Helicobacter Forums

Dear Helico Experts,

A year ago, I posted the following to get your comments about my second therapy.

viewtopic.php?f=33&t=206041

At that time, I got the following drugs for my second therapy.

Rabeprazole Sodium 20 mg - 2 times per day for 10 days
Tripotassium Bismuth Dicitrate 300 mg - 4 times per day for 10 days
Tetracycline HCl 500 mg - 4 times per day for 10 days
Metronidazole 500 mg - 3 times per day for 10 days

However, I didn't undergo the second therapy. Instead, I took a chance with mastic gum, acidophilus, probiotics, etc. to see if they can improve the condition. I know this sounds silly, but then I read that there are exceptionally rare cases where these worked.

I recently had an endoscopy with a new doctor, and it turns out that nothing changed. As a matter of fact, I don't recall seeing red spots on my stomach last year, but I could see red spots on my stomach this time so it might have got worse.

Anyway, the prescription that I got this time is almost the same as the previous second therapy except for the following.

Replaced "Rabeprazole Sodium 20 mg - 2 times per day for 10 days" with "Pantoprazole Sodium 40 mg - 2 times per day for 10 days"
Added "Irsogladine Maleate 2 mg - 2 times per day for 10 days"

I have two questions.

First, I googled the efficacy of Pantoprazole vs Rabeprazole and I found some literature concluding that rabeprazole is more effective than pantoprazole. I read in the FAQ page of helico.com that higher PPI gives a better result and I'm concerned that my second treatment might be jeopardized by the less effective Pantoprazole. I still have the previous drugs with Rabeprazole from the last year, but as it's more than a year old, I assume they lost some potency. Therefore, I don't think it's a good idea to take that Rabeprazole on their own by replacing with Pantoprazole I got recently. However, I'm wondering if it's a good idea to take an extra Rabeprazole 20 mg once a day from the past prescription in addition to the Pantoprazole 40 mg twice a day from the current prescription. Otherwise, I'm also wondering if taking any over-the-counter PPIs in addition to the Pantoprazole 40 mg twice a day might be a good idea. If neither is recommended, I'll just take Pantoprazole 40 mg twice a day only as prescribed.

Second, the doctor told me that he added Irsogladine Maleate to relieve my stomach comfort. It seems like this is not a part of a standard h. pylori treatment. Can Irsogladine Maleate negatively affect my second therapy? If so, I'll just throw it away. I googled, but couldn't find an answer.

Thank you for your help again.

Pantoprazole or Rabeprazole, we would prefer Rabeprazole. However, it's subjective. some people may find pantoprazole more effective. If you already bought the pantoprazole, just take it. Otherwise, you can switch to rabeprazole.

in regards to your treatment, i hope it includes bismuth, tetracycline and metronidazole.

as for the Irsogladine Maleate, i am not familiar with it. Your doctor must have good experience about it.

Helico_expert wrote: Sun Sep 08, 2019 10:20 pm Pantoprazole or Rabeprazole, we would prefer Rabeprazole. However, it's subjective. some people may find pantoprazole more effective. If you already bought the pantoprazole, just take it. Otherwise, you can switch to rabeprazole.

in regards to your treatment, i hope it includes bismuth, tetracycline and metronidazole.

as for the Irsogladine Maleate, i am not familiar with it. Your doctor must have good experience about it.

Thank you for the response.

Yes, it does include bismuth, tetracycline and metronidazole.

The following is my current prescription.

Pantoprazole 40 mg - 2 times per day for 10 days
Tripotassium Bismuth Dicitrate 300 mg - 4 times per day for 10 days
Tetracycline HCl 500 mg - 4 times per day for 10 days
Metronidazole 500 mg - 3 times per day for 10 days
Irsogladine Maleate - 2 times per day for 10 days

I've been already taking as above for two days.

Would taking additional rabeprazole (I already have it from a previous subscription) or esomeprazole (I can buy it from a pharmacy without any prescription) along with the current prescription be conducive to increasing the chance of h. pylori eradication?

I read this in the FAQ page so I'm just wondering if I should take more PPI that's beyond the doctor's prescription.

3. A higher dose of PPI always gives better results. So ask your doctor to give a higher PPI dose.

Your doctor is responsible for your overall well being. So it is better you consult your doctor who can physically examine you and monitor you.

I dont think it's good idea to overdose PPI. If you are already taking pantoprazole, just wait till you finish the course.

While they share similar functions, there are differences between the two that might make one more suitable for a particular patient than the other. Hole IO

Rabeprazole is often considered more potent with a faster onset of action compared to Pantoprazole. This means Rabeprazole might start reducing stomach acid more quickly after taking it.
Drive Mad

Both Pantoprazole and Rabeprazoleslope are proton pump inhibitors (PPIs) used to reduce stomach acid, which is crucial for effective H. pylori eradication as antibiotics work better in a less acidic environment. However, studies comparing PPIs show that Rabeprazole might have a faster onset of action and better efficacy in maintaining higher gastric pH than Pantoprazole. Still, both drugs are widely used in H. pylori treatments and generally effective.

Both Pantoprazole and Rabeprazole are proton pump inhibitors (PPIs) commonly used to treat conditions related to excessive stomach acid, such as gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome. Here's a comparison of their effectiveness:

1. **Mechanism of Action**:
- Both drugs work by inhibiting the H+/K+ ATPase enzyme (proton pump) in the stomach lining, reducing acid production.
- Rabeprazole has a slightly faster onset of action compared to Pantoprazole due to its higher pKa, allowing it to activate more quickly in the acidic environment of the stomach.

2. **Efficacy**:
- Studies suggest that Rabeprazole may provide faster relief of symptoms in some patients, particularly in cases of GERD.
- Pantoprazole is often preferred for long-term use due to its stable and prolonged acid suppression.
- Both drugs are generally equally effective in healing erosive esophagitis and preventing ulcer recurrence.

3. **Safety and Tolerability**:
- Both PPIs are well-tolerated, with similar side effect profiles (e.g., headache, diarrhea, nausea).
- Pantoprazole has a lower potential for drug interactions because it is metabolized primarily through non-enzymatic pathways, whereas Rabeprazole is metabolized by the CYP450 system, which may interact with other medications.

4. **Clinical Use**:
- Rabeprazole is often chosen for short-term treatment or when rapid symptom relief is needed.
- Pantoprazole is commonly used for long-term management and in patients with complex medication regimens due to its lower interaction risk.

In summary, both Pantoprazole and Rabeprazole are effective PPIs, but the choice between them depends on the specific clinical scenario, such as the need for rapid relief, long-term therapy, or consideration of drug interactions.

Bottom Line: Rabeprazole works faster and is more potent, while Pantoprazole has fewer drug interactions and is preferred for long-term use. Your doctor will decide based on your medical history.
Sprunked

Both are effective, but rabeprazole acts faster, while pantoprazole is more stable with fewer interactions. The choice depends on clinical context, cost, and patient-specific factors.