omeprazole

TOP 100

oh-mep-ra-zole

Trade Name(s): (Losec , PriLOSEC, PriLOSEC OTC)

Do not confuse omeprazole with ARIPiprazole, pantoprazole, or esomeprazole, or PriLOSEC with Plendil, Prevacid, Prinivil, or PROzac.

FIXED-COMBINATION(S)

Konvomep: omeprazole/sodium bicarbonate (an antacid): 2 mg/84 mg/mL. Yosprala: omeprazole/aspirin (a platelet aggregation inhibitor): 40 mg/81 mg, 40 mg/325 mg. Zegerid: omeprazole/sodium bicarbonate (an antacid): 20 mg/1,100 mg, 40 mg/1,100 mg. Zegerid Powder: 20 mg/1,680 mg, 40 mg/1,680 mg.

• PHARMACOTHERAPEUTIC:Benzimidazole. CLINICAL:Proton pump inhibitor.

Duodenal ulcer: Short-term treatment (usually within 4 wks) of active duodenal ulcer in adults. Gastric ulcer: Short-term treatment (4–8 wks) of active benign gastric ulcer in adults. Gastroesophageal reflux disease (GERD): Treatment of symptomatic GERD (e.g., heartburn and other symptoms) for up to 4 wks in pts 1 yr of age and older. Short-term treatment (4–8 wks) of erosive esophagitis (EE) due to acid-mediated GERD that has been diagnosed by endoscopy in pts 1 yr of age and older. Maintenance healing of EE due to acid-mediated GERD in pts 1 yr of age and older. Pathological hypersecretory conditions: Long-term treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic mastocytosis) in adults. OFF-LABEL: Prevention/treatment of NSAID-induced ulcers, stress ulcer prophylaxis in critically ill pts. Barrett's esophagus, dyspepsia (functional). Eosinophilic esophagitis.

Contraindications: Hypersensitivity to omeprazole, other proton pump inhibitors. Concomitant use with products containing rilpivirine. Cautions: May increase risk of fractures, gastrointestinal infections. Hepatic impairment, pts of Asian descent.

Inhibits hydrogen-potassium adenosine triphosphatase (H⁺/K⁺ ATP pump), an enzyme on the surface of gastric parietal cells. Therapeutic Effect: Increases gastric pH, reduces gastric acid production.

Rapidly absorbed from GI tract. Protein binding: 95%. Primarily distributed into gastric parietal cells. Metabolized in liver. Primarily excreted in urine. Unknown if removed by hemodialysis. Half-life: 0.5–1 hr (increased in hepatic impairment).

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Children: Safety and efficacy not established. Elderly: Use caution (bioavailability may be increased).

DRUG: May decrease concentration/effects of acalabrutinib, atazanavir, bosutinib, cefuroxime, clopidogrel, dasatinib, neratinib. May increase concentration/effects of escitalopram, voriconazole, oral anticoagulants (e.g., warfarin), phenytoin. HERBAL: St. John's wort may decrease concentration/effects. FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, ALT, AST.

Oral Suspension: 2.5 mg/packet, 10 mg/packet.

Capsules, Delayed-Release: (PriLOSEC): 10 mg, 20 mg, 40 mg. Tablets, Delayed-Release: (PriLOSEC OTC): 20 mg.

PO

• Give 30–60 min before meals (breakfast preferred).
• Give whole. Do not break, crush, dissolve, or divide delayedrelease forms.
• May open capsule, mix with applesauce, and give immediately.

PO (Suspension)

• Following reconstitution, allow to thicken (2–3 min).
• Administer within 30 min.

Duodenal Ulcer

PO: ADULTS, ELDERLY: 20 once daily for up to 4 wks.

Gastric Ulcer

PO: ADULTS, ELDERLY: 40 mg once daily for 4–8 wks.

GERD

PO: ADULTS, ELDERLY, CHILDREN 1–16 YRS OF AGE (20 KG OR GREATER): Symptomatic: 20 mg once daily for up to 4 wks. 10–19 KG: 10 mg once daily. 5–9 KG: 5 mg once daily. EE due to Acid-Mediated GERD: ADULTS, ELDERLY, CHILDREN 1–16 YRS OF AGE (20 KG OR GREATER): 20 mg once daily for 4–8 wks. 10–19 KG: 10 mg once daily. 5–9 KG: 5 mg once daily. INFANTS 1 MOS TO LESS THAN 1 YR: 10 KG OR GREATER: 10 818 ondansetron mg for up to 6 wks. 5–9 KG: 5 mg. 3–4 KG: 2.5 mg. Maintenance of Healing of EE due to Acid-Mediated GERD: ADULTS, ELDERLY, CHILDREN 1–16 YRS OF AGE (20 KG OR GREATER): 20 mg once daily. 10–19 KG: 10 mg once daily. 5–9 KG: 5 mg once daily for 1 yr (studies do not extend beyond 1 yr).

Pathological Hypersecretory Conditions

PO: ADULTS, ELDERLY: Initially, 60 mg once daily. May increase up to 120 mg 3 times/day. Continue as long as clinically indicated.

H. pylori

PO: ADULTS, ELDERLY: Triple Therapy: 20 mg (with amoxicillin 1000 mg and clarithromycin 500 mg) twice daily for 10 days. Continue omeprazole for additional 18 days for ulcer healing/symptom relief. Dual Therapy: 40 mg once daily (clarithromycin 500 mg 3 times/day) for 14 days. Continue omeprazole for additional 14 days for ulcer healing/symptom relief.

OTC Use (Frequent Heartburn)

PO: ADULTS, ELDERLY: 20 mg/day for 14 days. May repeat after 4 mos if needed.

Dosage in Renal/Hepatic Impairment

No dose adjustment.

Frequent (7%): Headache. Occasional (3%–2%): Diarrhea, abdominal pain, nausea. Rare (2%): Dizziness, asthenia, vomiting, constipation, upper respiratory tract infection, back pain, rash, cough.

Pancreatitis, hepatotoxicity, interstitial nephritis occur rarely. May increase risk of C. difficile infection.

• INTERVENTION/EVALUATIONEvaluate for therapeutic response (relief of GI symptoms). Question if GI discomfort, nausea, diarrhea occurs.PATIENT/FAMILY TEACHING
• Report headache, onset of black, tarry stools, diarrhea, abdominal pain.
• Avoid alcohol.
• Swallow capsules whole; do not chew, crush, dissolve, or divide.
• Take before eating.