What is the recommended dose of omeprazole (proton pump inhibitor) for a 14-year-old taking oral steroids (corticosteroids) for gastrointestinal protection?

Omeprazole Dosage for a 14-Year-Old on Oral Steroids for GI Protection

For a 14-year-old taking oral steroids, the recommended omeprazole dose for gastrointestinal protection is 20 mg once daily before meals.

Dosing Rationale

The FDA-approved dosing for omeprazole in pediatric patients provides clear guidance for this situation:

• For patients 2-16 years of age weighing 20 kg or more (which would include most 14-year-olds), the recommended dose is 20 mg once daily 1
• This dosage is appropriate for both treatment of symptomatic GERD and treatment of erosive esophagitis 1

Administration Instructions

• Omeprazole should be taken before meals 1
• The capsule should be swallowed whole without chewing 1
• If the patient cannot swallow the capsule intact:
  • Place one tablespoon of applesauce in a clean container
  • Open the capsule and empty all pellets onto the applesauce
  • Mix the pellets with the applesauce
  • Swallow immediately with water, without chewing the pellets 1

Duration of Therapy

• For patients on oral steroids requiring gastroprotection, omeprazole should be continued for the duration of steroid therapy
• Standard treatment courses for GERD symptoms typically last up to 4 weeks, but may be extended when used for gastroprotection during steroid therapy 1

Monitoring and Safety Considerations

• Omeprazole has been shown to be well-tolerated in pediatric patients at doses ranging from 0.7-3.5 mg/kg/day 2
• The recommended 20 mg dose falls within the safe and effective range for a typical 14-year-old 2
• No routine laboratory monitoring is required specifically for omeprazole therapy
• Long-term use of PPIs should be avoided when possible due to potential risks including bone changes and increased risk of infections 3

Common Pitfalls to Avoid

• Underdosing: Some older studies suggested lower doses, but more recent evidence supports the 20 mg dose for adolescents weighing more than 20 kg 1, 2
• Inappropriate timing: Omeprazole should be taken before meals for optimal effect 1
• Crushing or chewing the capsule: This destroys the enteric coating and reduces efficacy 1
• Discontinuing too early: Protection should continue throughout the course of steroid therapy

The 20 mg once-daily dosing provides appropriate gastroprotection for a 14-year-old on oral steroids while maintaining a favorable safety profile.