Is there a liquid formulation of omeprazole?

Omeprazole Liquid Formulation Availability

While there is no commercially manufactured liquid formulation of omeprazole, the enteric-coated granules from capsules can be effectively administered as an extemporaneous suspension in sodium bicarbonate solution, which remains stable for 8 weeks under refrigeration when prepared using the shaking method. 1

Alternative Administration Methods for Patients Unable to Swallow Capsules

FDA-Approved Methods

• The FDA approves sprinkling omeprazole capsule contents onto soft foods for pediatric patients and others with swallowing difficulties 2
• Capsule contents can be administered through nasogastric tubes when mixed with appropriate liquids, providing an option for patients with feeding tubes 2, 3
• Opening capsules is specifically mentioned in clinical guidelines as an appropriate alternative administration method for patients who cannot swallow intact capsules 3

Extemporaneous Liquid Preparation

• Liquid preparations are compounded extemporaneously from enteric-coated pellets for patients with nasogastric tubes, jejunal or feeding tubes, swallowing disorders, young children, and the elderly 1
• The pellets should be dissolved in sodium bicarbonate solution using the shaking method rather than grinding, as this significantly affects stability 1
• Omeprazole and lansoprazole may be administered via gastrostomy or nasogastric feeding tubes as suspensions in sodium bicarbonate 4

Critical Stability Considerations

Preparation Method Matters

• The shaking method produces stable suspensions for 4 weeks at room temperature (25°C/60% RH), while the grinding method only maintains stability for 1 week 1
• Both preparation methods maintain stability for 8 weeks when stored under refrigerated conditions (2°C) 1
• It is strongly recommended that the shaking method be employed for extemporaneously compounded omeprazole suspensions, and that the prepared suspension be stored in the refrigerator 1

Alternative Mixing Options

• Enteric-coated granules can be mixed with orange juice, Alka-Seltzer solution (aspirin-free), or applesauce and achieve gastric acid suppression as effectively as the intact capsule 5
• In a study of 11 volunteers, the median percentage of time gastric pH remained >4 was similar whether omeprazole was given as a capsule (68.5%) or as granules with orange juice (59%), Alka-Seltzer solution (63%), or applesauce (65%), with no significant differences 5

Common Pitfalls to Avoid

• Never crush or grind the enteric-coated pellets if long-term storage is needed, as this dramatically reduces stability at room temperature 1
• Do not expose omeprazole to gastric acid before administration, as it is inactivated by acid exposure—this is why enteric coating is essential 6, 7
• Weight-based dosing is important when administering omeprazole to pediatric patients 3
• Be aware that patients on H2 blockers or other acid-reducing medications may have reduced absorption of omeprazole capsules due to decreased gastric acidity 3

Commercially Available Alternatives

• Lansoprazole is available as commercially manufactured strawberry-flavored enteric-coated granules for suspension and as orally disintegrating tablets, which may be more appropriate for patients with dysphagia 4
• Three currently available PPIs are manufactured as capsules containing enteric-coated granules that may be mixed with soft foods or fruit juices before oral administration 4