Proton pump inhibitors (PPIs) are commonly recommended as a first line treatment for acid reflux and gastro oesophageal reflux disease (GORD) in the UK. However, there is not one standard dose for every PPI. For adults looking for information about PPI dosage for acid reflux, commonly used doses include omeprazole 20mg once daily, lansoprazole 30mg once daily, pantoprazole 40mg once daily, rabeprazole 20mg once daily, and esomeprazole 20mg to 40mg once daily. The appropriate dose can vary depending on the medicine, the condition being treated and how well symptoms respond to treatment. Heartburn is also very common and affects up to 1 in 4 UK adults.
This guide compares PPI doses based on NICE clinical guidance, so you can understand how standard, low and high doses differ between medicines and what a "standard dose" means for each one. It also covers famotidine as an H2 receptor antagonist, how PPIs work, how long treatment may be used, how to take them correctly, and when to speak to a prescriber if symptoms continue or treatment needs reviewing.
The doses in this guide are for general information only. If you are considering treatment for reflux or already taking a PPI, understanding the different doses can help you have a more informed conversation with your prescriber. Do not increase, reduce or change your dose without medical advice.
Key things to know
- PPIs do not all have the same standard dose. For example, the standard treatment dose is commonly 20mg for omeprazole and 40mg for pantoprazole.
- Lansoprazole 15mg is considered a low dose in NICE guidance, while 30mg is the standard treatment dose.
- Pantoprazole 20mg is considered a low dose, while 40mg is the standard treatment dose.
- The instructions can vary between products, but PPIs are often taken before a meal. Follow the instructions provided with your specific medicine or prescription.
- NICE recommends a PPI as an initial treatment option for many people with reflux symptoms. H2 receptor antagonists, such as famotidine, may be considered in some circumstances if a PPI is not suitable or does not provide enough symptom control.
What Is Acid Reflux and How Do PPIs Work?
Gastro oesophageal reflux disease (GORD) occurs when stomach contents, including stomach acid, flow back into the oesophagus, the tube that carries food from your mouth to your stomach. This can happen when the lower oesophageal sphincter, a muscular ring at the bottom of the oesophagus, does not close properly. Common symptoms include heartburn, an unpleasant taste in the mouth and a burning feeling in the chest. Some people may also experience symptoms such as a persistent cough or sore throat.
Proton pump inhibitors work by reducing the production of stomach acid. They do this by blocking acid producing pumps in the lining of the stomach.
This is different from antacids and H2 receptor antagonists, which work in different ways. Antacids help neutralise acid already present in the stomach, while H2 receptor antagonists reduce acid production through a different mechanism. PPIs are commonly used when ongoing treatment is needed for reflux, and NICE recommends them as a first line treatment option for GORD and dyspepsia. Lifestyle changes may also help manage reflux symptoms and can be used alongside treatment where appropriate.
PPI Dosage Comparison: Standard, Low and High Doses
The table below sets out commonly used standard, low and high doses for each PPI, based on NICE guideline CG184. A "standard dose" generally refers to the usual treatment dose, while a low dose may be used for maintenance or when a lower dose is appropriate. Higher dose regimens may be considered for more severe symptoms or certain conditions and should be used according to the advice of a prescriber or specialist.
| PPI | Low dose | Standard dose | High dose |
|---|---|---|---|
| Omeprazole | 10-20mg once daily | 20mg once daily (up to 40mg for severe oesophagitis) | 40mg twice daily |
| Lansoprazole | 15mg once daily | 30mg once daily | 30mg twice daily (off-label for GORD) |
| Pantoprazole | 20mg once daily | 40mg once daily | 40mg twice daily (off-label for GORD) |
| Rabeprazole | 10mg once daily | 20mg once daily | 20mg twice daily (off-label for GORD) |
| Esomeprazole | 20mg once daily | 20-40mg once daily | 40mg twice daily |
A few points are worth keeping in mind when looking at this table. Lansoprazole 15mg is commonly used as a lower dose or maintenance option, rather than the standard treatment dose. It may be appropriate for milder symptoms or when symptoms are already under control. Pantoprazole 20mg is similarly considered a lower dose, while 40mg is the standard treatment dose. Esomeprazole 20mg is broadly comparable with omeprazole 20mg in terms of acid suppression, while 40mg may be used for conditions such as more severe oesophagitis.
Higher dose options should not be started without advice from a prescriber. Twice daily dosing is also used in specific circumstances rather than as a routine treatment schedule.
Omeprazole: A Commonly Prescribed PPI
Omeprazole 20mg once daily is a commonly prescribed PPI dose in the UK and is often used as a starting dose for adults with reflux symptoms. For some people with more severe or erosive oesophagitis, a higher dose such as 40mg once daily may be prescribed. EveryDayMeds stocks both generic omeprazole 20mg capsules and branded Losec MUPS 20mg tablets, which contain the same active ingredient at the same dose.
