PRILOSEC Rx

Indications for PRILOSEC:

Triple therapy (w. amoxicillin + clarithromycin) or dual therapy (w. amoxicillin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment of active benign gastric ulcer, active duodenal ulcer, erosive esophagitis (EE), symptomatic GERD. Maintenance of healing of EE. Pathological hypersecretory conditions.

Adult Dose for PRILOSEC:

Take before eating. Caps: swallow whole, or may mix contents of caps in applesauce and take immediately; do not crush or chew granules; follow with water. Susp: Mix 2.5mg packet with 5mL of water; mix 10mg packet with 15mL of water. Leave 2–3 minutes to thicken, stir and drink within 30 minutes. NG or gastric tube: see full labeling. Triple therapy: omeprazole 20mg + clarithromycin 500mg + amoxicillin 1g, all every 12 hrs for 10 days; then (if ulcer was present at start): omeprazole 20mg once daily in the AM on days 11–28. Dual therapy (clarithromycin resistance more likely to develop than with triple therapy): omeprazole 40mg once daily in the AM + clarithromycin 500mg three times daily on days 1–14; then (if ulcer was present at start) omeprazole 20mg once daily in the AM on days 15–28. Active duodenal ulcer: 20mg once daily for 4 wks; may continue 4 more wks. Gastric ulcer: 40mg once daily for 4–8 weeks. GERD (no esophageal lesions): 20mg once daily for up to 4 weeks. EE with GERD symptoms: 20mg once daily for 4–8 wks; may give up to 4 more wks (if relapse of erosive esophagitis or GERD symptoms occurs may give additional 4–8 wk course). Maintenance of healing of EE: 20mg once daily. Hypersecretory conditions: initially 60mg once daily, then adjust; doses up to 120mg 3 times daily have been used; give doses >80mg/day in divided doses. Hepatic impairment or Asian: consider reducing dose (esp. for maintenance of healing of EE).

Children's Dose for PRILOSEC:

Take before eating. Caps: swallow whole, or may mix contents of caps in applesauce and take immediately; do not crush or chew granules; follow with water. Susp: Mix 2.5mg packet with 5mL of water; mix 10mg packet with 15mL of water. Leave 2–3 minutes to thicken, stir and drink within 30 minutes. NG or gastric tube: see full labeling. <1yr: not recommended. 1–16yrs: GERD, EE: 5<10kg: 5mg daily. 10<20kg: 10mg daily; ≥20kg: 20mg daily.

See Also:

PRILOSEC for ORAL SUSPENSION

Pharmacological Class:

Proton pump inhibitor.

Warnings/Precautions:

Gastric malignancy. Increased risk of osteoporosis-related fractures of the hip, wrist or spine with long-term and multiple daily dose PPI therapy. Monitor magnesium levels with long-term therapy. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions:

Concomitant St. John's wort, rifampin, atazanavir, nelfinavir: not recommended. Potentiates saquinavir, cilostazol; consider dose reduction of these drugs. May potentiate diazepam, phenytoin, warfarin, tacrolimus, methotrexate. Potentiated by voriconazole; may need to adjust omeprazole dose in Zollinger-Ellison syndrome. Antagonizes clopidogrel; consider alternative anti-platelet therapy. May alter absorption of pH-dependent drugs (eg, ketoconazole, digoxin, iron salts, ampicillin). Monitor drugs metabolized by CYP450 (eg, cyclosporine, disulfiram, benzodiazepines). May give antacids concomitantly. May interfere with neuroendocrine diagnostic tests.

Adverse Reactions:

Headache, abdominal pain, GI upset, flatulence; bone fracture, hypomagnesemia (w. prolonged PPI therapy), possible C. difficile associated diarrhea. Children: also, respiratory system events, fever.

Note:

Note: See Amoxil entry for more information on amoxicillin. See Biaxin entry for more information on clarithromycin.

Metabolism:

Hepatic (CYP450). 95% protein bound.

Elimination:

Renal, fecal.

Generic Availability:

Caps (YES); susp (NO)

How Supplied:

Caps 10mg—30; 20mg—30, 1000; 40mg—30, 100; packets—30