Oral Equivalent of 40mg PPI
The oral equivalent of 40mg omeprazole is 80mg pantoprazole, 60mg lansoprazole, 40mg esomeprazole, or 40mg rabeprazole. 1, 2
PPI Dose Equivalencies
The relative potency of PPIs varies significantly, and understanding these equivalencies is critical for appropriate dosing:
- 40 mg omeprazole = 80 mg pantoprazole 1, 2
- 40 mg omeprazole = 60 mg lansoprazole 1
- 40 mg omeprazole = 40 mg esomeprazole 1
- 40 mg omeprazole = 40 mg rabeprazole 1
These conversions are based on the standard equivalency where 20mg omeprazole = 40mg pantoprazole = 30mg lansoprazole = 20mg esomeprazole = 20mg rabeprazole. 2, 3
Clinical Context for Dosing
For H. pylori eradication therapy, the minimum recommended PPI dose is 40mg omeprazole (or equivalent) twice daily, which translates to: 1
- Esomeprazole or rabeprazole: 20-40mg twice daily (preferred agents) 1
- Lansoprazole: 45mg twice daily 1
- Pantoprazole: Should be avoided due to inferior potency (40mg pantoprazole = only 9mg omeprazole equivalent) 1, 4
For eosinophilic esophagitis, omeprazole 20mg twice daily (total 40mg daily) is the standard regimen, which would require 40mg pantoprazole twice daily (total 80mg daily) if substituting. 1
Important Caveats
Pantoprazole has markedly lower relative potency than other PPIs, with 40mg pantoprazole equivalent to only 9mg omeprazole, making it a poor choice for conditions requiring robust acid suppression. 1, 4
Esomeprazole and rabeprazole are preferred when higher potency is needed, particularly for amoxicillin-containing H. pylori regimens, as outcomes are superior with higher-potency PPIs dosed twice daily. 1
Timing matters: PPIs should be taken 30 minutes before meals for optimal absorption, preferably in the morning before breakfast. 4, 2
Twice daily dosing is superior to once daily dosing for most acid-related conditions requiring aggressive suppression, with meta-analyses showing non-significant trends toward improved efficacy with BID dosing. 1