How to compound Losec (omeprazole) 20mg?

How to Compound Losec (Omeprazole) 20mg

For patients who cannot take standard omeprazole capsules, a compounded oral suspension can be prepared from the contents of omeprazole delayed-release capsules. This is particularly important for patients who have difficulty swallowing or require administration through feeding tubes.

Compounding Instructions for Omeprazole 20mg Oral Suspension

Materials Needed:

• Omeprazole delayed-release 20mg capsules
• Sodium bicarbonate 8.4% solution
• Amber glass bottle (to protect from light)
• Oral syringes for measurement
• Mortar and pestle (optional)

Step-by-Step Compounding Process:

1. Open the omeprazole capsules:

   • Carefully open the required number of 20mg omeprazole capsules
   • Empty the enteric-coated granules into a clean container

2. Prepare the suspension base:

   • Use sodium bicarbonate 8.4% solution as the suspension vehicle
   • The sodium bicarbonate protects the acid-labile omeprazole from degradation 1

3. Mix the components:

   • Add the granules from the capsules to the sodium bicarbonate solution
   • Gently mix until a uniform suspension is formed
   • Do not crush the granules as this will destroy the enteric coating

4. Final concentration:

   • The standard concentration is 2mg/mL (10mL = 20mg dose)
   • For a typical preparation: 6mg/mL suspension can be made 2

5. Storage and stability:

   • Store in an amber glass bottle at room temperature
   • Label with preparation date and beyond-use date
   • The compounded suspension is stable for 14 days at room temperature 1

Administration Guidelines

• Timing: Administer on an empty stomach, 30-60 minutes before meals 3
• Shaking: Shake well before each use to ensure uniform distribution
• Dosing: Measure precisely using an oral syringe
• For feeding tubes: Flush the tube before and after administration with water

Important Considerations

• Acid protection: The sodium bicarbonate in the suspension neutralizes stomach acid, protecting the omeprazole from degradation before it reaches the small intestine 1
• Avoid crushing: Never crush the enteric-coated granules before suspending them, as this will expose the drug to acid degradation 1
• Bioavailability: The bioavailability of the compounded suspension is approximately 87% compared to intact capsules 1
• Interactions: Be aware that omeprazole is a time-dependent inhibitor of CYP2C19, which may affect metabolism of other drugs like clopidogrel 1

Special Populations

• Pediatric patients: For children who require omeprazole, the suspension can be prepared at appropriate concentrations based on weight 1
• Elderly patients: No special compounding considerations are needed, though dose adjustments may be required due to decreased clearance 1

Common Pitfalls to Avoid

• Using water alone: This will not protect omeprazole from acid degradation
• Crushing granules: Destroys the enteric coating and reduces effectiveness
• Improper storage: Light exposure can degrade the medication
• Incorrect concentration calculation: Always verify the final concentration

By following these compounding instructions, you can prepare an effective omeprazole suspension that maintains the drug's therapeutic properties while providing an alternative administration route for patients who cannot swallow intact capsules.