All About Omeprazole

Omeprazole is one of the most widely used drugs worldwide. It's used as a stomach protector to minimize the risk of developing ulcers.

Omeprazole is a drug known today for its active ingredient, but it was created in 1989 under the trade name Prilosec. Many people self-medicate with omeprazole and are unaware of its main warnings.

What is it for?

Omeprazole is recommended to treat or prevent diseases related to gastric secretion. In these pathologies, we find an imbalance between the acid irritants and the protection mechanisms of the gastric mucosa. The main diseases it’s used for are:

• The treatment of gastroesophageal reflux, produced when stomach acid returns to the esophagus, inflaming it.
• Treatment and prevention of duodenal and gastric ulcers. These areas are damaged, causing pain.
• Prevention of ulcers in patients receiving NSAIDs. The continued use of NSAIDs, such as ibuprofen or naproxen, constitutes a risk factor in the development of ulcers, and on many occasions, the specialist prescribes both drugs simultaneously.
• Zollinger-Hellison syndrome, caused by excess gastric acid production by the hormone gastrin.
• Eradication of Helicobacter pylori, a bacterium resistant to stomach acid pH and capable of penetrating the stomach lining.

How it works and its pharmacokinetics?

This medicine belongs to the group known as proton pump inhibitors (PPIs), whose purpose is to decrease the acid made by the stomach. Parietal cells are the epithelial cells of the stomach, which use the proton pump for acid production.

It’s a prodrug that requires a gastro-resistant coating because it’s a weak base. It’s absorbed in the small intestine and passes into its active form, which irreversibly and selectively inhibits the pump, after coming into contact with the acidic stomach environment.

Its absorption is rapid, reaching the maximum concentration in the bloodstream between the first and second hour after taking.

In addition, its bioavailability improves remarkably after repeated administration. Likewise, metabolism is carried out entirely by cytochrome P450, on which omeprazole doesn’t exert an inhibitory action on the main enzymes. About 80% of its metabolites will be excreted in the urine.

How is omeprazole used?

The form of administration is orally, generally in gastro-resistant capsules or in a syrup for babies. It’s advisable to take it half an hour before having breakfast with water. You should avoid opening the capsules, but if it’s essential, then proceed to dissolve the contents of the capsule in an acidic liquid, such as juice.

The dose of omeprazole varies, depending on the individual and their pathology. In most cases, adults in the prevention or treatment of gastroesophageal reflux or ulcers will take 20 milligrams a day, as in the prevention of ulcers by NSAIDs or in the eradication of Helicobacter pylori.

For the treatment of Zollinger-Hellison syndrome, 60 milligrams a day is usually prescribed. All these doses can be modified by the prescriber, if required by the patient.

Warnings to take into account

Omeprazole can cause different side effects, by modifying the behavior of the stomach. Therefore, it must be prescribed by a doctor. The effect of drugs with pH dependent absorption, such as digoxin, clopidogrel, ketoconazole, or nelfinavir, may be increased or decreased.

On the other hand, in prolonged treatments, it can produce hypomagnesemia – a lack of magnesium – causing fatigue, dizziness or cramps. This mineral deficiency can be confirmed by a blood test, and reversed by replenishing magnesium and discontinuing omeprazole.

Likewise, PPIs have been associated with an increased risk of gastrointestinal infections such as salmonellosis, and with an increased risk of bone fractures in the elderly, after prolonged use.

The difference between an antacid and a stomach protector

Antacids, such as bicarbonate, fruit salts, or almagate (Almax), neutralize the acid secretion of the stomach, causing a rapid increase in pH.

They’re used occasionally after a big or spicy meal. Although they don’t require a prescription, they can modify the absorption of other drugs. For this reason, it’s advisable to consult its administration if any drug is consumed.

On the other hand, stomach protectors, such as omeprazole or pantoprazole, do require a prescription, as they modify acid production after systemic absorption. They aren’t recommended to reduce occasional heartburn.