Omeprazole/Sodium bicarbonate

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[edit] BRAND NAMES

[edit] STRUCTURE

Omeprazole.jpg

[edit] MECHANISM OF ACTION

Omeprazole is a proton pump inhibitors. it decreases the amount of acid produced in the stomach by inhibition of H+/K+ ATPase located in the luminal membrane of gastric parietal cells.

Sodium bicarbonate raises the gastric pH and thus protects omeprazole from acid degradation.

[edit] INDICATIONS

[edit] DOSAGE

  • Gastroesophageal Reflux Disease and and Erosive Esophagitis: Adults, 20mg/day for 4-8 weeks
  • Treatment of duodenal ulcer: 20 mg once daily for 4-8 weeks
  • Treatment of gastric ulcer: 40 mg once daily for 4-8 weeks

[edit] CONTRAINDICATIONS

  • Known hypersensitivity to any components of the formulation

[edit] WARNINGS AND PRECAUTIONS

  • Symptomatic response to therapy with Omeprazole/Sodium bicarbonate combination does not preclude the presence of gastric malignancy
  • Proton pump inhibitor (PPI) therapy may be associated with increased risk of Clostridium difficile associated diarrhea.
  • Avoid concomitant use of Omeprazole/Sodium bicarbonate combination with clopidogrel
  • Long-term and multiple daily dose PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist, or spine.
  • Hypomagnesemia has been reported rarely with prolonged treatment with PPIs
  • Avoid concomitant use of Omeprazole/Sodium bicarbonate combination with St John’s Wort or rifampin due to the potential reduction in omeprazole concentrations.

[edit] INTERACTIONS

  • Drugs for which gastric pH can affect bioavailability (e.g.,ketoconazole, ampicillin esters, iron salts, and digoxin): Omeprazole/Sodium bicarbonate combination may interfere with absorption due to inhibition of gastric acid secretion.
  • Drugs metabolized by cytochrome P450 (e.g., diazepam, warfarin, phenytoin, cyclosporine, disulfiram, benzodiazepines): Omeprazole/Sodium bicarbonate combination can prolong their elimination. Monitor to determine the need for possible dose adjustments.
  • Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time
  • Atazanavir and Nelfinavir: Omeprazole/Sodium bicarbonate combination reduces plasma levels of Atazanavir and Nelfinavir. Concomitant use is not recommended
  • Saquinavir: Omeprazole/Sodium bicarbonate combination increases plasma levels of saquinavir
  • Voriconazole: Voriconazole, a combined inhibitor of CYP2C19 and CYP3A4, may increase plasma levels of omeprazole
  • Clopidogrel: Omeprazole decreases exposure to the active metabolite of clopidogrel
  • Tacrolimus: Omeprazole may increase serum levels of tacrolimus
  • Methotrexate: Omeprazole may increase serum level of methotrexate

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Omeprazole should be used during pregnancy only if clearly needed.
  • Nursing mothers: Omeprazole is excreted in human milk, because of the potential for serious adverse reactions in nursing infants from omeprazole, and because of the potential for tumorigenicity shown for omeprazole in rat carcinogenicity studies, a decision should be made to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. In addition, sodium bicarbonate should be used with caution in nursing mothers.

[edit] SIDE EFFECTS

  • Most common adverse reactions (incidence ≥ 2%) are: Headache, abdominal pain, nausea, diarrhea, vomiting, and flatulence

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Heartburn/Gastritis/Gastric ulcer/Duodenal ulcer/Gastroesophageal reflux
H2 antagonists Famotidine   Nizatidine   Ranitidine (Zantac)
Proton-pump inhibitors Dexlansoprazole (Dexilant)   Esomeprazole (Nexium)   Lansoprazole (Prevacid)   Omeprazole (Losec, Prilosec)   Omeprazole/Sodium bicarbonate (Zegerid)   Pantoprazole (Controloc, Pantecta, Pantoloc, Protonix) (  Rabeprazole (Aciphex, Pariet)
Prostaglandins Misoprostol (Cytotec)
Other drugs Alginic acid   Magaldrate   Sucralfate
Combination Regimens Bismuth Subcitrate Potassium/Metronidazole/Tetracycline (Pylera)   Lansoprazole/Amoxicillin/Clarithromycin (Prevpac)