Appendix A: Dosage information on proton pump inhibitors

Guidance

In 2004, when the original guideline was developed (CG17), doses of proton pump inhibitors (PPIs) were based on the BNF at the time, as in table 1 below.

During the update of this guideline (2014), the guideline development group (GDG) has further defined the PPI doses specifically for severe oesophagitis and Helicobacter pylori (H pylori) eradication therapy, as in tables 2 and 3 below.

**Table 1 Proton pump inhibitor doses relating to evidence synthesis and recommendations in the original guideline (CG17; 2004)**
Proton pump inhibitor	Full or standard dose	Low dose (on-demand dose)	Double dose
Esomeprazole	20 mg once a day	Not available	40 mg once a day
Lansoprazole	30 mg once a day	15 mg once a day	30 mg twice a day Off-label dose for GORD
Omeprazole	20 mg once a day	10 mg once a day Off-label dose for GORD	40 mg once a day
Pantoprazole	40 mg once a day	20 mg once a day	40 mg twice a day Off-label dose for GORD
Rabeprazole	20 mg once a day	10 mg once a day	20 mg twice a day Off-label dose for GORD

Lower than the licensed starting dose for esomeprazole in gastro-oesophageal reflux disease (GORD), which is 40 mg, but considered to be dose-equivalent to other PPI. When undertaking meta-analysis of dose-related effects, NICE classed esomeprazole 20 mg as a full-dose equivalent to omeprazole 20 mg.

40 mg is recommended as a double dose of esomeprazole because the 20‑mg dose is considered equivalent to omeprazole 20 mg.

**Table 2 Proton pump inhibitor doses for severe oesophagitis in this guideline update (2014)**
Proton pump inhibitor	Full/standard dose	Low dose (on‑demand dose)	High/double dose
Esomeprazole	40 mg once a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)	20 mg once a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)	40 mg twice a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)
Lansoprazole	30 mg once a day	15 mg once a day	30 mg twice a day (Off-label dose for gastro-oesophageal reflux disease.)
Omeprazole	40 mg once a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)	20 mg once a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)	40 mg twice a day (Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17)
Pantoprazole	40 mg once a day	20 mg once a day	40 mg twice a day (Off-label dose for gastro-oesophageal reflux disease.)
Rabeprazole	20 mg once a day	10 mg once a day	20 mg twice a day (Off-label dose for gastro-oesophageal reflux disease)

**Table 3 Proton pump inhibitor doses for H pylori eradication therapy in this guideline update (2014)**
Proton pump inhibitor	Dose
Esomeprazole	20 mg
Lansoprazole	30 mg
Omeprazole	20 to 40 mg
Pantoprazole	40 mg
Rabeprazole	20 mg