Omeprazole

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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

[edit] INDICATIONS

  • Treatment of Gastroesophageal reflux disease (GERD)
  • Treatment of duodenal and gastric ulcers
  • H. Pylori bacteria eradication to reduce recurrence of Duodenal Ulcer
  • Zollinger-Ellison syndrome

[edit] DOSAGE

  • Gastroesophageal Reflux Disease:
    • Adults: 20mg/day for 4-8 weeks
    • 1-16 Year Olds:
      • 5-10 kg, 5 mg once daily
      • 10-20 kg, 10 mg once daily
      • More than 20 kg, 20 mg once daily
  • Treatment of duodenal ulcer: 20 mg once daily for 4-8 weeks
  • Treatment of gastric ulcer: 40 mg once daily for 4-8 weeks
  • H. pylori Eradication (Triple Therapy): Omeprazole (20 mg) twice daily + Amoxicillin (1000 mg) Twice Daily + Clarithromycin (500 mg) Twice Daily, for 10-14 days
  • Zollinger-Ellison syndrome: 60 mg once daily

[edit] CONTRAINDICATIONS

  • Known hypersensitivity to Omeprazole

[edit] WARNINGS AND PRECAUTIONS

  • Symptomatic response to therapy with Omeprazole 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 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 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, Itraconazole, ampicillin esters, iron salts, and digoxin): Omeprazole 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 can prolong their elimination. Monitor to determine the need for possible dose adjustments when taken with Omeprazole.
  • 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 reduces plasma levels of Atazanavir and Nelfinavir. Concomitant use is not recommended
  • Saquinavir: Omeprazole 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: A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

[edit] SIDE EFFECTS

Most common adverse reactions in adults are: diarrhea, headache, flatulence, abdominal pain, nausea, constipation and dizziness/vertigo

[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)