Pri·lo·sec (pr  l -s k ) A trademark for the drug omeprazole. |
omeprazole
Losec (CA) (UK), Heartburn Relief (UK), Prilosec, Prilosec OTC, Zegerid, Zanprol (UK)
Pharmacologic class: Proton pump inhibitor
Therapeutic class: Antiulcer drug
Pregnancy risk category C
Action
Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating on gastric mucosa and easing discomfort from excess gastric acid
Availability
Capsules (delayed-release): 10 mg, 20 mg, 40 mg
Powder for oral suspension: 20 mg
Tablets (delayed-release): 20 mg
⊘Indications and dosages
➣ Gastroesophageal reflux disease
Adults: 20 mg P.O. (capsules, powder) daily for 4 weeks
➣ Erosive esophagitis
Adults: 20 mg P.O. (capsules, powder) daily for 4 to 8 weeks
➣ Short-term treatment of active duodenal ulcer
Adults: 20 mg P.O. (capsules, powder) daily for 4 weeks. Some patients may need 4 additional weeks of therapy.
➣ To reduce risk of duodenal ulcers caused by Helicobacter pylori
Adults: 40 mg P.O. (capsules) daily in morning, given with clarithromycin t.i.d. for 2 weeks; then 20 mg daily for 2 weeks
➣ Gastric ulcers
Adults: 40 mg P.O. (capsules) daily for 4 to 8 weeks
➣ Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome
Adults: Initially, 60 mg P.O. (capsules) daily; may increase up to 120 mg t.i.d. Divide daily dosages above 80 mg.
➣ Frequent heartburn (two or more episodes a week)
Adults ages 18 and older: 20 mg P.O. (OTC tablets) daily for 14 days
Off-label uses
• Posterior laryngitis
• To enhance pancreatin efficacy in treating steatorrhea in cystic fibrosis patients
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• hepatic disease
• pregnant or breastfeeding patients
• children (safety not established).
Administration
• Give 30 to 60 minutes before a meal, preferably in morning.
• If desired, give concurrently with antacids.
• Know that if patient has ulcer at start of therapy, treatment may be extended.
• When giving through nasogastric tube, use powder for oral suspension, or separate capsule and mix pellets with water. Agitate syringe while injecting. After administration, flush with 30 to 60 ml of water.
• Don't crush capsules.
• Be aware that symptomatic response doesn't rule out gastric cancer.
| Route | Onset | Peak | Duration |
| P.O. | Within 1 hr | Within 2 hr | 72-96 hr |
| P.O. (delayed) | Unknown | 10-90 min | Unknown |
Adverse reactions
CNS: dizziness, headache, asthenia
GI: nausea, vomiting, diarrhea, constipation, abdominal pain
Musculoskeletal: back pain
Respiratory: cough, upper respiratory tract infection
Skin: rash
Interactions
Drug-drug. Ampicillin, cyanocobalamin, iron salts, ketoconazole: reduced absorption of these drugs
Clarithromycin: increased omeprazole blood level
Diazepam, phenytoin, warfarin: prolonged elimination and increased effects of these drugs
Digoxin: increased digoxin absorption and blood level, possible digoxin toxicity
Drugs metabolized by CYP450 system: competitive metabolism
Drug-diagnostic tests. Alanine phosphatase, alkaline aminotransferase, aspartate aminotransferase, bilirubin: increased levels
Gastrin: increased level during first 1 to 2 weeks of therapy
Patient monitoring
• Assess vital signs.
• Check for abdominal pain, emesis, diarrhea, or constipation.
• Evaluate fluid intake and output.
• Watch for elevated liver function test results (rare).
Patient teaching
• Tell patient to take 30 to 60 minutes before a meal, preferably in morning.
• Instruct patient to swallow capsules or tablets whole and not to chew or crush them. If he can't swallow capsule, tell him he may open it, carefully sprinkle and mix entire contents into 1 tbsp of cool applesauce, and swallow immediately with glass of water.
• Inform patient taking OTC delayed-release tablets for heartburn that full effect may take 1 to 4 days. Advise him not to take tablets for more than 14 days without consulting healthcare professional.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Prilosec®
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