Pharm

Omeprazole

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Omeprazole, Prilosec, Zegerid

  • See Also
  1. Proton Pump Inhibitor
  2. Lansoprazole
  3. Esomeprazole
  4. Pantoprazole
  5. Rabeprazole
  6. Dexlansoprazole
  • Indications
  1. Peptic Ulcer Disease
  2. Gastroesophageal Reflux
  3. Erosive Esophagitis
  4. Zollinger-Ellison Syndrome
  • Contraindications
  1. Hypersensitivity to Proton Pump Inhibitors
  2. Use with caution in severe liver disease
  • Medications
  1. Omeprazole (Prilosec)
    1. Generic in 2002, OTC
    2. Capsules may be opened and sprinkled on apple sauce
    3. Suspension may be given via Nasogastric Tube or G-Tube
    4. Take at least 30 minutes prior to a meal
  2. Omeprazole with Bicarbonate (Zegerid)
    1. Generic and OTC
    2. May offer benefit in the first week of use, until Omeprazole has reached full effect
    3. Capsules contain 1100 mg Sodium Bicarbonate (300 mg Sodium)
    4. Powders contain 1680 mg Sodium Bicarbonate (460 mg Sodium)
    5. Take on an empty Stomach at least one hour before meals
    6. Capsules must be taken intact with meals
    7. Suspension may be given via Nasogastric Tube
  • Dosing
  • Adults
  1. See Helicobacter Pylori Treatment
  2. Background
    1. Take 30 to 60 minutes prior to a meal
  3. Duodenal Ulcer or erosive Esophagitis
    1. Take 20 mg orally daily
  4. Gastroesophageal Reflux
    1. Take 20 mg orally daily
  5. Gastric Ulcer
    1. Take 40 mg orally daily
  6. Zollinger Ellison Syndrome
    1. Take 60 mg orally daily
  • Dosing
  • Children
  1. Indicated in GERD, erosive Esophagitis, and off-label use for Peptic Ulcers
  2. Background
    1. May sprinkle opened capsule onto applesauce or acidic liquid
  3. Infants
    1. Give 0.7 mg/kg orally daily
  4. Weight 5-10 kg (and age >1 year old)
    1. Give 5 mg orally daily
  5. Weight 10-20 kg
    1. Give 10 mg orally daily
  6. Weight >20 kg
    1. Give 20 mg orally daily
  7. References
    1. Baird (2015) Am Fam Physician 92(8): 705-14 [PubMed]
  • Pharmacokinetics
  1. All PPIs have short plasma half life of 1-2 hours
  2. Effect is delayed 5-7 days until proton pumps are fully blocked
  3. Metabolized by CYP2C19 and CYP3A4
  4. Inhibits CYP2C19
  5. Induces CYP1A2
  • Mechanism
  1. See Proton Pump Inhibitor
  • Adverse Effects
  1. See Proton Pump Inhibitor
  • Precautions
  1. See Proton Pump Inhibitor
  • Safety
  1. Pregnancy Category C (other PPIs are category B)
  2. Unknown safety in Lactation
  • Efficacy
  1. See Proton Pump Inhibitor
  • Drug Interactions
  1. See Proton Pump Inhibitor
  2. Voriconazole
    1. Doubles the serum levels of Omeprazole
  3. Drug level increases specific to Omeprazole
    1. Carbamazepine (Tegretol)
    2. Diazepam (Valium)
    3. Phenytoin (Dilantin)
    4. Warfarin (Coumadin)
    5. Methotrexate
  4. Clopidogrel (Plavix)
    1. Omeprazole lowers Clopidogrel efficacy
    2. Increased major coronary events occurred within one year of PTCA
      1. Attributed to Omeprazole's interaction with Clopidogrel
      2. Gaglia (2010) Am J Cardiol 105(6): 833-8 [PubMed]
    3. Pantoprazole (Protonix) does not lower Clopidogrel efficacy
      1. Juurlink (2009) CMAJ 180(7): 713-8 [PubMed]
    4. Avoid Omeprazole following PTCA and coronary stenting
      1. Consider H2 Blocker or Pantoprazole instead
    5. As of 2015, no consistent Drug Interaction between Proton Pump Inhibitors and Clopidogrel
      1. Melloni (2015) Circ Cardiovasc Qual Outcomes 8(1): 47-55 +PMID: 25587094 [PubMed]
  • Resources
  1. Omeprazole Delayed Release Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5a09ce48-7139-4fc7-9b6e-439459c8e866
  • References
  1. (2022) Comparison of Proton Pump Inhibitors, Presc Lett, #380327
  2. (2012) Prescr Lett 19(3): 14 [PubMed]
  3. (2013) Prescr Lett 20(5): 30 [PubMed]
  4. (2001) Med Lett Drugs Ther 43(1103):36-7 [PubMed]
  5. Ament (2012) Am Fam Physician 86(1): 66-70 [PubMed]
  6. Vanderhoff (2002) Am Fam Physician 66(2):273-80 [PubMed]