Omeprazole

What is omeprazole?

Omeprazole reduces the amount of acid produced in your stomach. It belongs to a group of medicines known as proton pump inhibitors (PPIs). They are used to treat a number of conditions associated with high stomach acid affecting your stomach and gut, such as indigestion, reflux and ulcers. Omeprazole can prevent ulcers from forming or help the healing process where damage has already occurred.

Omeprazole can also:

• be given together with antibiotics to get rid of Helicobacter pylori, a bacteria found in your stomach that can cause ulcers. 
• be used to prevent ulcers caused by medicines such as non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs are diclofenac, ibuprofen, naproxen.

In New Zealand omeprazole is available as capsules and can be given as an injection in the hospital.  

Dose

• The usual dose of omeprazole is 20 mg a day.
• For some people, 10 mg a day is enough; others may need a higher dose of 40 mg a day.
• It is best to take the lowest effective dose, for the shortest possible time.
• Your doctor will advise you how long to take omeprazole for (usually for 4 to 8 weeks). Some people may need to take it for longer.
• The pharmacy label on your medicine will tell you how much omeprazole to take, how often to take it, and any special instructions. 

How to take omeprazole

• Take omeprazole at the same time each day, usually in the morning.
• Omeprazole is usually taken once a day, but some people may need to take it twice a day. Your doctor will tell you how often to take omeprazole.
• Swallow the capsule whole with a glass of water. Do not crush or chew – the medicine doesn't work properly if the capsule is crushed or chewed.
• If you have difficulty swallowing the capsule, you can open it and sprinkle the pellets over some fruit juice or yoghurt and swallow the pellets without chewing.
• Omeprazole can be taken before or after food, although taking it before food is best.
• If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Avoid long-term use – choose wisely

If you don’t need them, PPIs like omeprazole should not be taken long term, because of the possible side effects. There may be a small increased risk of bone fractures, chest infections, kidney problems and nutrient deficiencies such as low magnesium and vitamin B12. If you’ve been taking a PPI for reflux for longer than 4 to 8 weeks, and your symptoms seem to be well managed, it’s a good idea to talk to your healthcare provider about reviewing your medicine. They may recommend stepping down your treatment. This could include:

• reducing your daily dose of omeprazole
• taking omeprazole only when you experience the symptoms of heartburn and reflux (also known as on-demand therapy)
• stopping treatment completely, as your symptoms may not return. It may be best to reduce the dose over a few weeks before stopping.

Read more about PPIs for heartburn and reflux Choosing Wisely, NZ

Precautions – before starting omeprazole

• Are you pregnant, planning a pregnancy or breastfeeding?
• Do you have problems with your liver?
• Are taking any other medicines? This includes any medicines you are taking that you can buy without a prescription, as well as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start omeprazole. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines omeprazole can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Rebound acid secretion

When omeprazole is stopped, a common side effect is rebound acid secretion, where the acid secretion in your stomach increases significantly. This should return to normal within 2 weeks. Because the symptoms of rebound acid secretion are the same as for reflux (such as indigestion, discomfort and pain in your upper stomach and chest, feeling sick and an acid taste in your mouth), it can form an ongoing loop where stopping omeprazole treatment creates the need to start it again.

Rather than restart omeprazole, your doctor may advise you to use medicines that contain both an antacid and an anti-foaming agent, such as Acidex oral liquid or Gaviscon Double Strength tablets. Alternatively, ranitidine tablets could be used. These can be effective for treating rebound acid secretion. You can use these medicines to relieve the symptoms when they occur.

Talk to your doctor or pharmacist about how to manage rebound acid secretion.

Other side effects

Interactions

Omeprazole may interact with a few medications and herbal supplements, so check with your doctor or pharmacist before starting omeprazole or before starting any new medicines.

Learn more

Medsafe Consumer Information Sheets: Losec, Omezol Relief 
New Zealand Formulary Patient Information: Omeprazole

References

1. Stopping proton pump inhibitors in older people BPAC, NZ 2019
2. Proton pump inhibitors: When is enough, enough? BPAC, NZ, 2014
3. Proton pump inhibitors and the risk of acute kidney injury. BPAC, NZ, 2016
4. Omeprazole New Zealand Formulary