Zegerid

[Kathi49]

I took the first horse pill capsule this morning. :) But I have a correction to make too. Originally, I thought this was similar to Prevacid but it isn't. It is similar to Prilosec. Anyway, I will see how it goes. But I forgot to ask and maybe someone knows. Do you have to wait an hour before eating as you do with Nexium? I don't have a script for it just yet...just the samples. And they just say make sure to drink a full glass of WATER and no other type of liquids....but nothing about the timing.

[Pharmacist.steve]

Zegerid is Prilosec and Sod Bi Carb - a VERY OLD TIME antacid. Recommendation is one hr before meals .. Sod Bi Carb and stomach acid is a chemical reaction... which may cause some gas. Sod Bicarb at one time was "THE ANTACID" ... BUT... people who used it a lot would get acid rebound... Depending on cost ... I would try OTC Prilosec and Tums/Rolaids. IMO... this is another example of one of the Pharma's "Madison Ave tricks" to get a patent and maintain a HIGH PRICE on a drug that would otherwise be off patent... and available generically.

[Kathi49]

Thanks Steve, :)

I did try Prilosec prior to taking Nexium and it was less effective than the Nexium was. But I am or was taking only 20mg of the Nexium. The doc just gave me samples to try. But if need be, I can go to 40mg of Nexium instead. I believe the reason she wanted me to try this one is because it lasts through the night and because I told her the nausea is worse in the mornings. Sooo...that's probably why. And, well, Tums has calcium CARBONATE in them; something I can't handle at all. Which is why I take Calcium CITRATE instead. And I thank you...let me just see how this goes because if I can wake up in the mornings without nausea; that would be great. Then again, if headaches start in...forget it! :) And the probiotic is helping a great deal too...at least so far.

[Rozia]

I take 40 mg of Prilosece and its works great .

[Mark N]

Kathi, I hope you find something that works for you. I know Steve's idea is a good one as the drug companies do re-engineer their meds to keep a patent so I try to stay with the old one that is OTC and cheaper. I hope one of them helps you with the overnight problem though.

[Pharmacist.steve]

Tums has calcium CARBONATE in them; something I can't handle at all.

Mylanta has Al & Mg Oxide in it... Sod Bi Carb is a VERY SHORT ACTING antacid.. couple of hours - MAX... if your AM nausea is caused by excessive acid... I doubt if the Sod Bi Carb will do much for it.

[Kathi49]

Thanks Mark and Steve,

I will keep the suggestions in mind. But again, OTC Prilosec just did not do the trick. Then again, I was only taking 20mg of it also.

Wanted to add and forgot. Pub Med has a few promising articles on Zegerid.

[Kira]

I also wanted to add that prilosec and nexium are VERY similar drugs. Prilosec is omeprazole; Nexium is esomeprazole.

If anyone remembers from intro-level college chemistry... there are molecules called enantiomers or chiral molecules. Basically, for molecules that aren't symmetrical... there are two forms of the molecule that are almost the same, but are mirror images of each other... no matter how much you turn the molecules around and around, they will always look like mirror images and not be the same. For instance, your left hand and your right hand are mirror images of each other... and no matter how much you turn them around, you will never be able to make them look the same b/c they are mirror images.

Well, so... for molecules that are enantiomers, there is a "left-handed" form and a "right-handed" form. You usually see this worded as "D-[molecule's name]" or "L-[molecule's name]", but there are other ways of naming the left & right-handed molecules. One of these naming conventions includes the prefix "es-" (but I can't remember its opposite).

So... what does this have to do with drugs?

Lots of drugs work by binding to proteins in our bodies (such as receptors, enzymes, etc). There is usually a specific binding site on the protein the drug is targeting... and for the drug to bind and exert its action, it has to be the right "shape" to fit in the targeted protein...sort of like a key fitting into a lock.

There are many cases where only one enantiomer will "fit" (either the "left-hand" version of the molecule or the "right-hand" version of the molecule). In these cases, the version that "fits" is the active part of the drug... while the mirror-image version doesn't do much.

In the case of drugs such as prilosec/nexium, claritin/clarinex, celexa/lexapro, etc... the older version of the med contains a mixture of both enantiomers... while the newer version contains the active enantiomer.

Interestingly, the drug companies usually release the fancy new version (with just the active enantiomer) right around when their patent is expiring. When Claritin went OTC, they magically introduced Clarinex. When Prilosec went OTC, they magically introduced Nexium. And so on.

