Omeprazole

What Does Omeprazole Do?

Omeprazole reduces the amount of hydrochloric acid in your stomach. It is used primarily to handle conditions like gastroesophageal reflux disease (GERD), gastric ulcers, duodenal ulcers, and Zollinger-Ellison syndrome.

How Does Omeprazole Work?

Omeprazole works by irreversibly inhibiting the hydrogen-potassium ATPase enzyme (proton pump) in the parietal cells of the stomach lining. This enzyme is responsible for the final step in the production of hydrochloric acid (HCl) in the stomach. By inhibiting this enzyme, omeprazole effectively reduces the production of hydrochloric acid.

By decreasing the amount of acid produced in the stomach, omeprazole allows damaged tissue in the esophagus, stomach, and duodenum to heal. It provides relief from symptoms like heartburn, difficulty swallowing, and cough. Additionally, it has off-label uses for silent reflux treatment and preventing gastric ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs).

Drug Type and Category of Omeprazole

Omeprazole is a type of medication known as a Proton Pump Inhibitor (PPI).

What dosage of Omeprazole should you be taking?

For adults:

• Duodenal ulcer: 20 mg once daily for 4 weeks ⁴
• Gastric ulcer: 40 mg once daily for 4-8 weeks ³
• GERD: 20-40 mg once or twice daily for 4-8 weeks ²
• Erosive esophagitis: 20 mg once daily for 4-8 weeks, with maintenance of 20 mg once daily ^3,4
• Zollinger-Ellison syndrome: 60 mg once daily, with some patients using it continuously for over 5 years ³

For children:

• GERD and erosive esophagitis: Dosage based on weight, ranging from 2.5 mg to 20 mg once daily ^3,4

The maximum recommended daily dose is 360 mg, with doses higher than 80 mg needing to be divided. ⁵ Doctors may adjust the dosage and duration based on the individual's condition and response to treatment.

NHS Dosage Guidelines ⁶

Omeprazole is available in 10mg, 20mg, and 40mg tablet/capsule strengths. Most commonly 20mg are taken, or 40mg if symptoms require it, per day. Liquid omeprazole is available in 2mg/ml or 4mg/ml concentrations.

Usual Dosage

• For indigestion, the usual dose is 10-20mg once daily.
• For heartburn/acid reflux, the usual dose is 20-40mg once daily.
• For stomach ulcers, the usual dose is also 20-40mg once daily.
• For Zollinger-Ellison syndrome, the dose range is 20-120mg daily.
• Doses are usually lower for children and those with liver problems.

Adjusting the Dose

• The dose may be increased if the initial dose is not working well enough.
• A higher starting dose is sometimes used for a few weeks, then reduced.

Duration of Treatment

• For self-treatment from a pharmacy, omeprazole can be taken for up to 14 days.
• For longer-term conditions, treatment may continue for weeks, months or even years.
• Gradual dose reduction is recommended when stopping long-term omeprazole.

The NHS guidelines emphasise following the instructions from your doctor or the medication packaging closely when taking omeprazole. Dosage adjustments may be needed based on your specific condition and response to treatment.

What are the side-effects of Omeprazole?

The most common side effects of omeprazole include:

• Headache
• Abdominal pain 
• Diarrhea
• Constipation
• Nausea
• Vomiting
• Flatulence
• Children may also experience fever and rash in addition to the common side effects seen in adults.

Serious side effects are less common but can include:

• Severe diarrhea, abdominal pain, and bloody/mucus-containing stool due to a C. difficile infection
• Low magnesium levels leading to muscle spasms, irregular heartbeat, and seizures
• Vitamin B12 deficiency with symptoms like fatigue, sore tongue, numbness/tingling in hands/feet
• Osteoporosis and bone fractures, especially with long-term use, higher doses, and in older adults
• Cutaneous and systemic lupus erythematosus

Long-term use of omeprazole for over 1 year may also increase the risk of gut infections and slightly increase the chance of developing stomach cancer, though more research is needed to confirm this association.

