Introduction

Omeprazole, a proton pump inhibitor (PPI), is a widely prescribed medication known for its effectiveness in treating various gastrointestinal conditions. From managing acid reflux to healing ulcers, omeprazole plays a crucial role in alleviating symptoms and improving patients’ quality of life. In this detailed guide, we explore the diverse uses, recommended doses, potential side effects, and other essential aspects of omeprazole to provide you with a comprehensive understanding of this medication.

Indication of Omeprazole

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Omeprazole, according to the FDA label is a proton pump inhibitor (PPI) used for the following purposes:

  • Treatment of active duodenal ulcer in adults
  • Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence in adults
  • Treatment of Zollinger-Ellison syndrome.
  • Treatment of active benign gastric ulcer in adults
  • Reduction of risk of upper gastrointestinal (GI) bleeding in critically ill adult patients.
  • Treatment of symptomatic gastroesophageal reflux disease (GERD) in patients 1 year of age and older
  • Treatment of erosive esophagitis (EE) due to acid-mediated GERD in patients 1 month of age and older
  • Treatment of Acid related dyspepsia.
  • NSAID-associated ulceration
  • Maintenance of healing of EE due to acid-mediated GERD in patients 1 year of age and older
  • Pathologic hypersecretory conditions in adults

Doses of Omeprazole

Adult dose

Oral Peptic ulcer

Adult: 20 or 40 mg/day in severe cases for 4 weeks( duodenal ulcer) or for 8 weeks( gastric ulcer). Maintenance: 10- 20 mg/day. All doses to be taken once in the morning.

NSAID-associated ulceration

Adult: 20 mg once in the morning.

Gastro-esophageal reflux disease

Adult: 20 mg/day for 4 weeks may continue for another 4- 8 weeks if necessary. Refractory esophagitis: 40 mg/day.

Maintenance: 20 mg/day ( after healing of esophagitis); 10 mg/da (acid reflux). All doses to be taken once in the morning.

Zollinger-ellison syndrome

Adult: Initially, 60 mg once in the morning, adjust as required. Dose range: 20- 120 mg/day. Doses >80 mg are administered in 2 divided doses.

Prophylaxis of acid aspiration during general anesthesia

Adult: 40 mg given in the evening and another 40 mg 2- 6 hour pre-operation.

Acid-related dyspepsia

Adult: 10 or 20 mg once in the morning for 2- 4 weeks.

Erosive esophagitis

Adult: 20 mg/day for 4- 8 weeks. Maintenance of healing: 20 mg/day for up to 12 months.

All doses to be taken once in the morning.

H. pylori infection

Adult: As triple therapy: 20 mg bid or 40 mg once daily combined with amoxicillin 500 mg and metronidazole 400mg both tid or combined with clarithromycin 250 mg and metronidazole 400 mg ( or tinidazole 500 mg) both bid or combined with amoxicillin 1 g and clarithromycin 500 mg both bid.

Duration: 7 or 10 days.

As 2 weeks dual therapy: 20 mg bid or 40 mg/day combined with either amoxicillin 750 mg tid 1 g bid or with clarithromycin 500 mg tid.

Intravenous

Gastro-esophageal reflux disease; Gastric and duodenal ulcer; NSAID-associated ulceration

Adult: 40 mg once daily infused over 20- 30 min or slow Inj over 5 min until oral admin is possible.

Zollinger-ellison syndrome

Adult: Initially, 60 mg/day adjust according to response. Daily doses >60 mg/day should be given in 2 divided doses.

Elder: No dosage adjustment needed.

Hepatic impairment: 10- 20 mh/day.

Child dose

Oral GERD

Indicated for treatment of GERD

<1 year: Safety and efficacy not estadlished

>1 year 5- 10 kg: 5mg po qday.

10- 20 kg: 10 mg po qday

>20 kg: 20 mg po qday

Erosive esophagitia

Indicated for treatment and to maintain healing of erosive esophagitis caused

Side effects of omeprazole

While omeprazole is generally well-tolerated, it may cause certain side effects in some individuals. Understanding the potential side effects of omeprazole is essential for informed decision-making and prompt medical intervention if necessary.

Common Side Effects

Common side effects of omeprazole may include headache, nausea, abdominal pain, diarrhea, and constipation. These side effects are usually mild and transient, resolving on their own as the body adjusts to the medication.

Rare but Serious Side Effects

In rare cases, omeprazole may cause more serious side effects, including severe allergic reactions, kidney problems, liver damage, and vitamin B12 deficiency. While these side effects are uncommon, it is essential to seek medical attention if you experience any unusual symptoms while taking omeprazole.

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Administration

Delayed-release cap: Should be taken on an Empty stomach. Take at least one hour before meals. Swallow whole, do not chew/ crush. For patients with difficulty swallowing, the capsule may be carefully open and the entire contents Sprinkle in a spoonful of applesauce. swallow drug/food mixt with or chewing immediately after preparing drug/food mixt should not be store for future use.
powder for oral suspension: Should be take on an empty stomach. Take on an empty stomach at least one hour before a meal.
Mups tablet: May be take with or without food.
Capsule: Should be taken with food. Take it immediately before a meal.

Contraindication

Omeprazole is contraindicate in patients with a history of hypersensitivity to the drug or any excipients from the dosage form. Hypersensitivity reactions like anaphylactic shock, angioedema, interstitial nephritis, anaphylaxis, urticaria, and bronchospasm may occur.

