為使醫療院所能有效管理藥品使用，現今醫院都有院內處方集系統，其主要目的是確保使用藥品為高品質且符合成本效益。美國醫療機構藥師學會(ASHP)建議醫院的藥委會每年應執行同藥理類別藥品的整理分析，藉此根據藥品的效果、毒性、或價格差異來選出同類品項中最適合該醫院的藥品，並執行同療效藥品替代(therapeutic interchange)。
氫離子幫浦阻斷劑可有效地抑制胃酸分泌，普遍的被使用於治療消化性潰瘍或逆流性食道炎等。目前台灣市場共有五種氫離子幫浦阻斷劑：omeprazole 、lansoprazole 、esomeprazole、pantoprazole 與rabeprazole，其中四種(omeprazole、lansoprazole、esomeprazole、pantoprazole)除口服劑型外亦使用針劑。
本文統整各氫離子幫浦阻斷劑相關之臨床研究並佐以各藥品副作用與交互作用資料，比較各個藥品之療效及安全性，經文獻回顧，各氫離子幫浦阻斷劑間之等效劑量為omeprazole 20 mg，rabeprazole 20 mg，lansoprazole 30 mg，pantoprazole 40 mg，以及esomeprazole 20 mg。此外，更進一步探討醫療院所依藥品間之建議等效劑量轉換表進行此類藥品的同療效藥品替代之可行性與應注意事項。當執行同療效藥品替代時，與臨床醫師充分溝通，以及提供院內完整的教育推廣是提高成功率的重要因素。
In order to manage drug use effectively, most hospitals have established formulary systems to ensure high quality and cost-effective drug therapy. American Society of Health-System Pharmacists (ASHP) recommended the pharmacy and therapeutic (P&T) committee in the hospitals conduct several therapeutic drug class reviews each year. Based on the differences of effectiveness, toxicity, or cost, the committee can select the most suitable agent to be included in the hospital formulary and conduct therapeutic interchange.
Proton pump inhibitors (PPIs) can effectively suppress the secretion of gastric acid and therefore are widely used for the treatment of acid-peptic disorders, such as gastric or duodenal ulcer disease or gastroesophageal reflux disease. There are currently 5 PPIs on the market in Taiwan and 3 out of them have both oral and intravenous dosage forms.
In this article, we summarized the clinical trials comparing the effectiveness or safety profiles of PPIs. The equivalent dosages of PPIs, determined by literature review, were omeprazoel 20 mg, rabeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, and esomeprazole 20 mg. We further discussed the feasibility and important factors a healthcare institution should consider when implementing therapeutic interchange according to the equivalent doses. A fully communication with physicians and complete education for healthcare professionals regarding the policy and protocol are the main factors to make a therapeutic interchange program successful in an institution.