Drug Interactions

Omeprazole can interact with many medications, so it's important to inform your doctor of all drugs you are taking. Some of the most common interactions include:

• Clopidogrel, mavacamten, methotrexate (especially high-dose), rifampin, and St. John's wort - these drugs may have their metabolism affected by omeprazole.
• Drugs that require stomach acid for absorption, such as atazanavir, erlotinib, itraconazole, ketoconazole, and others - omeprazole can decrease the absorption of these medications.
• Omeprazole is very similar to esomeprazole, so you should not use any medications containing esomeprazole while taking omeprazole.
• Omeprazole can inhibit the metabolism of drugs primarily broken down by the CYP2C19 enzyme, such as diazepam and phenytoin, but does not affect drugs metabolised by other CYP450 enzymes like CYP1A, CYP2D6, and CYP3A.

Natural Alternatives to Omeprazole

Your lifestyle can greatly determine your health outcomes. There are a few lifestyle changes that could be implemented that could be used as a possible alternative to Omeprazole.

• Manage your weight through regular exercise, as excess weight can increase pressure on the abdomen and worsen reflux ⁷
• Quit smoking, as smoking is linked to a higher risk of GERD symptoms ⁷
• Elevate the head of your bed to reduce reflux at night ⁸ 
• Limit intake of trigger foods like caffeine, alcohol, chocolate, and fatty/spicy foods ⁸

There is also evidence supporting the use of herbal remedies:

• Drink chamomile tea, which can help reduce inflammation ⁸
• Take black garlic supplements, which may help lower esophageal irritation ⁸

Other supplements include:

• Melatonin, which studies suggest may be as effective as omeprazole in reducing reflux symptoms ¹⁰
• Deglycyrrhizinated licorice (DGL) and aloe vera, which may have soothing effects ¹¹

It's important to work closely with your healthcare provider when considering switching from omeprazole to a natural alternative, as they can help determine the best approach for your individual needs. Some natural remedies may interact with medications or have side effects, so medical supervision is advised.

Interesting facts about Omeprazole

Omeprazole was the first proton pump inhibitor (PPI) developed. It was first synthesised in 1979 by Swedish scientists and launched in 1988 under the brand name Losec. 

In 2024, omeprazole was the 3rd most commonly prescribed medication in the UK.

The drug is commonly coupled with anti-inflammatories such as Naproxen. 

Omeprazole is on the World Health Organization's List of Essential Medicines.

Controversies about Omeprazole

The issue with long-term use of proton pump inhibitors (PPIs) like Omeprazole is multifaceted. Some therapists believe that the root cause of digestive problems may not be excessive stomach acid, but rather too little. In such cases, further reducing stomach acid through PPIs may not provide a lasting solution. 

Additionally, lowering hydrochloric acid levels can impair the breakdown of food, leading to reduced mineral absorption and potential complications like osteoporosis with prolonged PPI use. Another concern is that patients are often prescribed PPIs for extended periods, sometimes lasting months or even years, without proper monitoring or consideration of alternative treatments. 

While there are ongoing debates about the potential links between long-term PPI use and cardiovascular disease, dementia, kidney disease, and gastric cancer, these associations remain largely unproven, and further research is necessary to establish clear causal relationships.

Disclaimer:

This article is generated for informational purposes only. It was created in June 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References:

1. https://www.mayoclinic.org/drugs-supplements/omeprazole-oral-route/proper-use/drg-20066836
2. https://www.nhs.uk/medicines/omeprazole/how-and-when-to-take-omeprazole/
3. https://www.medicalnewstoday.com/articles/325840
4. https://www.drugs.com/dosage/omeprazole.html
5. https://www.medicalnewstoday.com/articles/omeprazole-oral-capsule
6. https://www.nhs.uk/medicines/omeprazole/
7. https://www.singlecare.com/blog/omeprazole-alternatives/
8. https://perks.optum.com/blog/omeprazole-alternative
9. https://www.news-medical.net/news/20230912/Natural-compound-in-turmeric-may-be-as-effective-as-omeprazole-for-treating-indigestion.aspx
10. https://www.naturalgrocers.com/health-hotline-article/soothe-burn-healthy-alternatives-acid-blocking-drugs
11. https://www.naturomedica.com/blog/news/heart-health/top-5-natural-alternatives-to-treat-acid-reflux