Management of Omeprazole Sodium Overdose
In omeprazole overdose, treatment should be symptomatic and supportive only, as no specific antidote exists and symptoms are typically transient without serious clinical outcomes. 1
Clinical Presentation
Omeprazole overdose manifestations are variable but generally mild, even at doses up to 2400 mg (120 times the usual clinical dose). Reported symptoms include: 1
- Confusion and drowsiness
- Blurred vision
- Tachycardia
- Nausea and vomiting
- Diaphoresis and flushing
- Headache and dry mouth
- Other adverse reactions similar to those seen in normal clinical experience
Importantly, symptoms are transient and no serious clinical outcome has been reported when omeprazole was taken alone. 1
Management Approach
Immediate Assessment
- Contact Poison Control Center at 1-800-222-1222 for current management guidance 1
- Assess airway, breathing, and circulation
- Obtain history of co-ingestions, as multiple agents complicate the clinical picture 2
Treatment Strategy
Provide symptomatic and supportive care only. 1 This includes:
- Monitor vital signs, particularly for tachycardia 1
- Maintain hydration if vomiting is present 1
- Observe for resolution of symptoms, which typically occurs without intervention 1
What NOT to Do
Omeprazole is extensively protein bound and therefore not readily dialyzable—hemodialysis is not indicated. 1
Invasive procedures such as gastric lavage and whole-bowel irrigation are not appropriate for the majority of overdose situations, including omeprazole. 2 The use of oral activated charcoal may be of limited value given omeprazole's rapid absorption (peak plasma concentrations within 0.5-3 hours) and extensive protein binding. 2, 3
Pharmacokinetic Considerations
Understanding omeprazole's pharmacokinetics explains why overdose is typically benign: 3
- Rapid elimination from plasma with half-life less than 1 hour
- Almost entirely cleared from plasma within 3-4 hours
- Complete hepatic metabolism with inactive metabolites
- 80% excreted in urine, remainder via bile
Despite the long duration of antisecretory action, omeprazole itself is rapidly eliminated, limiting toxicity duration. 3
Special Populations and Caveats
Patients who are poor metabolizers of omeprazole (identified through genetic screening) may experience accumulation of metabolites and more severe adverse reactions, though this is rare. 4 However, even in these cases, supportive care remains the mainstay of treatment.
The risk of treating drug overdose with additional pharmacological agents often outweighs potential benefit—observation alone is frequently the best approach. 2
Disposition
Most patients can be observed until symptom resolution, typically within hours given omeprazole's rapid clearance. 1, 3 Admission is rarely necessary unless co-ingestions are present or complications develop. 2