Precautions and warnings

Gastric malignancy should be ruled out. Pregnancy, lactation child <1 year monitoring parameters monitor MG concentrations period to initiation and periodically thereafter.

Lactation
Risk summary
Limited data suggest omeprazole may be present in human milk. There are no clinical data on effects of omeprazole on breastfeed infants or on milk production. Developmental and health benefits of breastfeeding should be consider along with the mother’s clinical need for therapy and any potential adverse effects of breastfeed infants from treatment or from underlying maternal conditions.

Pregnancy and lactation

pregnancy category- Not classified FDA has not yet classified the drug into a specified pregnancy category.

Rich summary
There are no adequate and well-controlled studies with omeprazole in pregnant women. Available epidemiologic data fail to demonstrate an Increased risk of major congenital malformations or other adverse pregnancy outcomes with first trimester omeprazole use. Reproduction studies in rats and rabbits resulted In dose-dependent embryo-lethality at omeprazole doses that were approximately 3.4 to 34 times an Oral human dose of 40 mg (based on a body surface area for a 60 kg person). .

Teratogenicity was not observe in animal reproduction studies with administration of oral esomeprazole ( an enantiomer of omeprazole) magnesium in rats and rabbits during organogenesis with doses about 68 times and 42 times. Respectively an oral human dose of 40 mg esomeprazole or 40 mg omeprazole (based on body surface area for a 60 kg person). Changes in bone morphology were observe in offSpring at rats dosed through most of pregnancy and lactation at doses equal to or greater than approximately 34 times an oral human dose of 40 mg esomeprazole or 40 mg omeprazole. When maternal administration was confine To gestation only, there were no effects on bone physeal morphology in the offspring at any age.

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Therapeutic class

Proton pump inhibitor( PPI).

Mode of action in Omeprazole

Hydrochloric acid (HCl) secretion into the gastric lumen is a process regulate mainly by the H(+)/K(+)-ATPase of the proton pump, expressed in high quantities by the parietal cells of the stomach. ATPase is an enzyme on the parietal cell membrane that facilitates hydrogen and potassium exchange through the cell, which normally results in the extrusion of potassium and formation of HCl (gastric acid).

Omeprazole is a member of a class of anti secretory compounds, the substituted benzimidazoles, that stop gastric acid secretion by selective inhibition of the H+/K+ ATPase enzyme system. Proton-pump inhibitors such as omeprazole bind covalently to cysteine residues via disulfide bridges on the alpha subunit of the H+/K+ ATPase pump, inhibiting gastric acid secretion for up to 36 hours. This anti secretory effect is dose-related and leads to the inhibition of both basal and stimulate acid secretion, regardless of the stimulus Label.

Mechanism of H. pylori eradication

Peptic ulcer disease (PUD) is frequently associate with Helicobacter pylori bacterial infection (NSAIDs). The treatment of H. pylori infection may include the addition of omeprazole or other proton pump inhibitors as part of the treatment regimen Label. H. pylori replicates most effectively at a neutral pH. Acid inhibition in H. pylori eradication therapy, including proton-pump inhibitors such as omeprazole, raises gastric pH, discouraging the growth of H. pylori. It is generally believe that proton pump inhibitors inhibit the urease enzyme, which increases the pathogenesis of H. pylori in gastric-acid related conditions.

Interaction

Increased risk of hypomagnesemia with diuretics. May increase INR and prothrombin time with warfarin. Increased risk of digoxin-induced cardiotoxic effects. May increase plasma concentration benzodiazepines (e.g. Diazepam), clarithromycin and methotrexate. Decrease absorption of itraconazole, Ketoconazole, posaconazole, dasatinib, iron salt. May prolong elimination of diazepam, cilostazol, phenytion and ciclosporin. May reduce the anti platelet effect of clopidogrel.
potentially fetal: May decrease plasma concentration and pharmacological effect of rilpivirine, nelfinavir and atazanavir.

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Popular FAQ of Omeprazole

Can you take an antacid with omeprazole?

You can take an antacid with omeprazole if you are still getting symptoms of indigestion because it can take several days for omeprazole to start working. Take omeprazole as directed (usually taken once daily on an empty stomach), and take antacids as needed to relieve indigestion pain after eating. But tell your doctor if several weeks have gone past and omeprazole does not seem to be working or you are still taking antacids.

Is omeprazole (Prilosec) bad for your kidneys?

Omeprazole (Prilosec) is a proton pump inhibitor (PPI) that is using to reduce the amount of acid in your stomach and it can be bad for your kidneys. It can cause acute kidney injury and may also worsen the progression of chronic kidney disease (CKD).

Does omeprazole cause cancer?

Long-term use of proton pump inhibitor (PPI) acid-suppressing agents, such as omeprazole, has been associate with an increase risk of stomach cancer (also called gastric cancer). This is base on the results of several observational studies and is thought to be because PPIs such as omeprazole are potent gastric acid suppressants that may increase the risk of gastric cancer by causing atrophy (thinning) of the stomach lining, elevating levels of a hormone call gastrin, and an overgrowth of bacteria in the stomach.

What foods should I avoid when taking omeprazole?

There are no specific foods that interact with omeprazole, therefore there are no foods that you need to avoid.

Is famotidine safer than omeprazole for heartburn?

Famotidine is usually the first choice to treat occasional heartburn if your symptoms occur less than two times per week. It can be use as needed, provides quick relief (within 15 to 30 minutes), and is usually less expensive than omeprazole. Omeprazole may be an option if your heartburn occurs two or more days per week. Both products are available without a prescription.

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