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June 10: VDP Formulary, CAD, MCO Search Realignment Now Active

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1.1. Adults

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 – Monotherapy1-9
Drug NameDosage Form/StrengthTreatment IndicationMaximum Recommended Dosage 
dexlansoprazole (Dexilant)30 mg, 60 mg delayed- release capsuleserosive esophagitis (EE)60 mg/day
  gastroesophageal reflux disease (GERD) - nonerosive30 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 suspensionEE40 mg/day
  GERD - nonerosive20 mg/day
  Helicobacter pylori eradication40 mg/day*
  heartburn20 mg/day
  hypersecretory conditions240 mg/day in divided doses
lansoprazole (Prevacid, generics)15 mg, 30 mg delayed-release capsules, 15 mg, 30 mg orally disintegrating tabletsduodenal ulcer15 mg/day
  EE30 mg/day
  gastric ulcer30 mg/day
  GERD - nonerosive15 mg/day
  H. pylori eradication90 mg/day (in divided doses)*
  heartburn15 mg/day
  hypersecretory conditions180 mg/day in divided doses
  NSAID-associated gastric ulcer30 mg/day
omeprazole (Prilosec, generics)10 mg, 20 mg, 20.6 mg, 40 mg delayed-release capsule; 20 mg delayed-release orally disintegrating tabletduodenal ulcer20 mg/day
  EE20 mg/day
  gastric ulcer40 mg/day
  GERD - nonerosive20 mg/day
  heartburn20 mg/day
  H. pylori eradication
  • triple therapy: 40 mg/day in divided doses*
  • dual therapy: 40 mg/day*
  hypersecretory conditions360 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 capsuleduodenal ulcer20 mg/day
  EE20 mg/day
  gastric ulcer40 mg/day
  GERD - nonerosive20 mg/day
  H. pylori eradication
  • triple therapy: 40 mg/day in divided doses*
  • dual therapy: 40 mg/day*
  hypersecretory conditions360 mg/day in divided doses
pantoprazole (Protonix, generics)20 mg, 40 mg delayed-release tablets; 40 mg delayed-release granules for suspensionEE40 mg/day
  hypersecretory conditions240 mg/day in divided doses
rabeprazole (Aciphex, generics)20 mg delayed-release tabletduodenal ulcer20 mg/day
  EE20 mg/day
  GERD - nonerosive20 mg/day
  H. pylori eradication40 mg/day in divided doses*
  hypersecretory conditions120 mg/day in divided doses

Legend:

  • * Per ACG Guidelines, PPI dosing may be doubled depending on the regimen used for H. Pylori eradication [12]
Table 2. Adult Maximum Daily Acute Doses for Proton Pump Inhibitors – Combination Therapy1,2,10
Drug NameDosage Form/StrengthTreatment IndicationMaximum 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 suspensionduodenal ulcer20 mg/day (as mg of omeprazole)
  EE20 mg/day (as mg of omeprazole)
  gastric ulcer40 mg/day (as mg of omeprazole)
  GERD - nonerosive20 mg/day (as mg of omeprazole)
  heartburn20 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 – Monotherapy1-9
Drug NameDosage Form/StrengthTreatment IndicationMaximum Recommended Dosage 
dexlansoprazole (Dexilant)30 mg delayed- release capsuleserosive esophagitis (EE)30 mg/day
  heartburn30 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 suspensionEE20 mg/day
  hypersecretory conditions240 mg/day in divided doses
  risk reduction of NSAID-associated gastric ulcer40 mg/day
lansoprazole (Prevacid, generics)15 mg, 30 mg delayed-release capsules, 15 mg, 30 mg orally disintegrating tabletsduodenal ulcer15 mg/day
  EE15 mg/day
  hypersecretory conditions180 mg/day in divided doses
  hypersecretory conditions180 mg/day in divided doses
  risk reduction of NSAID-associated gastric ulcer15 mg/day
omeprazole (Prilosec, generics)10 mg, 20 mg, 40 mg delayed-release capsule; 20 mg delayed-release orally disintegrating tabletEE20 mg/day
  hypersecretory conditions360 mg/day in divided doses
omeprazole magnesium (Prilosec)2.5 mg, 10 mg packet with delayed-release granules for suspensionEE20 mg/day
  hypersecretory conditions360 mg/day in divided doses
pantoprazole (Protonix, generics)20 mg, 40 mg delayed-release tablets; 40 mg delayed-release granules for suspensionEE40 mg/day
  hypersecretory conditions240 mg/day in divided doses
rabeprazole (Aciphex, generics)20 mg delayed-release tabletEE20 mg/day
  hypersecretory conditions120 mg/day in divided doses
Table 4.  Adult Maximum Daily Maintenance Dose for Proton Pump Inhibitors – Combination Therapy [1,2,10,11]
Drug NameDosage Form/StrengthTreatment IndicationMaximum Recommended Dosage 
esomeprazole/ naproxen (Vimovo, generics)20 mg immediate-release/375 mg delayed-release, 20 mg immediate-release/500 mg delayed-release tabletsprevention of NSAID-associated gastric ulcer in patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis40 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 suspensionEE20 mg/day (as mg of omeprazole)