What is the recommended omeprazole (Proton Pump Inhibitor) dose for a 45kg child?

Omeprazole Dosing for a 45kg Child

The recommended omeprazole dose for a 45kg child is 20mg once daily, as this child weighs more than 20kg and falls within the pediatric dosing guidelines for children 2-16 years of age. 1

Weight-Based Dosing Approach

The FDA-approved dosing for omeprazole in pediatric patients is weight-based:

• For children weighing 10 to less than 20 kg: 10 mg once daily
• For children weighing 20 kg and greater: 20 mg once daily 1

Since this child weighs 45kg, they clearly fall into the "20 kg and greater" category, making 20mg the appropriate dose.

Duration of Treatment

The appropriate duration depends on the indication:

• For symptomatic GERD: Once daily for up to 4 weeks
• For erosive esophagitis: Once daily for 4 to 8 weeks
• For maintenance of healing of erosive esophagitis: Once daily (controlled studies don't extend beyond 12 months) 1

Administration Instructions

• Omeprazole should be taken before meals
• The capsule can be swallowed whole or opened and mixed with applesauce for children who cannot swallow capsules
• When mixing with applesauce:
  1. Use 1 tablespoon of soft, cool applesauce
  2. Mix the pellets with applesauce
  3. Have the child swallow immediately with water
  4. Do not allow chewing of the pellets 1

Alternative Dosing Considerations

Some studies suggest that higher doses may be needed in certain clinical scenarios:

• For severe reflux esophagitis, some children may require doses up to 0.7-3.3 mg/kg/day 2
• For a 45kg child, this would correspond to a range of 31.5-148.5 mg/day
• However, the FDA-approved dose of 20mg once daily should be tried first before considering dose escalation 1

Special Considerations

• If the child has hepatic impairment, consider reducing the maintenance dose to 10mg once daily 1
• For Asian patients, a reduced maintenance dose of 10mg once daily is also recommended 1
• Antacids may be used concomitantly with omeprazole if needed 1

Monitoring

• If symptoms persist after 8 weeks of treatment, an additional 4 weeks of therapy may be considered
• For recurrent symptoms, additional 4-8 week courses may be considered 1
• Long-term use should be avoided when possible due to potential risks including bone changes and increased risk of infections 2

Following these weight-based dosing guidelines will help ensure effective and safe treatment with omeprazole for this 45kg child.