Omeprazole IV Dosing and Administration
For non-variceal upper GI hemorrhage, administer omeprazole IV as an 80 mg bolus followed by 8 mg/hour continuous infusion for 72 hours. 1
Standard IV Dosing Regimen
The European Society of Gastrointestinal Endoscopy established this high-dose IV protocol specifically for managing acute upper GI bleeding after endoscopic intervention. 1 This represents the most clinically relevant and evidence-based IV dosing strategy for omeprazole in acute care settings.
Practical Administration Details
- Initial bolus: Give 80 mg IV push over 2-5 minutes 1
- Maintenance infusion: Follow immediately with 8 mg/hour continuous infusion for 72 hours (total of 576 mg over 3 days) 1
- Transition to oral: After completing the 72-hour IV regimen, switch to oral omeprazole 40 mg twice daily 1, 2
Alternative IV Dosing for Other Indications
When IV omeprazole is needed for conditions other than acute GI bleeding (such as inability to take oral medications):
- Standard dose: 40 mg IV every 12 hours effectively controls acid secretion in most patients 3
- Zollinger-Ellison syndrome: Start with 40 mg IV every 12 hours, which controlled acid secretion in all patients studied 3
Key Pharmacokinetic Considerations
The elimination half-life of IV omeprazole is approximately 2.3 hours, but the duration of action extends to 34 hours due to irreversible binding to the proton pump. 3 This prolonged effect justifies the every-12-hour dosing interval rather than more frequent administration. 3
Important Clinical Caveats
- Bioavailability: IV administration bypasses first-pass metabolism, providing more predictable drug levels than oral formulations 3
- Conversion to oral: When transitioning from IV to oral therapy, use 40 mg oral twice daily to maintain equivalent acid suppression 1, 2
- Drug interactions: Omeprazole inhibits CYP2C19 and can increase levels of drugs like diazepam and reduce clopidogrel effectiveness 4, 5
Monitoring Requirements
- No routine therapeutic drug monitoring is required for standard IV omeprazole therapy 6
- Monitor for rebleeding during the 72-hour infusion period for GI hemorrhage patients 1
- Assess clinical response rather than plasma drug concentrations, as the pharmacodynamic effect far outlasts measurable plasma levels 3