Omeprazole is one of the most commonly prescribed drugs in the UK. Omeprazole is mainly prescribed for the treatment of gastro-oesophageal reflux disease (GORD) with symptoms such as heartburn, which is caused by stomach acid, rising into the oesophagus (the tube that connects the mouth and stomach). Prescription-only omeprazole like many other drugs has recently been short in supply. Omeprazole alternatives which are reviewed in this post are broadly divided into two categories: drugs which can be purchased over the counter and prescription-only medications.
Omeprazole and alternatives: drug classification
Omeprazole belongs to a group of medications called proton pump inhibitors (PPIs). PPIs are the most effective group of drugs that suppress the production of acid in the stomach. Omeprazole and other PPIs are used in the treatment of:
- dyspepsia and gastro-oesophageal reflux disease (GORD)
- peptic ulcer bleeding
- treatment and prevention of ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen.
- eradication of H. pylori infection, in combination treatment with antibiotics
- Zollinger–Ellison syndrome, to control excessive production of stomach acid.
Omeprazole alternative drugs, discussed in this post, belong to one of the following classes:
- proton pump inhibitors (PPIs)
- H2-receptor antagonists (H2-blockers) and
- antacids
Omeprazole alternative drugs are available as:
- general sale list medicines (GSL), which can be sold in any shops, supermarkets and pharmacies (available for customer’s self-selection).
- pharmacy-only medicines (P), sold only in pharmacies, away from the public (behind the counter), and
- prescription-only medication (POM), available on prescription, written by a doctor or another qualified prescriber.
Is Omeprazole available over the counter without a prescription?
Omeprazole can be purchased over the counter without a prescription. Omeprazole 20mg tablets are sold by most pharmacies. Over the counter omeprazole can be used by adults over 18 years of age.
Pharmacy chains such as Boots and Lloyds sell their own branded version of Omeprazole 20mg tablets, for example, Boots pharmacy sells Acid Reflux tablets. Each tablet contains 20mg of omeprazole.
Omeprazole 20mg is also sold as branded medication, for example, Pyrocalm Control tablets. Each gastro-resistant tablet of Pyrocalm Control contains 20mg of omeprazole. Pyrocalm Control tablets have a GSL license, meaning that they can be sold not only in pharmacies but also in other retail outlets.
Omeprazole 20mg capsules are 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 and capsules.
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).
2. Guardium Acid Reflux Control as omeprazole alternative treatment
Guardium Acid Reflux Control is another medication used for acid reflux, 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 buy (Amazon.co.uk): a 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. Antacids as over the counter omeprazole alternative
Antacids are least effective as compared to two to PPIs and H2-blockers. 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 are several 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 (Gaviscon Double Action chewable tablets), and liquid
- Rennie’s range of heartburn and indigestion chewable tablets and liquid.
- Tums Antacid chewable tablets
- Peptac liquid.
Discontinued omeprazole alternatives
4. Pantoloc Control (discontinued)
Pantoprazole is another PPI used to relieve heartburn symptoms. Pantoloc Control used to be available in pharmacies as a P medicine. Pantoloc Control was discontinued and is no longer available in the UK.
5. Ranitidine as omeprazole alternative drug (discontinued)
Ranitidine (Zantac) belongs to a group of medications 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.
Over the counter and prescription-only ranitidine are no longer available in the UK. Ranitidine was recalled and consequently removed from the market due to possible contamination with N-Nitrosodimethylamine (NDMA), which is classified as a ‘probable human carcinogen’. This was 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).
Omeprazole alternative drugs: prescription-only options
Patients have a good choice of prescription-only alternatives. Few proton pump inhibitors are currently available on the market alongside omeprazole. Omeprazole is usually chosen as the first-line option due to the low cost of the drug.
The following PPIs are available as prescription-only medication:
6. Lansoprazole
Lansoprazole is most commonly prescribed as lansoprazole 15mg or 30mg capsules. Lansoprazole belongs to the same class of drugs as omeprazole and it is the second most commonly prescribed PPI. Lansoprazole is also available as 15mg and 30mg orodispersible tablets (in generic ‘cheaper’ form) and as a branded product called ZotonFasTab. Orodispersible tablets are placed on the tongue and allowed to disperse in the mouth, releasing gastro-resistant microgranules that are swallowed with saliva (eMC, 2019).
7. Esomeprazole
Esomeprazole is another omeprazole alternative. Esomeprazole is available as gastro-resistant capsules and tablets (20mg and 40mg), produced generically and under different brands such as Nexium. Esomeprazole available over the counter, Nexium Control or Guardium Acid Reflux Control contains the same active ingredient as the prescription-only option esomeprazole.
Nexium is also available as Nexium 10 mg gastro-resistant granules for oral suspension. Esomeprazole granules are mixed with water to produce a suspension.
8. Pantoprazole
Less popular pantoprazole is available as a prescription-only medication in form of 20mg and 40mg gastro-resistant tablets. Unlike over the counter pantoprazole, a prescription-only option of this drug is available and issued to patients.
9. Rabeprazole
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.
H2 receptor antagonist on prescription
Moving away from PPIs and into H2 receptor blockers. Historically, prescription-only ranitidine (Zantac) was the most commonly prescribed H2 receptor blocker until it was withdrawn and discontinued due to safety reasons.
Although less effective than PPIs, H2 receptor blockers may be considered as an alternative treatment. Sometimes, H2-blockers can be used as an add-on therapy for patients whose symptoms are not controlled just with PPI. For example, NICE recommends using H-2 receptor blockers in addition to PPIs in the treatment of dyspepsia (indigestion) when symptoms are not controlled just with PPI in patients with confirmed oesophagitis (NICE, 2022).
Why H2-blockers are less effective than PPIs in the suppression of stomach acid production?
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 of the pathways of acid production. PPIs, on the other hand, block the proton pump, which plays role in the final part of acid secretion, and this process makes them more effective than h2 receptor antagonists.
11. Cimetidine
Cimetidine is an option for the treatment of gastro-oesophageal reflux disease, however, cimetidine is usually not recommended due to the high risk of drug interactions (NICE, 2022) Cimetidine is not commonly prescribed and is the least prescribed h2-receptor blocker on the list.
Cimetidine is available in form of tablets: 200mg, 400mg and 800mg tablets and as an oral solution.
12. Famotidine
On the opposite side, famotidine is the most commonly prescribed h2-blocker. Unlike cimetidine, famotidine does not interact with other drugs making it (currently ) the most popular h2-blocker.
Famotidine is only available in the form of 20mg and 40mg tablets.
13. Nizatidine
Compared to famotidine, nizatidine is not commonly prescribed. Nizatidine is only available in the form of 150mg capsules.
14. Lifestyle changes
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 a 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.
References:
NICE (2022). Dyspepsia – proven GORD: H2-receptor antagonists. Available at: https://cks.nice.org.uk/topics/dyspepsia-proven-gord/prescribing-information/h2-receptor-antagonists/ Accessed on 28/11/2022
NICE (2022). Dyspepsia – proven GORD: Summary. Available at: https://cks.nice.org.uk/topics/dyspepsia-proven-gord/ Accessed on 29/11/2022
