What is the appropriate omeprazole dosing regimen for a 12‑ to 18‑year‑old adolescent?

Omeprazole Dosing for Adolescents (12–18 Years)

For adolescents aged 12–18 years with symptomatic GERD, start omeprazole 20 mg once daily, taken 30–60 minutes before meals, for 4–8 weeks. 1, 2, 3

Standard Initial Dosing

• The FDA-approved dose for adolescents weighing ≥20 kg is omeprazole 20 mg once daily for treatment of symptomatic GERD and erosive esophagitis. 3
• The American Academy of Pediatrics recommends this same 20 mg once-daily regimen for adolescents in this age group. 1, 2
• Timing is critical: Administer 30–60 minutes before meals (typically before breakfast) for optimal acid suppression. 2

Treatment Duration and Response Assessment

• Initial treatment should continue for 4–8 weeks before assessing response or considering dose escalation. 1, 2, 3
• For erosive esophagitis specifically, the full 8-week course may be necessary, as some patients require this duration to achieve complete healing. 3
• Do not escalate the dose prematurely—many adolescents continue to improve through week 8 even if early response seems incomplete. 1

Dose Escalation When Needed

• If symptoms persist after a full 4–8 week trial of 20 mg once daily, increase to omeprazole 40 mg once daily (or 20 mg twice daily before breakfast and dinner) for an additional 4–8 weeks. 1, 3
• The FDA label supports an additional 4-week course if healing is not achieved after the initial 8 weeks. 3
• Research demonstrates that 40 mg daily provides superior healing rates (64% vs. 45%) and heartburn relief (72% vs. 60%) compared to continuing 20 mg in patients who fail initial therapy. 4

Administration Instructions

• Capsules must be swallowed whole; do not chew or crush. 3
• For adolescents unable to swallow capsules, open the capsule and mix the pellets with one tablespoon of applesauce, then swallow immediately without chewing the pellets. 1, 3
• Antacids may be used concomitantly if needed for breakthrough symptoms. 3

Common Pitfalls to Avoid

• Do not diagnose GERD based solely on symptomatic response to omeprazole, as symptoms overlap with other conditions; endoscopic confirmation may be needed if diagnosis is uncertain. 2
• Avoid empiric long-term therapy beyond 12 months without clear indication—periodically reassess the need for continued treatment and consider step-down to the lowest effective dose once symptoms are controlled. 1, 2
• Do not automatically prescribe twice-daily dosing without first completing a full 8-week trial of once-daily therapy, as this approach increases costs and potential complications without proven benefit in most cases. 1

Safety Considerations

• Common adverse effects in adolescents include headaches (most frequent), diarrhea, constipation, and nausea, occurring in approximately 14–25% of patients. 1, 2
• Long-term use (>2.5 years) may be associated with enterochromaffin cell hyperplasia in up to 50% of pediatric patients. 1
• Reserve omeprazole for documented erosive esophagitis or severe, refractory GERD symptoms—it should not be used routinely for uncomplicated reflux. 1

Maintenance Therapy

• For adolescents requiring long-term therapy after initial healing, the FDA-approved maintenance dose is 20 mg once daily. 3
• Controlled studies do not extend beyond 12 months, so ongoing need should be reassessed regularly. 3
• Consider step-down therapy or on-demand dosing in patients without erosive disease once symptoms are well-controlled. 1, 2