Proton pump inhibitors (PPIs) have become a mainstay of therapy not only in the practice of gastroenterology, but also for general medicine and even for the general public. Recently, proton pump inhibitors have been associated with a number of potential complications including impaired vitamin and mineral absorption, altered drug metabolism and increased risk for infections.
All five PPIs on the market are equally effective at equivalent doses; no trials have demonstrated an intrinsic therapeutic advantage 01 the newest PPI, Nexium, over other PPls at equivalent doses. The initial choice 01 agent should therelore depend on cost. In Canada, Ihe PPIs Pariet and Apo-OmeprazoleU represent a reduction in cost of approximately 40% over other PPI drugs. We have used as a comparator a DDD of 20 mg of rabeprazole (Pariet) which is priced almost exactly at the generic Price of omeprazole.
'All PPIs appear to be similarly effective and well tolerated for treatment of peptic ulcer disease and GERD. Most are available generically and over the counter for a fraction of the cost of Nexium or other expensive brand name products"
This was the conclusion of The Medical letter in it's June 22 2015 issue.
But still the 'purple pill" myth lingers among physician and patient population and
Astrazeneca made many millions even after 2015
Omeprazole/sodium — generic 20.40 mg packets for susp•;
Zegerid (Salix) 20 mgn.l g. 40 mgn.l g capsE $ 344.70
zegerid OTC (Bayer) 20—40 mg 16.10'
The book color purple
Purple in Business
In using purple in business applications you need to understand the traits, qualities and mood of the color along with the psychological meaning. The messages the color sends to your customer base can have a major impact on your business success.
Purple suggests wealth and extravagance, fantasy and the world of dreams. It enhances spiritual pursuits and enlightenment.
Physiologically, it heightens people's sense of beauty and their reaction to more creative ideas.
It is often used to denote a high quality or superior product, such as Cadbury's chocolate or some women's cosmetics.
If you are in a service business, use some purple in your marketing to denote your premium service.
All five PPIs on the market are equally effective at equivalent doses; no trials have demonstrated an intrinsic therapeutic advantage 01 the newest PPI, Nexium, over other PPls at equivalent doses. The initial choice 01 agent should therelore depend on cost. In Canada, Ihe PPIs Pariet and Apo-OmeprazoleU represent a reduction in cost of approximately 40% over other PPI drugs. We have used as a comparator a DDD of 20 mg of rabeprazole (Pariet) which is priced almost exactly at the generic Price of omeprazole.
Excessive Medical Spending: Facing the Challenge
By Norman J. Temple, Andrew Thompson, Anwar Khan'All PPIs appear to be similarly effective and well tolerated for treatment of peptic ulcer disease and GERD. Most are available generically and over the counter for a fraction of the cost of Nexium or other expensive brand name products"
This was the conclusion of The Medical letter in it's June 22 2015 issue.
But still the 'purple pill" myth lingers among physician and patient population and
Astrazeneca made many millions even after 2015
Omeprazole/sodium — generic 20.40 mg packets for susp•;
Zegerid (Salix) 20 mgn.l g. 40 mgn.l g capsE $ 344.70
zegerid OTC (Bayer) 20—40 mg 16.10'
The book color purple
Purple in Business
In using purple in business applications you need to understand the traits, qualities and mood of the color along with the psychological meaning. The messages the color sends to your customer base can have a major impact on your business success.
Purple suggests wealth and extravagance, fantasy and the world of dreams. It enhances spiritual pursuits and enlightenment.
Physiologically, it heightens people's sense of beauty and their reaction to more creative ideas.
It is often used to denote a high quality or superior product, such as Cadbury's chocolate or some women's cosmetics.
If you are in a service business, use some purple in your marketing to denote your premium service.
Positive Color Meanings in Business:
- unusual and individual, creative and inventive
- psychic and intuitive
- humanitarian, selfless and unlimited
- mystery, fantasy and the future
Negative Color Meanings in Business:
- immaturity
- impractical
- cynical and aloof, pompous and arrogant
- fraudulent and corrupt
- delusions of grandeur and the social climber
Table 1. Oral Proton Pump Inhibitors
Drug Some Available Formulations Usual Adult Dosage1,2 Cost3
Dexlansoprazole – Dexilant (Takeda) 30, 60 mg DR caps 30-60 mg once/d $222.10
Esomeprazole magnesium – generic 20, 40 mg DR caps 20-40 mg once/d 204.50
Nexium (AstraZeneca) 20, 40 mg DR caps4
250.90
Nexium 24HR (OTC) (Pfi zer) 22.3 mg DR caps5 16.406
Lansoprazole – generic 15, 30 mg DR caps 15-30 mg once/d 64.60
Prevacid (Takeda) 333.70
Prevacid Solutab (Takeda) 15, 30 mg ODT 333.70
Prevacid 24HR (OTC)7
(Novartis) 15 mg DR caps 17.806
Omeprazole – generic 10, 20, 40 mg DR caps 20-40 mg once/d 16.30
Prilosec (AstraZeneca) 10, 20, 40 mg DR caps4
218.70
Prilosec OTC7 (AstraZeneca/P&G) 20 mg DR tabs 16.806
Omeprazole/sodium bicarbonate8
– generic 20, 40 mg packets for susp9
; 20-40 mg once/d 344.70
Zegerid (Salix) 20 mg/1.1 g, 40 mg/1.1 g caps10 383.40
Zegerid OTC (Bayer) 20 mg/1.1 g caps10 16.106
Pantoprazole – generic 20, 40 mg DR tabs 40 mg once/d 6.40
Protonix (Pfi zer) 20, 40 mg DR tabs4
274.20
Rabeprazole – generic 20 mg DR tabs 20 mg once/d 52.40
Aciphex (Eisai) 419.70
Aciphex Sprinkle (Eisai) 5, 10 mg DR sprinkle caps11 699.80
DR = delayed-release; OTC = over the counter; ODT = orally disintegrating tablets
1. The lower end of the range is generally used for initial treatment of GERD. Higher or more frequent doses may be needed for patients with erosive
esophagitis, peptic ulcer disease, hypersecretory conditions such as Zollinger-Ellison syndrome, or for treatment of Helicobacter pylori infection.
2. PPIs are generally taken 30-60 minutes before the fi rst meal of the day. Taking one before the evening meal or taking the drug twice daily may be more
effective for nocturnal acid control. PPIs should generally be swallowed whole and should not be crushed or chewed. Omeprazole/sodium bicarbonate
(Zegerid) should be taken on an empty stomach at least 1 hour before a meal. Dexlansoprazole (Dexilant) can be taken with or without food.
3. Approximate WAC for 30 days’ treatment with the lowest usual adult dosage. WAC = wholesaler acquisition cost or manufacturer’s published price to
wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. June 5,
2015. Reprinted with permission by First Databank, Inc. All rights reserved. ©2015. www.fdbhealth.com/policies/drug-pricing-policy.
4. Also available in delayed-release powder or granules for suspension.
5. Equivalent to 20 mg of esomeprazole.
6. Cost for 28 tablets or capsules.
7. Also available generically.
8. Immediate-release formulation that contains sodium bicarbonate as a buffer; it should be used with caution in patients on a low-sodium diet.
9. Each packet also contains 1680 mg of sodium bicarbonate.
10. Each capsule contains 1.1 g of sodium bicarbonate; therefore, two 20-mg caps are not equivalent to one 40-mg cap.
11. Contents of the capsule should be sprinkled on soft food or liquid and taken within 15 minutes
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