omeprazole

(oh me' pray zol)

Losec (CAN), Prilosec

Pregnancy Category C

Drug classes
Antisecretory agent
Proton pump inhibitor

Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of
the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric
parietal cells; blocks the final step of acid production.

Indications
 Short-term treatment of active duodenal ulcer
 First-line therapy in treatment of heartburn or symptoms of gastroesophageal
reflux disease (GERD)
 Short-term treatment of active benign gastric ulcer
 GERD, severe erosive esophagitis, poorly responsive symptomatic GERD
 Long-term therapy: Treatment of pathologic hypersecretory conditions (Zollinger-
Ellison syndrome, multiple adenomas, systemic mastocytosis)
 Eradication of H. pylori with amoxicillin or metronidazole and clarithromycin
 Prilosec OTC: Treatment of frequent heartburn (2 or more days per wk)
 Unlabeled use: Posterior laryngitis; enhance efficacy of pancreatin for the
treatment of steatorrhea in cystic fibrosis

Contraindications and cautions

 Contraindicated with hypersensitivity to omeprazole or its components.
 Use cautiously with pregnancy, lactation.

Available forms
DR capsules—10, 20, 40 mg; DR tablets—20 mg (OTC)

Dosages
ADULTS
 Active duodenal ulcer: 20 mg PO daily for 4–8 wk. Should not be used for
maintenance therapy.
 Active gastric ulcer: 40 mg PO daily for 4–8 wk.
 Severe erosive esophagitis or poorly responsive GERD: 20 mg PO daily for 4–8
wk. Do not use as maintenance therapy. An additional 4–8 wk course can be
considered if needed.
 Pathologic hypersecretory conditions: Individualize dosage. Initial dose is 60 mg
PO daily. Doses up to 120 mg tid have been used. Administer daily doses of >
80 mg in divided doses.
  Frequent heartburn (2 or more days/wk): 20 mg (Prilosec OTC tablet) PO once
daily before eating in the AM for 14 days. May repeat the 14-day course q 4 mo.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak
Oral Varies 0.5–3.5 hr

Metabolism: Hepatic; T1/2: 0.5–1 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and bile

Adverse effects
 CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety,
paresthesias, dream abnormalities
 Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
 GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue
atrophy
 Respiratory: URI symptoms, cough, epistaxis
 Other: Cancer in preclinical studies, back pain, fever

Interactions
Drug-drug
 Increased serum levels and potential increase in toxicity of benzodiazepines,
phenytoin, warfarin; if these combinations are used, monitor patient very closely
 Decreased absorption with sucralfate; give these drugs at least 30 min apart

Nursing considerations
Assessment
 History: Hypersensitivity to omeprazole or any of its components; pregnancy,
lactation
 Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam;
respiratory auscultation

Interventions
 Administer before meals. Caution patient to swallow capsules whole—not to
open, chew, or crush them.
 Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux
disorders; not intended for maintenance therapy. Symptomatic improvement does
not rule out gastric cancer, which did occur in preclinical studies.
 Administer antacids with omeprazole, if needed.

Teaching points
 Take the drug before meals. Swallow the capsules whole; do not chew, open, or
crush them. This drug will need to be taken for up to 8 wk (short-term therapy) or
for a prolonged period (> 5 yr in some cases).
  Have regular medical follow-up visits.
 These side effects may occur: Dizziness (avoid driving or performing hazardous
tasks); headache (request medications); nausea, vomiting, diarrhea (maintain
proper nutrition); symptoms of upper respiratory tract infection, cough (do not
self-medicate; consult with your health care provider if uncomfortable).
 Report severe headache, worsening of symptoms, fever, chills.

Adverse effects in Italic are most common; those in Bold are life-threatening.