Omeprazole Drip Preparation and Administration Protocol
Standard Preparation for Upper GI Bleeding
For patients with non-variceal upper gastrointestinal bleeding and high-risk endoscopic stigmata, prepare omeprazole as an 80 mg IV bolus followed by 8 mg/hour continuous infusion for exactly 72 hours after endoscopic hemostasis. 1, 2
Initial Bolus Preparation
- Reconstitute 80 mg omeprazole for IV administration 1, 2
- Administer as a single IV bolus push 1, 2
- Begin this bolus as soon as possible, even before endoscopy is performed 1, 2
Continuous Infusion Preparation
- Prepare a continuous infusion delivering 8 mg/hour of omeprazole 1, 2
- For a 24-hour bag: Mix 192 mg omeprazole (8 mg/hour × 24 hours) in appropriate IV solution 1, 2
- Continue this exact rate for the full 72-hour period following successful endoscopic therapy 1, 2
Evidence Supporting This Protocol
The high-dose continuous infusion protocol reduces critical outcomes compared to no PPI or H2-receptor antagonists 1:
- Mortality reduction: OR 0.56 (95% CI 0.34-0.94) 1
- Rebleeding reduction: OR 0.43 (95% CI 0.29-0.63) 1
- Decreased need for surgical intervention 1
This regimen maintains gastric pH above 6, which is necessary for platelet aggregation and clot stability, while preventing clot lysis that occurs when pH drops below 6 1.
Post-Infusion Transition
After completing the 72-hour IV infusion 1, 2:
- Transition to oral omeprazole 40 mg twice daily on days 4-14 1
- Then continue oral omeprazole 40 mg once daily from day 15 onward for 6-8 weeks total to allow complete mucosal healing 1, 2
Critical Caveats and Common Pitfalls
Do not rely solely on PPI therapy without urgent endoscopic intervention in patients with active bleeding - PPIs are adjunctive therapy to endoscopic hemostasis, not a replacement 1, 2. Delaying endoscopy while depending only on the omeprazole drip is inappropriate and potentially dangerous 1.
Do not use lower doses or intermittent bolus dosing in high-risk patients - the mortality and rebleeding benefits are seen specifically with the high-dose continuous infusion protocol 1. The continuous infusion maintains stable gastric pH elevation throughout the 72-hour period 1.
Do not discontinue the infusion early - the full 72-hour duration is required based on the evidence demonstrating clinical benefit 1, 2.
Do not skip the oral PPI transition phase - completing the full 6-8 week course allows adequate mucosal healing and prevents recurrent bleeding 1, 2.
Alternative PPI Options
If omeprazole is unavailable, pantoprazole can be substituted using the identical dosing protocol: 80 mg IV bolus followed by 8 mg/hour continuous infusion for 72 hours 1, 2. Both agents are considered equivalent class effects when dosed appropriately for upper GI bleeding 1.
Patient Selection
This high-dose protocol is most beneficial for patients with high-risk endoscopic stigmata including 1, 2:
- Active arterial bleeding
- Visible vessel
- Adherent clot
Patients without these high-risk features may not require the intensive 72-hour infusion protocol 2.
Additional Management Considerations
Test all patients for H. pylori infection and provide eradication therapy if positive, as this reduces recurrent bleeding risk 1, 2.
Administer pre-endoscopy erythromycin to enhance gastric visualization during endoscopy 1, 2.