What is an example prescription for a patient with heartburn and indigestion?

Example Prescription for Heartburn and Indigestion

For an adult patient with heartburn and indigestion, prescribe omeprazole 20 mg once daily taken 30-60 minutes before breakfast for 4-8 weeks, with antacids as needed for breakthrough symptoms. 1, 2

Initial Prescription Components

Primary Acid Suppression

• Omeprazole 20 mg delayed-release capsules 2
  • Take one capsule once daily, 30-60 minutes before breakfast 1, 2
  • Swallow whole; do not chew 2
  • Duration: 4-8 weeks initially 1, 2
  • Dispense: #30-60 capsules (depending on treatment duration) 2

Breakthrough Symptom Relief

• Antacid (alginate-containing preferred) 3, 1
  • Take as needed for immediate symptom relief 1
  • Can be used while awaiting PPI effect (which takes 3-5 days to reach full efficacy) 1
  • Particularly effective for post-prandial and nocturnal symptoms 3

Dosing Instructions to Include

Write on prescription: "Take omeprazole 20 mg by mouth once daily, 30-60 minutes before breakfast. Swallow capsule whole. Use antacid as needed for immediate relief. If dose is missed, take as soon as possible unless next dose is due; do not double dose." 2

Alternative H2-Receptor Antagonist Option (If PPI Contraindicated)

If PPIs are not appropriate, use: 4

• Ranitidine 150 mg twice daily (or famotidine 20 mg twice daily if ranitidine unavailable) 4
• Less effective than PPIs but acceptable alternative 1
• Pediatric dosing: ranitidine 5-10 mg/kg/day divided in 2-3 doses 4

Lifestyle Modifications to Prescribe Alongside Medication

Include these specific written instructions: 4, 1

• Elevate head of bed by 6-8 inches for nighttime symptoms 1
• Avoid eating within 3 hours of bedtime 4
• Eliminate specific trigger foods: alcohol, coffee, chocolate, spicy foods, citrus 1
• Weight loss if BMI >25 1

Follow-Up Assessment Protocol

Reassess at 4-8 weeks: 1, 2

• If symptoms resolve: consider trial off therapy to assess for recurrence 1
• If partial response: increase to omeprazole 20 mg twice daily (before breakfast and dinner) 1
• If no response after 8 weeks on twice-daily PPI: refer for endoscopy to rule out erosive esophagitis, Barrett's esophagus, or alternative diagnosis 1, 5

Critical Prescribing Pitfalls to Avoid

• Do NOT prescribe metoclopramide for heartburn—it is ineffective and has significant neurologic side effects 1
• Do NOT prescribe cisapride—it has been withdrawn due to cardiac toxicity 1
• Do NOT continue empiric PPI beyond 8-12 weeks without objective testing if symptoms persist on twice-daily dosing 1
• Do NOT use antacids as monotherapy if symptoms occur ≥2 times per week—this requires acid suppression therapy 3

Pediatric Modifications (Ages 2-16 Years)

For children with heartburn: 4, 2

• Weight 10-20 kg: omeprazole 10 mg once daily 4, 2
• Weight ≥20 kg: omeprazole 20 mg once daily 4, 2
• Can open capsule and sprinkle on applesauce if unable to swallow whole 2
• Duration: up to 4 weeks for symptomatic GERD; 4-8 weeks for erosive esophagitis 4, 2

Sample Complete Prescription

Rx: Omeprazole 20 mg delayed-release capsules
Sig: Take 1 capsule by mouth once daily, 30-60 minutes before breakfast
Disp: #56 capsules
Refills: 1
Instructions: Swallow whole. Do not chew or crush. 2

Rx: Calcium carbonate/alginate antacid tablets
Sig: Chew 1-2 tablets as needed for breakthrough heartburn
Disp: #100 tablets
Refills: 2 3, 1