Hyperacidity, GERD, and ulcers:
Indications for Omeprazole:
Triple therapy (w. amoxicillin + clarithromycin) or dual therapy (w. clarithromycin) 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.
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 mins to thicken, stir and drink within 30 mins. NG or gastric tube: see full labeling. Triple therapy: omeprazole 20mg + clarithromycin 500mg + amoxicillin 1g, all every 12hrs 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 weeks; may continue 4 more weeks. 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 weeks; may give up to 4 more weeks (if relapse of erosive esophagitis or GERD symptoms occurs may give additional 4–8 week 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).
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 mins to thicken, stir and drink within 30 mins. NG or gastric tube: see full labeling. <1yr: not established. 1–16yrs: GERD, EE: 5–<10kg: 5mg daily. 10–<20kg: 10mg daily; ≥20kg: 20mg daily.
Gastric malignancy. Discontinue and evaluate if acute tubulointerstitial nephritis, cutaneous/systemic lupus erythematosus occurs. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12 or atrophic gastritis. Monitor magnesium levels during prolonged therapy. Increased risk of fundic gland polyps with long-term use (esp. >1yr) or osteoporosis-related fractures (hip, wrist or spine) with long-term (>1yr) and multiple daily dose PPI therapy. Use lowest dose for shortest duration appropriate to condition. Pregnancy. Nursing mothers.
Proton pump inhibitor.
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. Caution with drugs that may cause hypomagnesemia (eg, digoxin, diuretics); monitor. 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, erlotinib, mycophenolate mofetil, digoxin, iron salts, ampicillin). Monitor drugs metabolized by CYP450 (eg, cyclosporine, disulfiram, benzodiazepines). May give antacids concomitantly. May interfere with neuroendocrine diagnostic tests; discontinue omeprazole 14 days prior to CgA level assessment.
Headache, abdominal pain, nausea, vomiting, diarrhea, flatulence; bone fracture, possible C. difficile-associated diarrhea; rare: hypomagnesemia. Children: also, respiratory system events, fever.
Note: See Amoxil entry for more information on amoxicillin. See Biaxin entry for more information on clarithromycin.
Generic Drug Availability:
Caps (YES); susp (NO)
Caps—contact supplier; Packets—30