What I'm trying to say is that Prilosec (omeprazole... a mix of the right and left-handed forms) contains the same active ingredient as Nexium (esomeprazole)... it just contains "extra" stuff as well. Same with Claritin (loratidine) and Clarinex (desloratidine), etc.

There are still a lot of people who say that Nexium works better for them than Prilosec, or the Clarinex works better than Claritin.

One example is with carnitine (one of the supplements I take for mito). L-carnitine (levocarnitine) is the active form, and there is some reason (I can't remember what) that D-carnitine is bad to take. So, there may be a valid reason why some people feel better with these newer meds.

But, chemically speaking, it does sound like you're getting the same active ingredient in both forms, though... it is just all the other junk included with it that is different (which may or may not make a difference).

Hope that makes sense. It is kind of a weird concept and gets explained a lot more in depth in college intro chemistry.

[Kandra]

I took the first horse pill capsule this morning. :) But I have a correction to make too. Originally, I thought this was similar to Prevacid but it isn't. It is similar to Prilosec.

Sorry, I think I was the one who said it was Prevacid rather than Prilosec..Prevacid which is lansoprazole rather than omeprazole (Prilosec).

Theyre all fairly similiar, but I just wanted to apologize. I misread it! :(

[Kathi49]

Thank you for explaining that Kira. :)

I was reading a bit about what you just said last night. But since I have slept, lol, I believe the articles were stating "S" and something else. It APPEARS they are mirror images of each other; but basically they aren't. And I am not even speaking of the Sodium Bicarbonate in the Zegerid. And you must have ESP because I was thinking of Claritin at the same time. :D And why did Nasonex work better than Nasocort for me? They seemed to be pretty much the same thing but one gave me headaches and the other didn't. Same thing with the PPI's...most gave me headaches. Nexium didn't. Anyway, I might be mixing apples and oranges. I think the key word is what you said...SIMILAR...but not EXACT. And I suppose that is why we have so many choices with these PPI's. Just as a side note; my mom was taking Protonix. But after awhile she still had pleghm and coughing from acid reflux. The doc switched her to Nexium and she says all of that stopped right away. My sister in law? I am not sure what she was taking at first; but she had an upper endoscopy done and they switched her to Nexium. Sooo...I think it is as you said; it is the "fit" and probably what might be really going on. And I really think the reason the doc wanted me to TRY the Zegerid is because of the instant release and that it works through the night. I was reading a study about that too on Pub Med and it appeared to be positive.

Oh, and Kandra don't apologize; I was thinking it was similar to Prevacid at first too until I actually read the thing. :)

[sleepy]

Hi Kathi-Hope you get some relief. When Nexium became too expensive, my gastro doc put me on generic Prilosec (omeprazole) 20mg. twice a day. It seems to work as well as 40mg. Nexiium. Judy

[Nana4&cntn]

Kathi,

If I remember correctly you were taking 20mg of nexium. It is my understanding from my GI that 40 mg is the therapeutic dose. I know that prevacid comes in 30mg capsules, the GI stated for me to take 2 as 40 mg are needed to provide relief.

Hope this makes sense, and you are finding relief you need.

Take care,
Kathy

[Kathi49]

Kathy,

40mg is the standard dose. 20mg worked just fine until now. This other seems to be working fine so far. I haven't had any gas or bubbles or problems. AND...no nausea or that crampy feeling this morning. Perhaps the Probiotic is helping as well as the fiber. Because...everything came out just fine this morning. :) But give me time...this is only the second day on Zegerid.

[Nana4&cntn]

Kathi,

I am keeping you in my thoughts and prayers. I am glad the crampy's and nausea are not with you today! I am all for probiotics, I eat a bunch of yogurt daily and so far it works fine for me. I really hope it continues because I really don't want another pill to take.
I know you don't like yogurt, so I really hope you get good relief.

