Omeprazole Dosing for an 11-Year-Old Weighing 33.25 kg
For an 11-year-old child weighing 33.25 kg, the appropriate omeprazole dose is 20 mg once daily for symptomatic GERD or erosive esophagitis, as this child weighs ≥20 kg. 1
FDA-Approved Dosing Guidelines
The FDA label provides clear weight-based dosing for pediatric patients aged 2-16 years 1:
- Children weighing 10 to <20 kg: 10 mg once daily
- Children weighing ≥20 kg: 20 mg once daily 1
Since your patient weighs 33.25 kg, they fall into the ≥20 kg category and should receive 20 mg once daily 1.
Treatment Duration by Indication
The duration varies based on the specific condition 1:
- Symptomatic GERD: Up to 4 weeks 1
- Erosive esophagitis: 4 to 8 weeks initially 1
- Maintenance of healing: 20 mg once daily (controlled studies do not extend beyond 12 months) 1
If the patient does not respond after 8 weeks of treatment for erosive esophagitis, an additional 4 weeks may be given 1. If symptoms recur, additional 4-8 week courses can be considered 1.
Administration Instructions
Take omeprazole before meals 1. The capsule should be swallowed whole without chewing 1.
For patients unable to swallow capsules 1:
- Mix the pellets from the capsule with one tablespoon of applesauce (not hot, soft enough to swallow without chewing)
- Swallow immediately with cool water
- Do not chew or crush the pellets
- Do not save for future use 1
Antacids may be used concomitantly 1.
Higher Dosing for Refractory Cases
While the FDA-approved dose is 20 mg once daily for this weight category, clinical evidence suggests that some children with severe or refractory GERD may require higher doses 2, 3, 4, 5:
- For eosinophilic esophagitis: Initial treatment may be 1 mg/kg twice daily (up to 40 mg twice daily), which would be approximately 33 mg twice daily for this patient 2
- For severe refractory GERD: Doses may be escalated up to 1.4-2.8 mg/kg/day in divided doses 2
However, start with the FDA-approved 20 mg once daily dose and only escalate if there is inadequate response documented by clinical assessment or pH monitoring 1, 4, 5.
Common Pitfalls to Avoid
- Do not use body surface area calculations for pediatric dosing; always use weight-based dosing 6
- Do not extrapolate adult doses to children, as pharmacokinetics differ significantly 4
- Do not routinely prescribe for uncomplicated reflux in infants, as placebo-controlled trials show no benefit over placebo for reducing irritability 2
- Reserve omeprazole for documented erosive esophagitis or severe, refractory symptoms 2
Monitoring Considerations
For long-term therapy (>2.5 years), monitor for 2:
- Enterochromaffin cell hyperplasia (may occur in up to 50% of children)
- Common side effects: headaches, diarrhea, nausea (occur in approximately 14-25% of patients)
- Increased risk of lower respiratory tract infections with prolonged acid suppression
Omeprazole demonstrates superior efficacy compared to H2-receptor antagonists for pediatric GERD 2, 3.