larger supermarkets stock ranitidine. Over the counter ranitidine products contain 75mg of ranitidine per tablet.
Ranitidine over the counter: recommended daily dose
- Over the counter ranitidine is licensed for adults and adolescents from 16 years of age.
- One tablet (75mg of ranitidine) should be taken on the onset of symptoms.
- No more than two tablets should be taken in 24 hours.
Ranitidine recalls: supply issues
In recent months most ranitidine 75mg products including Zantac, most supermarket own labeled versions of ranitidine and prescription-only ranitidine were subject to a number of recalls due to possible contamination with N-Nitrosodimethylamine (NDMA), which is classified as ‘probable human carcinogen‘. This is a global issue with a number of ranitidine products in the USA containing above the acceptable daily intake of NDMA. In the UK investigation is being conducted by The Medicines and Healthcare Regulatory Agency (MHRA). This means the supply of ranitidine products will be disrupted in the coming months. You can learn more about ranitidine recalls and the link between NDMA and cancer in my separate post.
Some of you may ask: why PPIs are more effective than H2-receptor antagonist?
The difference in effectiveness comes from different mechanisms of action of PPIs and H2 receptor antagonists. In plain language, H2 receptor antagonists suppress acid production by blocking only one pathway of acid production. PPIs, on the other hand, block proton pump, which plays a role in the final part of acid secretion. This mechanism of action makes them more effective than H2 receptor antagonists.
5. Antacids as over the counter omeprazole alternative
Antacids are least effective as compared to two other groups of drugs discussed so far. However, antacids provide fast, short term relief from symptoms of heartburn by neutralising acid in the stomach.
Antacid can be purchased from pharmacies and other outlets. There is a number of antacid products available on the market. Antacids come in different forms, for example as chewable tablets and most popularly as a liquid formulation.
Popular brands of antacid products include:
- Gaviscon, available as chewable tablets, and liquid
- Rennie range of heartburn and indigestion chewable tablets
- Tums chewable tablets
- Peptac liquid
Click on the image to check for the best deals.
OTHER POPULAR HEARTBURN AND INDIGESTION ANTACIDS
Omeprazole alternative drugs: prescription-only options
Alternative Proton Pump Inhibitors:
The following PPIs are available as prescription-only medication:
Lansoprazole is most commonly prescribed as Lansoprazole 15mg or 30mg capsules. Lansoprazole is also available as 15mg and 30mg orodispersible tablets (as generic ‘cheaper’ form) and as a branded product called ZotonFasTab. Orodispersible tablets are placed on the tongue and allow to disperses in the mouth, releasing gastro-resistant microgranules that are swallowed with the saliva (eMC, 2019).
Another Omeprazole alternative that is available as gastro-resistant capsules and tablets (20mg and 40mg) produced generically and under different brands such as Nexium. Nexium is also available as Nexium 10 mg gastro-resistant granules for oral suspension. Esomeprazole granules are mixed with water to produce a suspension.
Less popular Pantoprazole is available as a prescription-only medication in form of 20mg and 40mg gastro-resistant tablets.
The last PPI available as Omeprazole alternative is Rabeprazole. Rabeprazole is the least commonly prescribed PPI in the UK. Rabeprazole is available in the form of 10mg and 10mg gastro-resistant tablets.
10. Omeprazole liquid
For those with swallowing difficulties or babies and toddlers, Omeprazole can be specially made into Omeprazole liquid. Learn more about Omeprazole liquid in the post: Omeprazole liquid: indications, special form, cost & availability.
H2 receptor antagonist on prescription
Prescription-only ranitidine is available in the form of 150mg and 300mg tablets. Additionally, Ranitidine can be prescribed in the form of oral solution, available as ranitidine 150mg/10ml oral solution, and as branded product Zantac Syrup ( 150mg of Ranitidine per 10ml). Oral solution of Ranitidine is prescribed for babies (young population) or patients with swallowing difficulties.
Other H2 blockers available on prescription include:
The above three drugs are not commonly prescribed in the UK.
Lifestyle changes such as weight loss can reduce episodes of heartburn. Other lifestyle modifications to consider include:
- avoid foods that cause acid reflux
- reduce alcohol consumption
- reduce coffee consumption
- stop smoking
Anyone experiencing symptoms of heartburn for longer than three weeks should consult their GP. Patients should be aware of other symptoms needed GP referral, such as weight loss (for no reason), frequent episodes of feeling sick (NHS, 2017), and other symptoms. Visit the NHS website for more information on indigestion.
Always read the product information leaflet.
Omeprazole alternative drugs: FAQ
Is Zantac the same as Omeprazole?
Zantac belongs to a group of drugs called H2 receptor antagonists and Omeprazole to Proton Pump Inhibitors (PPIs). PPIs are more effective in reduction of stomach acid production.
Is it better to take Ranitidine or Omeprazole?
Omeprazole is more effective in reduction of stomach acid than Ranitidine, however ranitidine is associated with less common side effects as compared to Omeprazole.
Can I stop taking Omeprazole suddenly?
Some patients may be able to stop Omeprazole suddenly, however this depends on the indicated use and the duration of treatment. Speak to your prescriber before stopping Omeprazole.
What can I use in place of antacids?
Drugs used instead of antacid include Ranitdine a H2 receptor antagonist; Proton Pump Inhibitors (PPIs) such as Omeprazole and Esomeprazole. H2 antagonist and PPIs are more effective in reduction of stomach acid production.
- Dias, L.M. Clin. Drug Investig. (2009) 29(Suppl 2): 3. https://doi.org/10.2165/1153121-S0-000000000-00000 Accessed on 05/06/2019
- eMC (2019). Summary Product Characteristics: ZotonFasTab. Available at: https://www.medicines.org.uk/emc/product/1714/smpc Accessed on 30/12/2019
- NHS (2017). Heartburn and acid reflux. Available at: https://www.nhs.uk/conditions/heartburn-and-acid-reflux/ Accessed on 05/06/2019
- Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME (2013). Short‐term treatment with proton pump inhibitors, H2‐receptor antagonists and prokinetics for gastro‐oesophageal reflux disease‐like symptoms and endoscopy negative reflux disease. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD002095. DOI: 10.1002/14651858.CD002095.pub5. Available at: https://doi.org/10.1002/14651858.CD002095.pub5 Accessed on 05/06/2019