Recommended Omeprazole Dosing for GERD Treatment
For the treatment of symptomatic GERD in adults, the recommended dosage of omeprazole is 20 mg once daily for up to 4 weeks. 1, 2
Adult Dosing Recommendations
- Standard initial treatment for symptomatic GERD is omeprazole 20 mg once daily, which should be taken 30-60 minutes before meals for optimal efficacy 1
- For treatment of erosive esophagitis (EE) due to acid-mediated GERD, the recommended dosage is also 20 mg once daily for 4-8 weeks 2
- If symptoms persist after 4-8 weeks of once-daily therapy, an additional 4 weeks of treatment may be given 2
- For maintenance of healing of EE due to acid-mediated GERD, 20 mg once daily is recommended, though controlled studies do not extend beyond 12 months 2
Pediatric Dosing Recommendations
- For children 2-16 years weighing less than 20 kg: 10 mg once daily for up to 4 weeks for symptomatic GERD 2
- For children 2-16 years weighing 20 kg or greater: 20 mg once daily for up to 4 weeks for symptomatic GERD 2
- For treatment of EE due to acid-mediated GERD in children, the same weight-based dosing applies but for 4-8 weeks 2
Administration Guidelines
- Omeprazole should be taken before meals, not at bedtime, for optimal acid suppression 1
- Capsules should be swallowed whole; for patients unable to swallow intact capsules, they can be opened and the pellets mixed with applesauce 2
- Antacids may be used concomitantly with omeprazole 2
Treatment Duration and Step-Down Therapy
- After initial symptom control, patients should be considered for step-down to the lowest effective dose 1
- Most patients with non-erosive GERD do not require continuous long-term therapy 1
- Patients with severe erosive esophagitis (LA Classification grade C/D), Barrett's esophagus, or esophageal strictures require continuous daily maintenance therapy 1
Special Considerations
- Dosage reduction to 10 mg once daily is recommended for patients with hepatic impairment and Asian patients when used for maintenance of healing of EE 2
- Twice-daily PPI dosing is not FDA-approved but may be considered if symptoms persist after 4-8 weeks of once-daily therapy 1
- All patients on long-term PPI therapy should have their need for continued treatment periodically reassessed to avoid unnecessary long-term use 1
Common Pitfalls
- Prescribing twice-daily dosing without first trying standard once-daily dosing 1
- Taking PPIs at bedtime rather than before meals, which reduces efficacy 1
- Continuing long-term therapy without periodic reassessment of the need for continued treatment 1
- Failing to step down to the lowest effective dose after initial symptom control 1