Lansoprazole: A Lower Dose Maintenance Option
Lansoprazole 15mg is licensed as a lower strength and maintenance dose. It may be suitable for milder symptoms or for people whose reflux is already controlled with treatment. It is available as standard capsules and as orodispersible tablets that dissolve in the mouth, which may be useful for people who find standard tablets or capsules difficult to swallow.
If your symptoms are not adequately controlled with 15mg, speak to your prescriber about whether the standard 30mg treatment dose may be more appropriate for you.
Pantoprazole: A Once Daily Alternative
Pantoprazole works in a similar way to other PPIs and is available from EveryDayMeds as a 20mg tablet, which is considered a lower dose. The standard treatment dose is 40mg once daily.
Pantoprazole may be preferred in some situations because it has fewer clinically significant medicine interactions than some other PPIs. However, the most suitable PPI depends on your medical history and any other medicines you take, so your prescriber can help you choose the appropriate option.
Rabeprazole and Esomeprazole: Different Strength Options
Rabeprazole 20mg once daily is a commonly used standard dose for reflux. A prescriber may consider changing the PPI or adjusting the dose if your symptoms are not adequately controlled.
Esomeprazole is closely related to omeprazole and is available in different strengths, including 20mg and 40mg. Some evidence suggests that PPIs can differ in their ability to reduce stomach acid, but individual responses vary. If your symptoms do not improve enough with your current treatment, your prescriber can review whether a different PPI or dose would be appropriate.
Famotidine: An H2 Blocker Alternative
Famotidine works differently from PPIs. It is an H2 receptor antagonist that blocks histamine receptors involved in stimulating stomach acid production. This reduces acid production through a different mechanism from PPIs.
Antacids work differently again. They can neutralise stomach acid that is already present and may provide quicker relief from occasional heartburn symptoms, while famotidine and PPIs are used to reduce acid production.
NICE considers H2 receptor antagonists as an option when a PPI has not provided an adequate response. Famotidine may also be considered when a PPI is not suitable for someone. Your healthcare professional can help you decide which treatment is appropriate for your symptoms.
How Long Does PPI Treatment Usually Last?
PPIs are often prescribed for around 4 to 8 weeks before treatment is reviewed. After this period, your prescriber can check whether your symptoms have improved and whether you still need the same dose.
Some people need longer term treatment, particularly those with ongoing GORD or certain conditions such as Barrett's oesophagus. NICE recommends regular reviews for people taking PPIs long term, including checking whether the current dose is still needed and whether a lower dose may be appropriate.
Lifestyle changes may also help manage reflux symptoms. For example, avoiding food for around 3 to 4 hours before going to bed and raising the head of the bed by around 10 to 20cm may help some people who experience reflux at night. If you have been taking a PPI for a long time, speak to your healthcare professional before stopping it, as stopping suddenly can sometimes cause a temporary increase in acid related symptoms.
How to Take PPIs
The best time to take a PPI depends on the specific medicine and the instructions provided with your prescription or patient information leaflet. Many PPIs are taken before a meal, often around 30 to 60 minutes beforehand, because this can help optimise their effect.
PPIs do not usually provide immediate relief from heartburn. Some people may need several days before they notice the full benefit of treatment. If you have been given specific instructions by your doctor or the patient information leaflet for your medicine, follow those instructions.
Certain foods and drinks may trigger reflux symptoms for some people, including spicy foods, fatty foods or tomato based products. Triggers vary from person to person, so you do not necessarily need to avoid foods that do not cause problems for you. Simple changes to meal timing, portion sizes and other lifestyle habits may also help alongside your treatment.
Available Treatments
| Treatment | Price from |
|---|---|
| Lansoprazole 15mg Capsules | £5.99 |
| Pantoprazole | £5.99 |
| Famotidine Tablets | £8.49 |
| Lansoprazole 15mg Orodispersible Tablets | £8.49 |
| Esomeprazole | £16.99 |
| Omeprazole 20mg | £12.99 |
| Rabeprazole | £19.99 |
| Losec MUPS 20mg Tablets | £29.99 |
Prices update live and may change.
Over-the-counter PPIs should be used in accordance with the product instructions, and persistent symptoms should be discussed with a healthcare professional .
Medical Disclaimer
This page provides general information about PPI dosage options for acid reflux, based on NICE clinical guidance. It is not a substitute for personalised medical advice. The most appropriate dose for you can depend on your symptoms, medical history and response to treatment, and should be confirmed by a prescriber.
Do not start, stop or change your PPI dose based on general information alone. Speak to your GP, pharmacist or prescriber if you have questions about your treatment or need advice about changing your dose.
