Consumer Reports Rates Prilosec OTC As Best Buy Proton Pump Inhibitor

Magazine finds five top PPIs, and one combination, roughly the same in effectiveness and safety.

Procter & Gamble's Prilosec OTC (omeprazole) is recommended over AstraZeneca's Nexium (esomeprazole) in the new Consumer Reports Best Buy Drugs report on proton pump inhibitors.

Although the recommendation does not appear in Consumer Reports magazine, it does appear under the health & fitness section of the magazine's Web site. The Consumers Union told "The Pink Sheet" DAILY that the Web site has 2.5 million subscribers while the magazine has 4.2 million.

"The five PPI medicines are roughly equal in effectiveness and safety, but differ in cost," CR says on its Web site. "Prilosec OTC is our choice as a Consumer Reports Best Buy Drug if you need a PPI."

"You could save $100 to $200 a month by choosing this medicine over more expensive prescription PPIs," CR continues. "If you have health insurance, find out if your plan helps pay for Prilosec OTC. If not, talk to your doctor about taking the PPI with the lowest out-of-pocket cost to you."

CR evaluated five proton pump inhibitors and one combination drug in the report: Nexium, TAP's Prevacid (lansoprazole), Prilosec and Prilosec OTC, Schering-Plough/Santarus' Zegerid (omeprazole/sodium bicarbonate), Wyeth's Protonix (pantoprazole) and Johnson & Johnson/Eisai's Aciphex (rabeprazole).

Procter & Gamble markets Prilosec OTC for AstraZeneca. Novartis gained the Rx-to-OTC switch rights for Prevacid in 2005, although TAP previously said that a launch would likely not occur before 2009.

CR lists the average monthly costs, based on retail prices in September 2006, for the different dosage forms of five PPIs; Nexium 20 mg and 40 mg average monthly costs were $193 and $181, respectively, with Prevacid costs for the 15 mg and 30 mg doses ranging from $131 to $186.

Branded prescription Prilosec 40 mg sustained release topped the list at $265, with generic 10 mg and 20 mg omeprazole coming in at $116 and $89, respectively.

Protonix 20 mg and 40 mg cost, respectively, $159 and $146 per month; Zegerid prices range from $138 to $176 depending on dosage strength, and Aciphex 20 mg tablets cost $189, CR says.

Although the nonprofit did say that the effectiveness and safety of the different PPIs were roughly the same, the report does compare Nexium, Protonix, Prevacid and generic omeprazole. "Recent studies have shown Nexium 40 mg equivalent to Protonix at 40 mg and to Prevacid 30 mg."

In addition, "one key recent study found that people with GERD who did not have esophagitis faired just as well with generic omeprazole at 20 mg as with Nexium at 40 mg," the report says.

"The makers of Nexium have promoted it heavily as the superior drug to treat people with GERD and esophagitis," CR asserts. "However, in the main, the justification for such a claim seems marginal at best."

The report also says that PPIs are overprescribed. It also notes safety concerns with the medications, including prevalence for hip fractures and an increased risk of certain infections due to reduced acid levels in the stomach.

In August, pharmacy benefits manager Medco said that it will offer the CR drug reports through a new "Saving Advisor" tool on the PBM's Web site (¹ (Also see "Medco Savings Tool Spotlights Consumer Reports’ “Best Buy” Drugs" - Pink Sheet, 15 Aug, 2006.)).

In response to the CR report, AstraZeneca told "The Pink Sheet" DAILY that Nexium controls stomach acid production better than any other branded PPI.

The company also said that the report primarily focused on costs of PPIs while other factors should be considered. Specifically, even in patients who only suffer occasional heartburn, they may still have damaged esophagi. Prilosec OTC has not been proven to heal that damage while Nexium has, AZ said.

The firm added that Prilosec OTC is only recommended for a treatment period of up to 14 days and that patients need to consult with physicians for the treatment of even occasional heartburn, and not solely rely on an OTC medication.

- Christopher Hollis ([email protected])