IV Omeprazole Dosing for a 14-Year-Old with Severe GERD/Erosive Esophagitis
For a 14-year-old with severe GERD or erosive esophagitis requiring IV therapy, use weight-based dosing of 0.7-3.3 mg/kg/day of omeprazole, typically starting at 1 mg/kg/day, which can be administered intravenously when oral therapy is not feasible. 1
Pediatric IV Omeprazole Dosing Framework
Initial Dosing Strategy
- Start with 1 mg/kg/day IV as this is the dose most consistently reported to heal esophagitis and provide symptom relief in pediatric patients 2
- The FDA-approved dosing range for omeprazole in children aged 2-16 years is 0.7-3.3 mg/kg/day, allowing for dose escalation if needed 1
- For a typical 14-year-old (approximately 50 kg), this translates to an initial dose of 40-50 mg IV daily, which can be increased up to 80-165 mg daily if inadequate response 1, 2
Route and Administration Considerations
- IV esomeprazole (the S-isomer of omeprazole) 40 mg once daily provides equivalent acid suppression to oral formulations and can be given by injection or infusion 3
- The adult high-dose IV regimen used for upper GI bleeding (80 mg bolus followed by 8 mg/h infusion for 72 hours) is primarily for acute hemorrhage control, not routine GERD management 1
- Transition to oral therapy as soon as the patient can tolerate it, typically within 7-10 days, as IV formulations are intended for short-term use when oral administration is not possible 3
Treatment Duration and Monitoring
Acute Phase Management
- Continue IV therapy for 4-8 weeks to assess therapeutic response before considering dose escalation 1
- Monitor for symptom improvement (reduced heartburn, regurgitation) and healing of erosive lesions if endoscopy is repeated 2, 4
- Healing rates approach 80% at 4 weeks with appropriate PPI dosing in erosive esophagitis 3
Dose Escalation Criteria
- If symptoms persist after 4-8 weeks at 1 mg/kg/day, increase to 1.4-2.8 mg/kg/day (up to the maximum of 3.3 mg/kg/day) 1, 2
- For severe erosive esophagitis refractory to standard dosing, higher doses within the approved range are justified 1, 2
Important Clinical Considerations
Safety Profile in Adolescents
- Omeprazole is FDA-approved for ages 2-16 years, making it appropriate for this 14-year-old patient 1
- Common adverse effects include headaches, diarrhea, constipation, and nausea (occurring in up to 14% of patients) 1, 5
- Long-term use (>2.5 years) has been associated with enterochromaffin cell hyperplasia in up to 50% of children, though this is considered a benign histologic change 1
Critical Pitfalls to Avoid
- Do not use twice-daily dosing empirically - this is not FDA-approved in pediatrics and lacks strong evidence support 6
- Ensure proper timing: PPIs should be administered 30-60 minutes before meals for optimal acid suppression, even when given IV 6, 5
- Avoid indefinite therapy without reassessment - periodically evaluate the need for continued treatment and consider step-down to oral therapy and lower doses once symptoms are controlled 6, 5
Transition Planning
- Once the patient can tolerate oral intake, switch to oral omeprazole at the same daily dose (capsule contents can be sprinkled on soft foods if swallowing is difficult) 1
- After achieving symptom control and mucosal healing, attempt to step down to the lowest effective maintenance dose to minimize long-term exposure 6
- Patients with severe erosive esophagitis (LA grade C/D) typically require continuous maintenance therapy, as recurrence rates approach 80% at one year without treatment 7, 8