Oral esomeprazole vs. intravenous pantoprazole: a comparison of the effect on intragastric pH in healthy subjects

Background: Intravenous (IV) proton-pump inhibitor therapy is used in patients who cannot take oral medications or require greater acid suppression. Oral esomeprazole produces greater acid suppression than oral pantoprazole; however, no comparative data exist for oral esomeprazole and IV pantoprazole. Aim: To compare acid suppression (time with pH > 3.0, 4.0, 5.0 and 6.0) produced by standard doses of oral esomeprazole and IV pantoprazole in healthy subjects. Methods: A randomized, two-way crossover study in 30 subjects receiving oral esomeprazole (40 mg o.d.) or IV pantoprazole (40 mg o.d.) for 5 days followed by a 2-week washout period before the second 5-day drug administration period using the crossover drug regimen. Results: Oral esomeprazole produced greater acid suppression than IV pantoprazole on day 1 [pH > 3.0 (56.9%, 35.8%; P < 0.001), pH > 4.0 (43.4%, 25.0%; P < 0.001) and pH > 5.0 (28.7%, 15.6%; P < 0.001)] and on day 5 [pH > 3.0 (70.4%, 45.9%; P < 0.001), pH > 4.0 (59.2%, 33.9%; P < 0.001), pH > 5.0 (45.5%, 23.9%; P < 0.001) and pH > 6.0 (19.6%, 12.6%; P = 0.045)]. The adverse event profiles indicated both treatments to be safe and well tolerated. Conclusions: In healthy subjects, esomeprazole, 40 mg o.d. dispersed in water, produces greater acid suppression than pantoprazole 40 mg IV o.d. after 1 and 5 days of medication.