How should intravenous omeprazole be prepared and administered as a drip in an adult patient without renal or hepatic dose adjustment?

How to Administer Omeprazole IV Drip

Administer omeprazole as an 80 mg IV bolus followed immediately by 8 mg/hour continuous infusion for exactly 72 hours after endoscopic hemostasis in patients with upper gastrointestinal bleeding. 1, 2, 3

Preparation Protocol

Solution Concentration

• Prepare the infusion by mixing 240 mg omeprazole in 240 mL of normal saline (0.9% NaCl) or 5% dextrose to create a 1 mg/mL solution. 1
• An alternative acceptable method uses 160 mg in 200 mL (0.8 mg/mL concentration) with an infusion rate of 10 mL/hr to achieve the target 8 mg/hr dose. 1
• Both preparation methods are acceptable; choose based on your institution's protocol. 1

Initial Bolus Administration

• Give 80 mg IV bolus first, administered over at least 15 minutes to minimize risk of thrombophlebitis. 1
• Start the bolus as soon as possible, even before endoscopy is performed. 2, 3

Continuous Infusion Setup

Infusion Rate and Duration

• Set the infusion pump to deliver 8 mg/hour (8 mL/hr if using 1 mg/mL concentration or 10 mL/hr if using 0.8 mg/mL concentration). 1, 3
• Continue the infusion for exactly 72 hours after successful endoscopic therapy—no shorter, no longer. 1, 2, 3
• Change the infusion bag every 12 hours maximum, as omeprazole degrades significantly after this timepoint even at higher concentrations. 4

Administration Route Considerations

• Use peripheral IV access when possible, but infuse slowly to reduce thrombophlebitis risk. 1
• Consider central venous access if prolonged therapy is needed and peripheral access becomes problematic. 1
• If thrombophlebitis develops at the infusion site, apply warm compresses and consider switching to a different site or central access. 1

Post-Infusion Transition

Oral PPI Therapy

• After completing the 72-hour IV infusion, transition to oral PPI 40 mg twice daily through day 14. 1, 2, 3
• From day 15 onward, reduce to oral PPI 40 mg once daily for 6-8 weeks total to allow complete mucosal healing. 1, 2, 3

Critical Caveats

What NOT to Do

• Never rely solely on PPI therapy without performing urgent endoscopy in patients with active bleeding—PPIs are adjunctive therapy only, not a replacement for endoscopic hemostasis. 1, 2, 3
• Do not discontinue therapy before completing the full 6-8 week course, as premature discontinuation prevents adequate mucosal healing. 1, 2
• Do not use lower doses or intermittent bolus dosing in high-risk patients, as the mortality benefit is seen only with high-dose continuous infusion. 1, 5
• Do not prepare infusion bags more than 12 hours in advance, as significant degradation occurs after this timepoint. 4

Patient Selection

• This high-dose regimen is specifically indicated for patients with high-risk endoscopic stigmata (active bleeding, visible vessel, or adherent clot) who have undergone successful endoscopic hemostasis. 1, 3
• The benefits are most pronounced in this high-risk population; lower-risk patients may not require this intensive regimen. 3

Additional Management

• Test all patients for H. pylori infection and provide eradication therapy if positive to reduce recurrent bleeding risk. 2, 3
• Administer pre-endoscopy erythromycin to enhance gastric visualization during endoscopy. 1, 2