Omeprazole

(oh-MEH-pray-ZAHL)

  Action:
Suppresses gastric acid secretion by blocking "acid (proton) pump" within gastric parietal cell.

  Indications:
Short-term treatment of active duodenal ulcer, gastroesophageal reflux disease (GERD), including erosive esophagitis and symptomatic GERD; long-term treatment of pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic mastocytosis); to maintain healing of erosive esophagitis; in combination with clarithromycin to eradicate H. pylori, use clarithromycin and amoxicillin in combination with omeprazole in patients with a 1-yr history of duodenal ulcers or active duodenal ulcers to eradicate H. pylori; short-term treatment of active benign gastric ulcer. Unlabeled use(s):Posterior laryngitis; enhanced efficacy of pancreatin for treatment of steatorrhea in cystic fibrosis.

  Contraindications:
Standard considerations.

  Route/Dosage:

Active Duodenal Ulcer

Adults:
PO 20 mg/day for 4 to 8 wk.

Erosive Esophagitis

Adults:
PO 20 mg/day for 4 to 8 wk.

Maintenance: 20 mg daily.

Pathologic Hypersecretory Conditions

Adults:
PO Initial dose: 60 mg/day. Doses up to 120 mg tid have been given. Divide daily doses > 80 mg.

H. pylori

Adults (triple therapy):
PO 20 mg omeprazole plus clarithromycin 500 mg plus amoxicillin 1000 mg each given bid for 10 days; continue omeprazole 20 mg daily for an additional 18 days if an ulcer is present at start of therapy.

Adults (dual therapy):
PO 40 mg omeprazole once daily plus clarithromycin 500 mg tid for 14 days; continue omeprazole 20 mg daily for an additional 14 days if an ulcer is present at start of therapy.

Gastric ulcer

Adults:
PO 40 mg once daily for 4 to 8 wk.

GERD

Adults (without esophageal lesions):
PO 20 mg daily for 4 wk.

Adults (with erosive esophagitis):
PO 20 mg daily for 4 to 8 wk.

  Interactions:

Benzodiazepines: Clearance of benzodiazepines may be decreased.

Clarithromycin: Serum concentrations of clarithromycin and omeprazole may be increased.

Drugs depending on gastric pH for bioavailability (eg, ketoconazole, iron salts, ampicillin): Absorption of these drugs may be affected.

Phenytoin: Decreased plasma clearance and increased half-life phenytoin.

Warfarin: Prolonged warfarin elimination.

  Lab Test Interferences:
None well documented.

  Adverse Reactions:

CV:

Angina; tachycardia; bradycardia; palpitation.

CNS:

Headache; dizziness.

DERM:

Rash.

GI:

Diarrhea; abdominal pain; acid regurgitation; nausea; vomiting; constipation; flatulence.

RESP:

Cough; upper respiratory infection.

OTHER:

Asthenia; back pain.

  Precautions:

Pregnancy: Category C.

Lactation: Undetermined.

Children: Safety and efficacy in children not established.

  Administration/Storage:

• Do not open, chew, or crush capsule. Instruct patient to swallow capsule whole.
• Divide daily doses > 80 mg.
• Give before meals or as one-time daily dose. If medication is administered once daily, give before dinner.
• Store at room temperature in original container tightly closed and protected from light.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies.
• Review baseline CBC and liver function test results, and monitor as indicated.
• Assess for coffee ground emesis, tarry stools, or constipation.
• Assess for any symptoms of hyperacidity (eg, dyspepsia, nausea, vomiting).
• Monitor elimination patterns and document any problems such as constipation.
• Assess skin for rashes or hives.
• Encourage adequate fluid intake and roughage in diet.

  Patient/Family Education:

• Advise patient not to chew or crush medication, and to swallow medication whole.
• Remind patient to take medication before meals.
• Inform patient that antacids may be taken concurrently with omeprazole.
• Advise patient to avoid tasks requiring alertness until response to medication is established.
• Caution patient to report the following symptoms to health care provider: cramping, diarrhea, rash, or hives.

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