Take care,
Kathy

[Kathi49]

Thanks Kathy,

I am glad you like yogurt. I wish I did and I was cheating SOMETIMES when I was eating it. I would sometimes get the "kid" kind with M&M's LOL! I just never really did like the sour taste of it. BUT...it worked well with the intake of fiber too. It is just that I had to eat so much of it. And I think, although NOT SURE, that dairy disagrees with me a bit. I just notice that when I drink milk it is a feeling of "yuk"! Oh, but the Soy Silk agrees with me just fine! Oh, he@@ who knows what is wrong with me? LOL It just goes likes this...Gastris, GERD, IBS, pelvic floor issues (prolapses) constipation and just plain...ick! :eek::) But I AM feeling much better. And I swear there that probiotic is helping. The day I took it my stomach just felt better overall. :)

[Kandra]

(snip) Same thing with the PPI's...most gave me headaches. Nexium didn't. Anyway, I might be mixing apples and oranges. I think the key word is what you said...SIMILAR...but not EXACT. And I suppose that is why we have so many choices with these PPI's. Just as a side note; my mom was taking Protonix. But after awhile she still had pleghm and coughing from acid reflux. The doc switched her to Nexium and she says all of that stopped right away. My sister in law? I am not sure what she was taking at first; but she had an upper endoscopy done and they switched her to Nexium. Sooo...I think it is as you said; it is the "fit" and probably what might be really going on. And I really think the reason the doc wanted me to TRY the Zegerid is because of the instant release and that it works through the night. I was reading a study about that too on Pub Med and it appeared to be positive.

Oh, and Kandra don't apologize; I was thinking it was similar to Prevacid at first too until I actually read the thing. :)

Kathi,

Interestingly enough (at least to me..lol!) I was talking to one of the pharmacists at the sample clinic about different meds that are essentially the same. She related it to how "the light shines through a molecule from one angle" and a different drug, yet extremely similiar will have that "light" shining in from yet a different angle. So, some people will have great success with one drug and not the other and vice versa. Similiar to Kira's explanation.

I take Nexium 40mg BID and normally don't have a problem..altho earlier tonight I did but I think it was due to being very upset over something.

I haven't tried any of the probiotics...and even though your IBS is different than mine I'm going to be really interested to see how things go for you! Let me know, please :)

Oh, I know this is a different thread I think but I do take Fish Oil 2GM/day and the same with Flaxseed Oil. I have noticed some differences in some issues but not with IBS. I do take Coumadin so I did clear the fish oil with my pulmonologist. The interesting thing is that I've had to increase the amount of Coumadin I'm taking!

[Kira]

The different PPIs are, in general, different-but-similar molecules (i.e. omeprazole/Prilosec vs. pantoprazole/Protonix vs. lansoprazole/Prevacid vs...)

But, with omeprazole (Prilosec) and esomeprazole (Nexium), the molecule that is causing the therapeutic effect is the same for both Prilosec and Nexium (esomemprazole, the active enantiomer). Omeprazole (Prilosec) contains both enantiomers, whereas esomeprazole (Nexium) is just the active enantiomer.

Of course, both of those meds also contain various inactive ingredients (fillers, dyes, coatings, etc). And, as in my other post, there ARE some meds that it is important to take only one form and not the other (such as L-carnitine=good and D-carnitine=bad).

Like I said, I have heard of people doing better on one PPI than another. I have heard of people who do better on Prilosec and other people who do better on Nexium. Since the active ingredient is the same in both, I would guess that any differences people notice are due to one of a couple of things:
-Some effect of the inactive enantiomer, whether it helps the Prilosec work better than the Nexium or makes the Prilosec less effective than the Nexium (maybe by interfering with binding, pharmacokinetics, metabolism & excretion of the drug & its metabolites, etc)
-Something to do with the inactive ingredients in one med vs. another... like a patient's individual intolerance of an ingredient, effects of the inactive ingredients on things like drug absorption & efficacy, etc.
-People's indivdual quirks in how they respond to various meds
-Successful marketing of the current "latest, greatest" PPI to patients and/or docs (from television & magazine ads to samples & free lunches for doctors)
-People's tendency to intuitively reason that a prescription product must be more potent/effective/etc than an OTC product
-And, probably a bunch of other reasons, too.

That is not to say that the difference you notice between Prilosec and Nexium isn't valid, or that it is all just a psychological thing. Some meds just plain work better than others for individual people.

Anyway, the reason I posted that attempted explanation of enantiomers is b/c a lot of drug companies seem to be using it lately as a way to extend the amount of money they can make off of a particular drug with the least amount of research needed... and it just bugs me when they act like it is some new, fabulous drug when it really isn't a new drug at all.

