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Prilosec (omeprazole)


Proton pump inhibitor (PPI)




Short-term treatment of active duodenal ulcer (DU) and active benign gastric ulcer in adults. Treatment of heartburn and other symptoms associated with GERD in adults and pediatric patients. Short-term treatment and maintenance of healing of erosive esophagitis in adults and pediatric patients. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic mastocytosis) in adults. Combination therapy with clarithromycin +/- amoxicillin in Helicobacter pylori infection and DU disease for H. pylori eradication in adults.


Helicobacter pylori Eradication

Triple Therapy:
20mg + clarithromycin 500mg + amoxicillin 1000mg, each given bid x 10 days. Give additional 18 days of omeprazole 20mg qd if ulcer is present at the time of initiation of therapy

Dual Therapy:
40mg qd + clarithromycin 500mg tid x 14 days. Give additional 14 days of omeprazole 20mg qd if ulcer is present at the time of initiation of therapy

Active Duodenal Ulcer

20mg qd for 4-8 weeks

Gastroesophageal Reflux Disease

W/O Esophageal Lesions:
20mg qd for up to 4 weeks

W/ Erosive Esophagitis and Accompanying Symptoms:
20mg qd x 4-8 weeks

Erosive Esophagitis

20mg qd

Gastric Ulcers

40mg qd x 4-8 weeks

Pathological Hypersecretory Conditions

Long-term Treatment:
60mg qd
Titrate: Individualize and continue for as long as clinically indicated. Doses up to 120mg tid have been administered
Give >80mg/day in divided doses


Erosive Esophagitis

1-16 Years:
5-<10kg: 5mg/day
10-<20kg: 10mg/day
≥20kg: 20mg/day

Gastroesophageal Reflux Disease

1-16 Years:
5-<10kg: 5mg/day
10-<20kg: 10mg/day
≥20kg: 20mg/day


Hepatic Impairment
Consider dose reduction, particularly for maint of healing of erosive esophagitis

Other Important Considerations
Asian Population:
Consider dose reduction, particularly for maint of healing of erosive esophagitis


Oral route

Take ac

Swallow whole or, alternatively, open cap and sprinkle all pellets on 1 tbsp of applesauce, then swallow immediately w/ a glass of cool water; do not chew or crush the pellets

Empty the contents of a 2.5mg pkt into 5mL of water or 10mg pkt into 15mL of water
Stir and leave 2-3 min to thicken
Drink w/in 30 min
If any material remains after drinking, add more water, stir and drink immediately
NG/Gastric Tube:
Add 5mL of water to a catheter-tipped syringe and then add the contents of a 2.5mg pkt (or 15mL of water for the 10mg pkt)
Immediately shake the syringe and leave 2-3 min to thicken
Shake the syringe and inject through the NG or gastric tube, French size 6 or larger, into the stomach w/in 30 min
Refill the syringe w/ an equal amount of water; shake and flush any remaining contents into the stomach


Cap, Delayed-Release: 10mg, 20mg, 40mg; Sus, Delayed-Release: 2.5mg, 10mg (granules/pkt)


Symptomatic response does not preclude the presence of gastric malignancy. Atrophic gastritis reported with long-term use. Acute interstitial nephritis reported; d/c if this develops. Cyanocobalamin (vitamin B12) deficiency may occur due to malabsorption with daily long-term treatment (eg, >3 yrs) with any acid-suppressing medications. May increase risk of Clostridium difficile-associated diarrhea (CDAD), especially in hospitalized patients. May increase risk for osteoporosis-related fractures of the hip, wrist, or spine, especially with high-dose and long-term therapy. Use lowest dose and shortest duration appropriate to the condition being treated. Hypomagnesemia reported and may require Mg2+ replacement and discontinuation of therapy. Drug-induced decrease in gastric acidity results in enterochromaffin-like cell hyperplasia and increased chromogranin A (CgA) levels, which may interfere with investigations for neuroendocrine tumors; temporarily d/c treatment at least 14 days before assessing CgA levels and consider repeating test if initial CgA levels are high.


Headache, diarrhea, abdominal pain, N/V, flatulence.


May reduce atazanavir and nelfinavir levels; concomitant use not recommended. May change absorption or levels of antiretrovirals. May reduce absorption of drugs where gastric pH is an important determinant of their bioavailability; ketoconazole, atazanavir, iron salts, erlotinib, and mycophenolate mofetil (MMF) absorption can decrease, while digoxin absorption can increase. Caution in transplant patients receiving MMF. May prolong elimination of drugs metabolized by oxidation in the liver (eg, diazepam, warfarin, phenytoin). Monitor patients taking drugs metabolized by CYP450 (eg, cyclosporine, disulfiram, benzodiazepines). Monitor for increases in INR and PT with warfarin. Voriconazole (a combined inhibitor of CYP2C19 and CYP3A4) may increase levels; consider dose adjustment with Zollinger-Ellison syndrome. Decreased levels with CYP2C19 or CYP3A4 inducers; avoid with St. John's wort or rifampin. Reduces pharmacological activity of clopidogrel; avoid concomitant use. May increase levels of saquinavir, cilostazol, and tacrolimus; consider saquinavir and cilostazol dose reduction. Caution with digoxin or other drugs that may cause hypomagnesemia (eg, diuretics). May elevate and prolong levels of MTX and/or its metabolite, possibly leading to toxicities; consider temporary withdrawal of therapy with high-dose MTX.


Category C, caution in nursing.


Proton pump inhibitor; substituted benzimidazole that suppresses gastric acid secretion by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell.


Absorption: Rapid. Absolute bioavailability (30-40%); Tmax=0.5-3.5 hrs. Distribution: Plasma protein binding (95%); found in breast milk. Metabolism: Extensive via CYP450. Elimination: Urine (77%, metabolites), feces; T1/2=0.5-1 hr.


Assess for hypersensitivity to the drug or to substituted benzimidazoles, risk for osteoporosis-related fractures, hepatic impairment, pregnancy/nursing status, and possible drug interactions. Obtain baseline Mg2+ levels in patients expected to be on prolonged therapy.


Monitor for signs/symptoms of atrophic gastritis, acute interstitial nephritis, cyanocobalamin deficiency, bone fractures, hypersensitivity reactions, CDAD, and other adverse reactions. Monitor Mg2+ levels periodically in patients expected to be on prolonged therapy. Monitor INR and PT when given with warfarin.


Advise to immediately report and seek care for diarrhea that does not improve and for any cardiovascular/neurological symptoms. Inform of alternative administration options if patient has difficulty swallowing.


(Cap) 15-30°C (59-86°F). Protect from light and moisture. (Sus) 25°C (77°F); excursions permitted to 15-30°C (59-86°F).


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