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OMEPRAZOLE

(o-me'pra-zole)
Losec , Prilosec, Prilosec OTC, Zegerid
Classifications: gastrointestinal agent; proton pump inhibitor
Pregnancy Category: C

Availability
10 mg, 20 mg, 40 mg capsules; 20 mg powder for oral suspension

Actions
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid
secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in
the parietal cells.

Therapeutic Effects
Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer
healing.

Uses
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive
esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory
conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and
systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers
associated with Helicobacter pylori.

Contraindications
Long-term use for gastroesophageal reflux disease (GERD), duodenal ulcers; proton
pump inhibitors (PPIs), hypersensitivity; children <2 y; use of OTC formulation in
children <18 y or GI bleeding; pregnancy (category C); use of Zegerid in metabolic
alkalosis, hypocalcemia, vomiting, GI bleeding.

Cautious Use
Dysphagia; metabolic or respiratory alkalosis; lactation.
Route & Dosage
Gastroesophageal Reflux, Erosive Esophagitis, Duodenal Ulcer
Adult: PO 20 mg once/d for 4–8 wk

Gastric Ulcer
Adult: PO 20 mg b.i.d. for 4–8 wk

Hypersecretory Disease
Adult: PO 60 mg once/d up to 120 mg t.i.d.

Duodenal Ulcer Associated with H. pylori


Adult: PO 40 mg once/d for 14 d, then 20 mg/d for 14 d, in combination with
clarithromycin 500 mg t.i.d. for 14 d

Administration
Oral

• Give before food, preferably breakfast; capsules must be swallowed whole (do not
open, chew, or crush).
• Note: Antacids may be administered with omeprazole.

Adverse Effects ( 1%)


CNS: Headache, dizziness, fatigue. GI: Diarrhea, abdominal pain, nausea, mild transient
increases in liver function tests. Urogenital: Hematuria, proteinuria. Skin: Rash.

Diagnostic Test Interference


Omeprazole has been reported to significantly impair peak cortisol response to
exogenous ACTH. This finding is undergoing further investigation.

Interactions
Drug: Concomitant administration of diazepam and omeprazole may increase diazepam
concentrations. Concomitant administration of phenytoin and omeprazole may increase
phenytoin levels. Concomitant administration of warfarin and omeprazole may increase
warfarin levels.
Pharmacokinetics
Absorption: Poorly absorbed from GI tract; 30%–40% reaches systemic circulation.
Onset: 0.5–3.5 h. Peak: Peak inhibition of gastric acid secretion: 5 d. Metabolism:
Metabolized in liver. Elimination: 80% excreted in urine, 20% in feces. Half-Life: 0.5–
1.5 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

• Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver
function tests with prolonged use.

Patient & Family Education

• Report any changes in urinary elimination such as pain or discomfort associated


with urination, or blood in urine.
• Report severe diarrhea; drug may need to be discontinued.
• Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined: generic names in


bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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