Acid peptic disorder compass: An Indian expert consensus on comprehensive management

Table 1 Acid suppression therapy for acid peptic disorders

Ref.	GERD	Reflux/erosive esophagitis	NERD	PUD/H. pylori eradication
Bhatia et al[16], 2020; Yadlapati et al[17], 2022; Iwakiri et al[18], 2022; ZANTAC® SmPC[19]	Rabeprazole 20 mg OD	Vonoprazan 20 mg OD for 4 weeks (in mild condition)	Ranitidine 150 mg TID	Vonoprazan 20 mg BD (dual/triple therapy)
Iwakiri et al[18], 2022; NEXIUM SmPC[20]; PEPCID® SmPC[21]	Esomeprazole 20/40 mg OD	Vonoprazan 20 mg + prokinetics (in severe condition) for 8 weeks	Famotidine 20 mg BD	Esomeprazole 40 mg OD
Bhatia et al[16], 2020; Yadlapati et al[17], 2022; Farrell et al[22], 2017	Dexlansoprazole 30 mg OD	Esomeprazole 40 mg OD	Esomeprazole 20 mg OD	Rabeprazole 20 mg OD (post-breakfast) for up to 4 weeks
PROTONIX SmPC[23]; DEXILANT SmPC[24]; Central Drugs Standard Control Organization Government of India[25]	Pantoprazole 40 mg OD	Dexlansoprazole 30/60 mg OD	Dexlansoprazole 30 mg OD	Ilaprazole 5-10 mg OD
ZANTAC® SmPC[19]; PEPCID® SmPC[21]; ACIPHEX® SmPC[26]; PRILOSEC SmPC[27]	Famotidine 40 mg OD	Ranitidine 150 mg QID	Rabeprazole 20 mg OD	Omeprazole 20 mg BD or 40 mg OD
ZANTAC® SmPC[19]; PEPCID® SmPC[21]; Central Drugs Standard Control Organization Government of India[28]	Ranitidine 150 mg BD	Famotidine 20/40 mg TID		Lafutidine 5-10 mg

BD: Twice-daily; GERD: Gastroesophageal reflux disease; GU: Gastric ulcer; NERD: Non-erosive reflux disease; OD: Once-daily; PUD: Peptic ulcer disease; QID: Four times a day; TID: Three times a day; H. pylori: Helicobacter pylori.

Table 2 Pharmacokinetics of proton pump inhibitors

Agents	Bioavailability (%)	Tmax (hour)	Cmax (mg/mL)	Protein binding (%)	T1/2 (hour)	pKa	AUC 0-24 (mg/hour/L)	V (L/kg)	CL (mL/minute)
Esomeprazole	64-90	1.5	1.5	97	1-1.5	4.0	2.0	160-330	1.3-1.6
Dexlansoprazole	-	4-5	-	96	1-2	4.0	-	-	-
Pantoprazole	77	2-3	2.5	98	1-1.9	3.9	5.0	90-225	0.8-2.0
Rabeprazole	52	2-5	0.4	96.3	1-2	5.0	0.8	-	0.6-1.4
Omeprazole	30-40	0.5-3.5	0.7	95	0.5-1	4.0	2.0	400-620	0.5-1.2
Lansoprazole	80-85	1.7	0.5-1.0	97	1.6	4.0	2.5	400-650	0.9-2.1

AUC: Area under the curve; CL: Clearance; T_max: Time to peak plasma level; C_max: Maximum plasma concentration; T_1/2: Half-life; V: Apparent volume of distribution.

Table 3 Use of acid suppressants in special populations

Treatment	Indication	Dose/frequency	Risk/conditions
Renal impairment
Ranitidine[19]	GERD	150 mg OD	Risk of toxic reactions: In elderly patients with reduced renal function, in patients with hepatic dysfunction
Famotidine[21]	Erosive esophagitis	20 mg OD or 40 mg every other day	Risk of CNS adverse reactions and QT prolongation in moderate and severe renal impairment
	GU/DU
Vonoprazan[63]	Erosive esophagitis	10/20 mg OD	Not recommended: In severe renal impairment (eGFR < 30 mL/minute), for maintenance of healed erosive esophagitis
	H. pylori eradication	20 mg BD
Hepatic impairment
Vonoprazan[63]	Erosive esophagitis	10/20 mg OD	Not recommended for H. pylori eradication in moderate to severe hepatic impairment
	H. pylori eradication	20 mg BD

BD: Twice-daily; CNS: Central nervous system; DU: Duodenal ulcer; eGFR: Estimated glomerular filtration rate; GERD: Gastroesophageal reflux disease; GU: Gastric ulcer; OD: Once-daily; H. pylori: Helicobacter pylori.