For instance, if "Big Drug Company" discovers and makes a PPI called "blurpeprazole," they spend on a lot on identifying a drug that mightwok and then doing all of the clinical trials needed to show safety and efficacy for FDA approval. Then, when "blupeprazole's" patent is about to run out, it's okay for other drug companies to make generic "blurpeprazole" and sell it for much cheaper because they never had to do all of the stuff involved in discovering & selling a new drug.

So, to keep the money rolling in, "Big Drug Company" needs to come up with a way to continue milking money out of "blurpeprazole" to maximize their profits. They continue selling "blurpeprazole" and even get it approved as an OTC drug (for MUCH cheaper than the current group of prescription-only PPIs. Then "Big Drug Company" comes up with the idea of identifying and isolating the active enantiomers in "blurpeprazole" and call it a new drug... without a much more streamlined pathway to FDA approval b/c much of the research was already done when it was just "blurpeprazole" instead of "esblurpeprazole."

So, they can study "esblupeprazole" more quickly than they did with the original "blurpeprazole" studies. If they time it right, they have a "new" PPI to release around the time when "blurpeprazole's" patent is up. That helps them keep the money flowing.

They count on the general public not really catching on to to the fact that "esblurpeprazole" is pretty much the same as "blurpeprazole." They also count on doctors to hand out samples of whichever PPI they have on hand... and since they are heavily marketing the "latest, greatest" form of their PPI, docs are likely to grab a handful of samples for the patient to try...and then they tend to stick with whichever med the patient started on,as long as it's working.

Regardless of the drug companies' somewhat shady behavior, I think the bottom line is to to with what works for you and what your doctor prescribes.

[Jim59]

My wife has a terrible stomach. She has a family history of both esophageal and stomach cancers. She must have control of her stomach acid as it could precipitate a life threatening condition. For years she has taken two 20m.g. Omeprezole a day and one Pepsid AC, OTC, at night for overnight coverage. She also takes a Pepsid Complete, OTC, during the day as necessary. her doctor has also used 40m.g. Protonix 2x a day but
had to stop because it gave her terrible diarrhea but was much more effective. The routine with Omprezole, generic Prilosec, gives her decent but far from perfect coverage. I get 90 day supplies of Omeprezole, 180 capsules, for $20 by mail order under our Rx plan. It may be worth discussing with your doctor. Best to you.

[Kathi49]

Thank you Kira and Jim,

And Jim, I know what you are saying. I have tried them all it seems. Prevacid wasn't bad; it worked...BUT I had diarrhea badly from it. Protonix gave me headaches and that seems to be the way it went down all the time. Either headaches or diarrhea or both...until Nexium. And Zantac would give me backaches. It is all just weird...only Nexium sat well with me.

Okay, now I think I have spoken too soon. I am noticing that when I take the Zegerid I get tingling in my cheeks...face cheeks that is. :) And then it goes away throughout the day. Well, tingling is a SE; just don't know if it is a serious one or not. But it makes me nervous since I have neuropathy anyway. And, I think this stuff is working well...almost too well I think. It is harder for me to fall asleep and STAY asleep. And it makes me wonder if my other medications are getting through or absorbed rather. So, I will call the Gastro doc today; it may be that I just need to stick with Nexium at 40mg instead of 20mg. I know, I know...it all sounds crazy. But I DO get that tingling sensation that I never had before until starting Zegerid.

[Kathi49]

The Gastro's office called me back yesterday. Now, another new plan...ugh! LOL

They do NOT want me taking Zegerid if I am tingling in the face (glad I called them about that). So, I can do one of two things; double up on the Nexium (of course they will write me a new script), or take the 20mg in the morning and then (thank you Pharmacist Steve) Zantac at night. But darn it, I forgot to ask them how MUCH Zantac...duh! Also, forgot to ask them how far apart do I take the Zantac and the Klonopin since I take the Klonopin right before I go to bed. And while I don't mind the Fibercon too much (it is working just fine) it does make me feel bloated. Seems the Benefiber worked better since it wasn't pill form. It just feels with the Fibercon, and oh, I am NOT taking two right away, that it sits and expands in my stomach. And, yes, I am drinking lots of water. Benefiber doesn't do that to me. And, yes, I know...when starting fiber it is common to have bloating until I adjust. It has been awhile so I know that much. I just don't like the capsules. Does anyone know what is SIMILAR to Fibercon that would be in powder form instead? I guess I can ask the Pharmacist today since I have to go over there anyway.

And I tried to call on the results of the bloodwork but they don't have them in yet. So, I told them...okay, but I will be checking every day. :)