What is the recommended dosing for omeprazole (Proton Pump Inhibitor)?

Recommended Omeprazole Dosing

For most indications, omeprazole should be dosed at 20 mg once daily, with specific conditions requiring higher or adjusted dosing based on patient characteristics and disease severity. 1

Adult Dosing by Indication

Gastroesophageal Reflux Disease (GERD)

• Symptomatic GERD: 20 mg once daily for up to 4 weeks 1
• Erosive Esophagitis: 20 mg once daily for 4-8 weeks 1
• Maintenance of Healing of Erosive Esophagitis: 20 mg once daily (studies don't extend beyond 12 months) 1
  • Reduce to 10 mg daily for Asian patients and those with hepatic impairment 1

Ulcer Treatment

• Active Duodenal Ulcer: 20 mg once daily for 4 weeks 1
• Active Benign Gastric Ulcer: 40 mg once daily for 4-8 weeks 1

H. pylori Eradication

• Triple Therapy: Omeprazole 20 mg + amoxicillin 1000 mg + clarithromycin 500 mg, all taken twice daily for 10 days 1
• Dual Therapy: Omeprazole 40 mg once daily + clarithromycin 500 mg three times daily for 14 days 1

Pathological Hypersecretory Conditions (including Zollinger-Ellison Syndrome)

• Starting dose: 60 mg once daily 1
• Adjustment: Based on patient needs; daily dosages >80 mg should be administered in divided doses 1
• Maximum dose: Up to 120 mg three times daily has been administered 1
• Duration: As long as clinically indicated (some patients have been treated continuously for >5 years) 1

Pediatric Dosing (2-16 years)

• Weight-based dosing:
  • 10 to <20 kg: 10 mg once daily
  • ≥20 kg: 20 mg once daily 1
• Treatment duration:
  • Symptomatic GERD: Up to 4 weeks
  • Erosive Esophagitis: 4-8 weeks
  • Maintenance of Healing: Once daily (controlled studies don't extend beyond 12 months) 1

Administration Guidelines

• Take before meals 1
• For patients unable to swallow capsules:
  1. Place 1 tablespoon of applesauce in a clean container
  2. Open capsule and empty pellets onto applesauce
  3. Mix pellets with applesauce
  4. Swallow immediately with cool water
  5. Do not chew or crush pellets 1

Special Considerations

Dosing for Acute Upper GI Bleeding

• For high-risk patients with nonvariceal upper GI bleeding: IV omeprazole 80 mg bolus followed by 8 mg/h for 72 hours after endoscopic therapy 2
• For patients awaiting endoscopy: High-dose PPI therapy (empirical) 2

Efficacy Considerations

• 20 mg daily reduces esophageal acid exposure to within normal range (0.9%), while 10 mg daily (6.3%) does not achieve normal levels 3
• Twice-daily dosing (20 mg BID) provides better control of gastric acidity than lansoprazole 30 mg BID 4

Dosing in Special Populations

• Hepatic Impairment: Reduce maintenance dose to 10 mg daily for patients with Child-Pugh Class A, B, or C 1
• Asian Patients: Reduce maintenance dose to 10 mg daily due to different metabolism 1
• Infants under 1 year: Not recommended as efficacy has not been established 5
• Children 1-2 years: May require higher weight-based dosing up to 1.4 mg/kg/day, with some requiring up to 2.8 mg/kg/day 6

Monitoring and Safety

• Long-term use should be avoided when possible due to risks of bone changes and infections 5
• For patients on long-term therapy, consider objective testing within 12 months to confirm GERD diagnosis 5
• Monitor for vitamin B12 deficiency, hypomagnesemia, and bone fracture risk in long-term use 5

Remember that omeprazole has an excellent safety profile but should be used at the lowest effective dose for the shortest duration necessary to achieve treatment goals.