What is the protocol for starting an omeprazole (proton pump inhibitor) drip?

How to Start an Omeprazole Drip

Administer an 80 mg IV bolus of omeprazole followed immediately by a continuous infusion of 8 mg/hour for 72 hours after endoscopic hemostasis in patients with non-variceal upper gastrointestinal bleeding. 1, 2

Initial Bolus Administration

• Give 80 mg omeprazole as an intravenous bolus injection 1, 2
• Start this therapy as soon as possible, even before endoscopy is performed 1, 2
• The bolus should be administered over a short period to achieve rapid acid suppression 1

Continuous Infusion Setup

• Immediately after the bolus, begin continuous infusion at 8 mg/hour 1, 2
• Continue this infusion rate for exactly 72 hours following successful endoscopic hemostasis 1, 2, 3
• This regimen maintains gastric pH above 6, which is necessary for platelet aggregation and clot stability 1

Rationale for This Protocol

• Blood clot stability is reduced in acidic environments, and pH must remain above 6 to prevent clot lysis 1
• The 80 mg bolus followed by 8 mg/hour infusion achieves superior 24-hour pH control compared to single-dose regimens 4
• This high-dose continuous infusion approach significantly reduces rebleeding rates, need for surgery, and hospital length of stay 1, 3

Post-Infusion Management

• After completing the 72-hour IV infusion, transition to oral PPI therapy 1, 2
• Continue oral omeprazole for 6-8 weeks to allow complete mucosal healing 1, 2
• Long-term PPI therapy beyond this period is not recommended unless the patient has ongoing NSAID use 1

Critical Caveats to Avoid

• Do not delay endoscopic intervention while relying solely on omeprazole infusion - PPI therapy complements but does not replace endoscopic hemostasis 1, 2
• Do not discontinue the infusion before 72 hours, as premature cessation may not maintain adequate pH control 1, 3
• Do not stop oral PPI therapy before 6-8 weeks post-bleeding, as this prevents adequate mucosal healing 1, 2
• The benefits are most pronounced in patients with high-risk endoscopic stigmata (active bleeding, visible vessel, or adherent clot) 1

Alternative PPI Option

• IV pantoprazole can be substituted using the identical dosing regimen (80 mg bolus followed by 8 mg/hour for 72 hours) with comparable efficacy 1, 3
• Both omeprazole and pantoprazole achieve equivalent outcomes when dosed appropriately for upper GI bleeding 1