Omeprazole

About Omeprazole

Omeprazole blocks the proton pump that acid-producing cells in the stomach use to release acid. The Prilosec label approves it in adults for active duodenal and benign gastric ulcers, for H. pylori infection with clarithromycin (alone or with amoxicillin) to lower the risk of a duodenal ulcer returning, and for conditions with too much acid, such as Zollinger-Ellison syndrome. In children it is labeled for healing erosive esophagitis from 1 month of age, and for reflux symptoms and keeping erosive esophagitis healed from age 1. Adults usually take 20 mg once a day before a meal for four to eight weeks (up to four for reflux symptoms; 40 mg for a gastric ulcer); H. pylori and Zollinger-Ellison regimens differ, and children are dosed by weight.

There is no boxed warning. Omeprazole must not be taken by anyone allergic to it or to related drugs (substituted benzimidazoles), or with rilpivirine, an HIV medicine. Relief of symptoms does not rule out stomach cancer. The label warns of acute kidney inflammation; C. difficile diarrhea, especially in hospitalized patients; hip, wrist and spine fractures with high doses (several a day) and long-term use (a year or longer); severe skin reactions; lupus; vitamin B12 deficiency after daily acid suppression over a long time (for example, longer than three years); low magnesium, reported rarely after at least three months and mostly after a year, which can cause muscle spasms, abnormal heart rhythms and seizures; and fundic gland polyps with long-term use. It advises the lowest dose for the shortest time that suits the condition. Headache, abdominal pain, nausea, diarrhea, vomiting and gas are the most common side effects.

Over-the-counter omeprazole (Prilosec OTC, Zegerid OTC and generics) treats frequent heartburn in adults 18 and older: one dose each morning before eating for 14 days, repeated no more often than every 4 months unless a doctor directs. Prescription omeprazole with sodium bicarbonate is for adults only, is taken at least an hour before a meal and carries enough sodium to matter on a sodium-restricted diet; two 20 mg capsules or packets must not replace one 40 mg, since each holds the same amount of bicarbonate. Konvomep (2022), a suspension of the two that the pharmacy mixes, is labeled for adults with a gastric ulcer and critically ill adults at risk of upper GI bleeding. Omeprazole is stopped at least 14 days before a chromogranin A blood test, and studies of use early in pregnancy have not shown more major birth defects.

Taking Omeprazole

How to take it

Take capsules and packets before a meal, usually once a day. Swallow capsules whole, or sprinkle the contents on a tablespoon of applesauce that is not hot and swallow at once with a glass of cool water, without chewing; mix a 2.5 mg packet with 5 mL of water or a 10 mg packet with 15 mL, wait 2 to 3 minutes, stir and drink within 30 minutes. Take capsules or packets with sodium bicarbonate at least an hour before a meal, with water only.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take two doses at once.

Storage

At room temperature in a tightly closed container, away from light, heat and moisture, out of reach of children. Refrigerate Konvomep once mixed and use it within 30 days.

Interactions to know about

Never with rilpivirine; avoid clopidogrel, St. John’s wort, rifampin, atazanavir and nelfinavir. Citalopram is limited to 20 mg a day, cilostazol is lowered, and warfarin, phenytoin, tacrolimus and diazepam may need monitoring. It can raise high-dose methotrexate levels and reduce absorption of iron, erlotinib, ketoconazole and mycophenolate.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Omeprazole differs from pharmacy to pharmacy

Generic omeprazole capsules come from many makers, so quotes for the same capsules differ mainly by each pharmacy’s fee and markup and by whether omeprazole is on its flat-price generic list. Prilosec packets have no generic and are priced as a brand, Konvomep is a brand the pharmacy prepares, and omeprazole with sodium bicarbonate is a separate product from plain omeprazole; none of these forms can be swapped for another at the counter.

Over-the-counter omeprazole is sold off the shelf, outside a prescription quote.

Ways to pay less for Omeprazole without insurance

• Ask for generic capsules, check that the prescription does not block substitution, and compare more than one pharmacy.
• If packets, Konvomep or omeprazole with sodium bicarbonate is prescribed and you can swallow capsules, ask the prescriber whether capsules would suit you.
• For long-term use, ask for a ninety-day supply, and ask the prescriber at each review whether you still need it.
• Ask the prescriber whether an over-the-counter 20 mg product fits your treatment.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Omeprazole

1. 1.Which form is my prescription for, and can it be swapped?
2. 2.Is it safe with my clopidogrel, HIV medicine, citalopram or warfarin?
3. 3.When should my need for it be reviewed?
4. 4.Should my magnesium or vitamin B12 be checked?

Related medications