Typical Dose for Omeprazole Drip
For adult patients with upper gastrointestinal bleeding, administer omeprazole as an 80 mg intravenous bolus followed by a continuous infusion of 8 mg/hour for 72 hours after endoscopic hemostasis. 1, 2, 3
Standard Dosing Protocol
Initial Bolus
- Administer 80 mg IV omeprazole as a bolus injection immediately upon presentation, even before endoscopy is performed 1, 2, 3
- This initial bolus should be given as soon as upper GI bleeding is suspected 3
Continuous Infusion
- Following the bolus, start a continuous infusion at 8 mg/hour 1, 2, 3
- Continue this infusion for exactly 72 hours after successful endoscopic hemostasis 1, 2, 3
- This high-dose regimen maintains gastric pH above 6, which is necessary for platelet aggregation and clot stability 1
Preparation
- Mix 240 mg omeprazole in 240 mL of normal saline or 5% dextrose to create a 1 mg/mL solution 1
- Alternatively, use 160 mg in 200 mL (0.8 mg/mL concentration) with an infusion rate of 10 mL/hour to achieve 8 mg/hour 1
Evidence Supporting This Regimen
This high-dose continuous infusion protocol has demonstrated:
- Mortality reduction (OR 0.56,95% CI 0.34-0.94) compared to no PPI or H2-receptor antagonists 1, 3
- Reduced rebleeding rates (OR 0.43,95% CI 0.29-0.63) 1, 3
- Decreased need for surgical intervention 1
The rationale is that blood clot stability requires a gastric pH above 6, and clot lysis occurs when pH drops below 6 1
Post-Infusion Management
Transition to Oral Therapy
- After completing the 72-hour infusion, transition to oral PPI 40 mg twice daily 1, 2, 3
- Continue oral PPI 40 mg once daily after day 14 1, 2
- Total duration should be 6-8 weeks minimum to allow complete mucosal healing 1, 2, 3
Patient Selection
This high-dose regimen is specifically indicated for patients with high-risk endoscopic stigmata, including:
Patients with low-risk stigmata do not require this intensive regimen 3
Critical Pitfalls to Avoid
- Never rely solely on PPI therapy without endoscopic intervention in active bleeding—PPIs are adjunctive therapy to endoscopic hemostasis, not a replacement 1, 2, 3
- Do not use lower doses in high-risk patients, as only the high-dose continuous infusion has demonstrated mortality benefit 1, 3
- Do not discontinue therapy before 6-8 weeks, as premature discontinuation prevents adequate mucosal healing 1, 2, 3
- Administer the infusion slowly to avoid thrombophlebitis at the infusion site, which can occur with too-rapid administration through peripheral veins 1
Alternative Dosing (Less Optimal)
While 40 mg IV bolus twice daily has been studied 4, 5, research shows that a single 40 mg dose is only as effective as the 80 mg bolus plus 8 mg/hour infusion for the first 12 hours 5. To maintain intragastric pH above 6 for the full 24 hours in all patients, the 80 mg bolus followed by 8 mg/hour infusion is superior 5.