From the Guidelines
Omeprazole 40 mg twice daily is not the recommended dose, instead, omeprazole at a dose of 20 mg two times per day is recommended for the management of EoE. This dosage is based on the most recent and highest quality study available, which suggests that a dose of 20 mg two times per day is effective in managing EoE 1. The study also notes that treatment duration of 8-12 weeks is recommended prior to assessment of histological response while on treatment.
Key Points to Consider
- The recommended dose of omeprazole for EoE is 20 mg two times per day, not 40 mg twice daily.
- Treatment duration of 8-12 weeks is recommended prior to assessment of histological response while on treatment.
- Omeprazole works by blocking the hydrogen-potassium ATPase enzyme system (the "proton pump") in gastric parietal cells, effectively reducing stomach acid production by up to 90%, which allows damaged tissues to heal and symptoms to improve.
- Common side effects may include headache, abdominal pain, nausea, diarrhea, and vitamin B12 deficiency with long-term use.
Clinical Considerations
- Patients should be made aware of the reasons for the prescription of PPI, that is, for the management of EoE, rather than as a GORD treatment.
- Dose reduction to lower doses is not indicated, especially in primary care.
- The use of PPI therapy to manage EoE has been shown to be effective, but it is essential to follow the recommended dosage and treatment duration to maximize effectiveness and minimize side effects.
From the Research
Omeprazole Dosage
- The dosage of omeprazole can vary depending on the patient's condition, with some studies suggesting that a dose of 40 mg twice daily (bid) may be necessary for certain patients with Zollinger-Ellison syndrome 2, 3.
- However, other studies have reported that most patients require only a once-daily dose of omeprazole, with approximately 20-60% requiring a split dosage regimen 4, 5.
- The effective dose of omeprazole for patients with Zollinger-Ellison syndrome has been reported to range from 10 to 180 mg/24 hr, with some patients requiring an increase or decrease in dose over time 5.
Efficacy and Safety
- Omeprazole has been shown to be a highly effective inhibitor of gastric acid secretion in patients with Zollinger-Ellison syndrome, with approximately 99% of patients experiencing control of gastric acid hypersecretion 5.
- The safety of omeprazole has also been established, with adverse effects reported in only 2% of patients, and these effects were generally mild 5.
- Long-term omeprazole therapy has been shown to be safe and effective, with no evidence of tachyphylaxis or significant changes in laboratory variables or toxicity 3, 6.
Treatment Regimens
- Omeprazole can be administered once or twice daily, depending on the patient's response to treatment and the severity of their condition 2, 3.
- The dose of omeprazole can be adjusted based on the patient's gastric acid secretion and symptom response, with some patients requiring an increase or decrease in dose over time 5.
- Omeprazole has been shown to be effective in patients whose peptic-ulcer disease is relatively resistant to treatment with histamine H2-receptor antagonists 6.