1.1. Adults

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Maximum daily adult doses for PPIs when prescribed as acute and maintenance therapy, as well as components of combination treatments, are summarized in Tables 1-4. Dosages exceeding these recommended values will be reviewed.

Table 1. Adult Maximum Daily Acute Doses for Proton Pump Inhibitors – Monotherapy^1-9
Drug Name	Dosage Form/Strength	Treatment Indication	Maximum Recommended Dosage
dexlansoprazole (Dexilant)	30 mg, 60 mg delayed- release capsules	erosive esophagitis (EE)	60 mg/day
		gastroesophageal reflux disease (GERD) - nonerosive	30 mg/day
esomeprazole magnesium (Nexium®, generics)	20 mg, 40 mg delayed-release capsules; 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg delayed-release powder for suspension	EE	40 mg/day
		GERD - nonerosive	20 mg/day
		Helicobacter pylori eradication	40 mg/day*
		heartburn	20 mg/day
		hypersecretory conditions	240 mg/day in divided doses
lansoprazole (Prevacid®, generics)	15 mg, 30 mg delayed-release capsules, 15 mg, 30 mg orally disintegrating tablets	duodenal ulcer	15 mg/day
		EE	30 mg/day
		gastric ulcer	30 mg/day
		GERD - nonerosive	15 mg/day
		H. pylori eradication	90 mg/day (in divided doses)*
		heartburn	15 mg/day
		hypersecretory conditions	180 mg/day in divided doses
		NSAID-associated gastric ulcer	30 mg/day
omeprazole (Prilosec®, generics)	10 mg, 20 mg, 20.6 mg, 40 mg delayed-release capsule; 20 mg delayed-release orally disintegrating tablet	duodenal ulcer	20 mg/day
		EE	20 mg/day
		gastric ulcer	40 mg/day
		GERD - nonerosive	20 mg/day
		heartburn	20 mg/day
		H. pylori eradication	triple therapy: 40 mg/day in divided doses* dual therapy: 40 mg/day*
		hypersecretory conditions	360 mg/day in divided doses
omeprazole magnesium (Prilosec®)	2.5 mg, 10 mg packet with delayed-release granules for suspension, 20.6 mg delayed-release capsule	duodenal ulcer	20 mg/day
		EE	20 mg/day
		gastric ulcer	40 mg/day
		GERD - nonerosive	20 mg/day
		H. pylori eradication	triple therapy: 40 mg/day in divided doses* dual therapy: 40 mg/day*
		hypersecretory conditions	360 mg/day in divided doses
pantoprazole (Protonix®, generics)	20 mg, 40 mg delayed-release tablets; 40 mg delayed-release granules for suspension	EE	40 mg/day
		hypersecretory conditions	240 mg/day in divided doses
rabeprazole (Aciphex®, generics)	20 mg delayed-release tablet; 5 mg, 10 mg delayed-release sprinkle capsule	duodenal ulcer	20 mg/day
		EE	20 mg/day
		GERD - nonerosive	20 mg/day
		H. pylori eradication	40 mg/day in divided doses*
		hypersecretory conditions	120 mg/day in divided doses

Legend:

*Per ACG Guidelines, PPI dosing may be doubled depending on the regimen used for H. Pylori eradication¹²

Table 2. Adult Maximum Daily Acute Doses for Proton Pump Inhibitors – Combination Therapy^1,2,10
Drug Name	Dosage Form/Strength	Treatment Indication	Maximum Recommended Dosage
omeprazole/ sodium bicarbonate (Zegerid®, generics)	20 mg/1100 mg, 40 mg/1100 mg capsules; 20 mg/1680 mg, 40 mg/1680 mg packets for suspension	duodenal ulcer	20 mg/day (as mg of omeprazole)
		EE	20 mg/day (as mg of omeprazole)
		gastric ulcer	40 mg/day (as mg of omeprazole)
		GERD - nonerosive	20 mg/day (as mg of omeprazole)
		heartburn	20 mg/day (as mg of omeprazole)
		upper GI bleed risk reduction in critically ill (suspension only)	Day 1: 80 mg (in divided doses); Days 2-14: 40 mg/day (as mg of omeprazole)

Table 3. Adult Maximum Daily Maintenance Dose for Proton Pump Inhibitors – Monotherapy^1-9
Drug Name	Dosage Form/Strength	Treatment Indication	Maximum Recommended Dosage
dexlansoprazole (Dexilant)	30 mg, 60 mg delayed- release capsules	erosive esophagitis (EE)	30 mg/day
		heartburn	30 mg/day
esomeprazole magnesium (Nexium®, generics)	20 mg, 40 mg delayed-release capsules; 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg delayed-release powder for suspension	EE	20 mg/day
		hypersecretory conditions	240 mg/day in divided doses
		risk reduction of NSAID-associated gastric ulcer	40 mg/day
lansoprazole (Prevacid®, generics)	15 mg, 30 mg delayed-release capsules, 15 mg, 30 mg orally disintegrating tablets	duodenal ulcer	15 mg/day
		EE	15 mg/day
		hypersecretory conditions	180 mg/day in divided doses
		hypersecretory conditions	180 mg/day in divided doses
		risk reduction of NSAID-associated gastric ulcer	15 mg/day
omeprazole (Prilosec®, generics)	10 mg, 20 mg, 40 mg delayed-release capsule; 20 mg delayed-release orally disintegrating tablet	EE	20 mg/day
		hypersecretory conditions	360 mg/day in divided doses
omeprazole magnesium (Prilosec®)	2.5 mg, 10 mg packet with delayed-release granules for suspension	EE	20 mg/day
		hypersecretory conditions	360 mg/day in divided doses
pantoprazole (Protonix®, generics)	20 mg, 40 mg delayed-release tablets; 40 mg delayed-release granules for suspension	EE	40 mg/day
		hypersecretory conditions	240 mg/day in divided doses
rabeprazole (Aciphex®, generics)	20 mg delayed-release tablet; 5 mg, 10 mg delayed-release sprinkle capsule	EE	20 mg/day
		hypersecretory conditions	120 mg/day in divided doses

Caption^XXX
Drug Name	Dosage Form/Strength	Treatment Indication	Maximum Recommended Dosage
esomeprazole/ naproxen (Vimovo®, generics)	20 mg immediate-release/375 mg delayed-release, 20 mg immediate-release/500 mg delayed-release tablets	prevention of NSAID-associated gastric ulcer in patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis	40 mg/1000 mg/day in divided doses
omeprazole/ sodium bicarbonate (Zegerid®, generics)	20 mg/1100 mg, 40 mg/1100 mg capsules; 20 mg/1680 mg, 40 mg/1680 mg packets for suspension	EE	20 mg/day (as mg of omeprazole)