What is the recommended dose and frequency of omeprazole?

From the Guidelines

The recommended dose of omeprazole for adults with eosinophilic oesophagitis (EoE) is 20 mg two times per day, as this has been shown to be effective in inducing and maintaining remission 1.

Key Considerations

• The dose of 20 mg two times per day is recommended based on a strong level of agreement (100%) and a low grade of evidence, but it is considered the most effective dose for managing EoE 1.
• Treatment duration should be at least 8-12 weeks prior to assessment of histological response while on treatment, with some studies suggesting that longer treatment duration (>10-12 weeks) may be associated with a greater rate of response 1.
• Omeprazole is the only proton pump inhibitor (PPI) that has been assessed for the treatment of EoE, and its use in certain situations has been shown to be effective, although it is not licensed for this indication 1.

Maintenance Therapy

• For patients who achieve histological response, maintenance PPI therapy appears effective in maintaining remission, with 70.1% of patients exhibiting long-term histological remission in one study 1.
• The use of maintenance PPI treatment for at least 12 months has been shown to be effective in sustaining clinicopathological remission, with 69.9% of patients exhibiting sustained remission in one study 1.
• However, there are limited published data and no prospective randomized trials to define appropriate long-term maintenance strategies in patients with EoE who have responded to PPI treatment, and the decision to continue maintenance therapy should be made on a case-by-case basis 1.

From the FDA Drug Label

Table 1: Recommended Dosage Regimen of Omeprazole in Adults by Indication Indication Dosage of Omeprazole Treatment Duration Treatment of Active Duodenal Ulcer 20 mg once daily 4 weeks Helicobacter pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence Triple Therapy Omeprazole 20 mg Amoxicillin 1000 mg Clarithromycin 500 mg Take all three drugs twice daily 10 days Dual Therapy Omeprazole 40 mg once daily Clarithromycin 500 mg three times daily 14 days Active Benign Gastric Ulcer 40 mg once daily 4 to 8 weeks Treatment of Symptomatic GERD 20 mg once daily Up to 4 weeks Treatment of EE due to Acid-Mediated GERD 20 mg once daily 4 to 8 weeks Maintenance of Healing of EE due to Acid-Mediated GERD 20 mg once daily Pathological Hypersecretory Conditions Starting dose is 60 mg once daily; adjust to patient needs Daily dosages of greater than 80 mg should be administered in divided doses.

The recommended dose and frequency of omeprazole vary by indication.

• For Treatment of Active Duodenal Ulcer, the dose is 20 mg once daily for 4 weeks.
• For Helicobacter pylori Eradication, the dose is 20 mg twice daily as part of a triple therapy regimen for 10 days.
• For Active Benign Gastric Ulcer, the dose is 40 mg once daily for 4 to 8 weeks.
• For Treatment of Symptomatic GERD, the dose is 20 mg once daily for up to 4 weeks.
• For Treatment of EE due to Acid-Mediated GERD, the dose is 20 mg once daily for 4 to 8 weeks.
• For Maintenance of Healing of EE due to Acid-Mediated GERD, the dose is 20 mg once daily.
• For Pathological Hypersecretory Conditions, the starting dose is 60 mg once daily, with adjustments as needed, and daily dosages greater than 80 mg should be administered in divided doses 2.

From the Research

Omeprazole Dose and Frequency

• The usual omeprazole dosages are 10 to 40 mg/day for adults and 10 to 20 mg/day for children 3
• Optimal omeprazole regimens for anti-H. pylori therapy are those that administer the drug at a dosage of 40 mg/day (in 1 or 2 divided doses) for 7,10 or 14 days in combination with 2 antibacterial agents 3
• For patients with gastroesophageal reflux disease (GORD), the dose of omeprazole needed for maintained relief of symptoms and endoscopical signs of esophagitis is a median of 40 mg 4
• Esomeprazole, a single optical isomer proton-pump inhibitor, demonstrates greater antisecretory activity than other PPIs, with once-daily oral esomeprazole 40 mg being an effective dose 5

Treatment Duration

• The treatment duration for H. pylori infection is typically 7,10 or 14 days 3, 6
• For patients with GORD, the treatment duration with omeprazole can be several months, with a mean follow-up of 56.6 months in one study 4
• The treatment duration for esomeprazole is typically 4 weeks to 6 months 5

Special Considerations

• H. pylori infection may affect gastric acid output and intragastric pH, but it does not affect the efficacy of omeprazole therapy for GORD 4
• Patients with H. pylori-negative GORD may have a higher prevalence of Barrett's esophagus, but they do not require a higher dose of omeprazole to maintain symptomatic and endoscopical disease remission 4
• The choice of treatment regimen for H. pylori infection should take into account the patient's previous antibiotic exposure and the local resistance patterns 7