COMMON PRESCRIBING NAME
US: prilosec, rapinex
CAN: losec, losec MUPS
UK: losec, losec MUPS
AUS: losec, acimax
GER: losec, antra, ome-netron, gastroacid, omelind
PREPARATIONS
Capsules: 10, 20 and 40 mg. Generally opened and sprinkled on apple
sauce (not hot) or placed in a small amount of apple juice or water and
syringed to the child.
Tablets/MUPS: 10, 20 & 40 mg tablet either dissolved in water and given or
slightly crushed (do not chew or crush the beads)
Over the Counter: 20 mg tablet.
Powder for oral suspension: This is rapidly absorbed, is available in 20
mg packets for dilution with water. It is combined with sodium bicarbonate
to neutralize stomach acid that would destroy the omeprazole.
Compound: Made into a liquid by a compounding pharmacy. Must be stored in
the refrigerator.
THINGS TO BE AWARE OF
- With syringing a dissolved solution the beads may get stuck in a
small syringe, so the larger the syringe (i.e. 20ml) the better to get
the beads out, which is the active ingredient.
- Compound generally only lasts 14 days, though some Drs and
pharmacists will say 30 days, what is noticed that around the 14 day
mark an increase of symptoms occur due to the product becoming unstable.
Generally this is related to the effect of the flavorings added by
pharmacies. Flavorings cause the PPI to become unstable and break down.
Also many pharmacies do not add enough buffer to protect the drug from
being eaten up by the stomach acid on the way down, especially in low
doses.
- Compound must be refrigerated, and for best results go to a proper
compounding pharmacy.
- MUPS stands for multiple unit pellet system
- Like all PPI’s administer 30mins before food for maximum efficiency.
The beads are the ingredient these should be swallowed whole and should
not be crushed, split or chewed.
- Never stop taking or administering a PPI abruptly always consult
your doctor and note that in most cases, results are not immediate, on
average it takes 10-14 days to notice a definite change, this depends on
how severe the reflux and how much damage it is healing.
- It has been found that children metabolize PPI’s two to three times
faster than middle age adults, and thus splitting the dose over 2 to 3
times a day gives better results.
- In the past CaraCream and ChocoBase have been used to make a true at
home suspension of prilosec, but it has since been taken off the market.
The rights to the product were sold and they are no longer allowed to
distribute and produce the CaraCream and ChocoBase commercially due to a
non-compete agreement of Santarus Inc, which now makes zegerid. Both the
CaraCream and ChocoBase, is still made in small quantities for children
unable to take zegerid. Please contact the manufacturers.
STORAGE
Store at room temperature, 15-30°C (59-86°F). Keep away from moisture
and light. Compound should be refrigerated.
OTHER USES
Omeprazole is used for treating acid-induced inflammation and ulcers of
the stomach and duodenum, gastro esophageal reflux disease (GERD) and
Zollinger-Ellison Syndrome. It also is used in combination with
antibiotics for eradicating H. pylori infection of the stomach.
PEDIATRIC DOSING
Omeprazole is approved by the US Food and Drug Administration for
pediatric use in children 2 years and over at a dose of: 10mg if under
20kg and 20mg if over 20kg.
In general though Drs tend to prescribe an initial dose of 10mg and this
is upped to 20mg if need be. PPI’s are less weight sensitive then other
meds, so doses will depend on symptoms. A few Drs will prescribe lower
doses, especially in babies, but 20mg is generally a ‘max’ dose for
children without further testing.
DRUG INTERACTIONS
The absorption of certain drugs may be affected by stomach acidity. It
has been found that PPI’s reduce stomach acid also reduce the absorption
and concentration in blood of ketoconazole (Nizoral) so it has a reduced
effectiveness and increase the absorption. It has also been found to and
concentration in blood of digoxin (Lanoxin) hence an increased toxicity.
Also omeprazole potentially can increase the concentrations in blood of
diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin) by
decreasing the elimination of these drugs by the liver.
SIDE EFFECTS
Omeprazole like other PPI’s is well-tolerated. The most common side
effects are diarrhea, nausea, vomiting, headaches, rash and dizziness.
Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and
water retention occur infrequently.
Each dose of omeprazole powder for oral suspension contains 460 mg of
sodium, and this should be taken into consideration in patients who need a
sodium restricted diet.
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