Omeprazole IV Drip Preparation Protocol
Administer omeprazole as an 80 mg IV bolus followed by continuous infusion at 8 mg/hour for 72 hours after endoscopic hemostasis in patients with high-risk upper gastrointestinal bleeding. 1, 2, 3
Preparation Steps
Initial Bolus Dose
- Reconstitute 80 mg of omeprazole for IV administration 1, 2
- Administer as a single IV bolus injection 4
- This bolus should be given immediately after successful endoscopic therapy, or even before endoscopy in high-risk patients 2, 3
Continuous Infusion Setup
- Prepare omeprazole for continuous infusion at 8 mg/hour 1, 2, 3
- This requires 192 mg total over 24 hours (8 mg/hour × 24 hours) 1
- Continue the infusion for exactly 72 hours post-endoscopy 1, 2, 4
- The 72-hour duration is critical as most rebleeding episodes occur during the first three days (5 patients with omeprazole vs. 24 with placebo during this period) 4
Rationale for This Regimen
The high-dose continuous infusion maintains gastric pH above 6, which is essential for platelet aggregation and clot stability, while pH below 6 causes clot lysis 2, 3. This regimen reduces rebleeding from 22.5% to 6.7% compared to placebo 4, and is superior to standard-dose omeprazole (40 mg/day), which showed rebleeding rates of 24% vs. 7% with high-dose therapy 5.
Post-Infusion Management
- After completing the 72-hour infusion, transition to oral omeprazole 20-40 mg daily 4, 2
- Continue oral PPI therapy for 6-8 weeks to allow complete mucosal healing 2, 3
- Do not discontinue PPI therapy prematurely, as this prevents adequate mucosal healing 2, 3
Critical Caveats
- PPI infusion is NOT a replacement for urgent endoscopy and hemostasis - it is an adjunct therapy only 1, 2, 3
- Start the infusion as soon as possible, even before endoscopy in high-risk patients, as pre-endoscopy omeprazole reduces actively bleeding ulcers (12 vs. 28 patients) and increases clean-base ulcers (120 vs. 90 patients) 6, 2
- This regimen is most effective for high-risk endoscopic stigmata (active bleeding, visible vessel, or adherent clot) 3, 1
- Pantoprazole can be substituted using the identical dosing regimen (80 mg bolus + 8 mg/hour × 72 hours) as this is a class effect 1, 3, 7