1. Overview

Brand (Trade) names: Prilosec, Prilosec OTC

Omeprazole: is a proton pump inhibitor that reduces the amount of acid the stomach produces, hence is used for diseases which are caused (or worsened) by stomach acid. Generally speaking, omeprazole treats 4 different diseases:

• Heart burn (GERD)
• Acid related indigestion (dyspepsia)
• Stomach ulcers and duodenal ulcers
• Zollinger-Ellison symptom

Omeprazole is available as 10, 20 or 40mg.

2. Uses

Omeprazole is used to treat:

1. Heartburn: Clinically known as GERD and reflux esophagitis, it is the persistent reflux of gastric contents into the esophagus, it is associated with a weak or malfunctioning lower esophageal sphincter.
2. Acid related dyspepsia: dyspepsia= indigestion, which is defined as epigastric discomfort or pain following eating.
3. Peptic ulcers: are open sores that develop inside the lining of stomach (gastric ulcers) or Duodenum (duodenal ulcers).

   The most common symptom (clinical manifestation) of peptic ulcers is a burning or gnawing or cramp-like pain located in the center of the abdomen.

   Most common symptom: stomach pain.

   Less common symptoms include indigestion and heartburn.

   These ulcers could be caused by too much production of acid in stomach; hence omeprazole could be an effective treatment.

   A variety of risk factors have been shown to have an association with peptic ulcer disease. The two most important ones are infection with the bacteria Helicobacter pylori and use of NSAIDs (e.g., Aspirin).

   Omeprazole can also be used to treat:

   • Peptic ulcers associated with H pylori infection.
   • Peptic ulcers associated with NSAIDS (Aspirin appears to be the most ulcerogenic of the NSAIDs.)
4. Zollinger-Ellison syndrome: is a rare disorder caused by gastrin-secreting tumors (gastrinomas). These tumors are most commonly located in the small intestine or pancreas and release a large amount of gastrin that cause stomach to release large amount of acid.

3. Dosage forms

Omeprazole is available as:

1. Oral suspension: (Oral formulations of these drugs are enteric coated to prevent acid inactivation in the stomach).
2. Powder for solution for infusion.
3. Capsules: contain enteric coated granules.
4. Tablets: delayed-release and enteric coated.

An immediate-release formulation (omeprazole and sodium bicarbonate capsules and powder for oral suspension).

4. How & when to take omeprazole

It’s best to take omeprazole before meals (preferably before breakfast).

Don’t crush, break, divide or dissolve tablets which are intended to be taken as whole.

For children and some patients, you can open capsule formulations (but not tablets) and mix the microgranules with juice to be taken immediately.

Avoid alcohol drinking. Alcohol itself doesn’t interfere with how omeprazole works, but it irritates the stomach can result in ulceration and heartburn.

5. Dose per day

For adults:

1. Duodenal or Gastric Ulcer Healing: (20–40) mg once daily
2. Peptic ulcer disease and gastroesophageal reflux disease (GERD): 20 mg once daily for 4 or 8 weeks
3. severe esophagitis: 40 mg once a day
4. Prevention of rebleeding from peptic ulcers: 40 mg orally twice daily
5. Non-steroidal anti-inflammatory drug (NSAID) induced ulceration: 20 mg daily for 4 weeks
6. Helicobacter pylori Infection: Omeprazole 20 mg twice a day for 14 days with two other antibiotics (clarithromycin and amoxicillin)
7. Zollinger-Ellison syndrome: 60mg once daily

For infant and children, it’s often determined by the prescriber.

6. Using omeprazole without prescription

Adults and elderly who have frequent heartburn, can buy oral omeprazole from a near pharmacy and take 20mg per day for 14 days until the symptoms disappear.

7. Side effects

While most individuals who use omeprazole do not have any side effects, the medicine may also cause some unwanted effects. Side effects like diarrhea are usually mild, and usually disappear after a while of using omeprazole.

Common side effects: Headache, Diarrhea

Rare side effects: Nausea, Constipation and Rash

Discuss the above side effects with your doctor if they are severe, you should immediately stop using omeprazole if you notice rashes and discuss it with your physician as soon as possible in case of allergy possibility.

8. Interactions

Omeprazole can interact with the following medications and increase the likelihood and severity of side effects, hence it’s best not to take these medications with omeprazole.

Ciclosporin and Tacrolimus which are used as immunosuppressant medications.

Atazanavir: Used for treatment of HIV/AIDS, its effects will be reduced if used with omeprazole.

Warfarin: the effects of this blood-thinning medicine will be increased if used with omeprazole, hence there will be higher chance of bleeding.

Clopidogrel: Is also used as a blood-thinning medicine since it has anti-platelet effect, omeprazole causes reduction in its effects.

Ketoconazole and itraconazole: Omeprazole decrease the blood levels of these antifungal drugs.

Phenytoin: Anti-epilepsy effects may be increased if used with omeprazole.