Omeprazole

GENERAL MEDICINE CONTEXT — same active substance and SPC posology as the main omeprazole entry. Dose by indication (all adults): Active duodenal ulcer — 20 mg once daily; healing usually within two weeks, with a further two weeks if not fully healed; poorly responsive duodenal ulcer — 40 mg once daily, healing usually within four weeks. Prevention of relapse of duodenal ulcer (H. pylori negative or where eradication is not possible) — 20 mg once daily; 10 mg daily may suffice in some patients; on therapy failure increase to 40 mg. Gastric ulcer — 20 mg once daily, healing usually within four weeks (further four weeks if needed); poorly responsive gastric ulcer — 40 mg once daily, healing usually within eight weeks. Prevention of relapse of poorly responsive gastric ulcer — 20 mg once daily, increased to 40 mg once daily if needed. H. pylori eradication in peptic ulcer disease (antibiotic choice per national/regional/local resistance patterns and guidelines): omeprazole 20 mg + clarithromycin 500 mg + amoxicillin 1,000 mg, each twice daily for one week; OR omeprazole 20 mg + clarithromycin 250 mg (alternatively 500 mg) + metronidazole 400 mg (or 500 mg, or tinidazole 500 mg), each twice daily for one week; OR omeprazole 40 mg once daily with amoxicillin 500 mg and metronidazole 400 mg (or 500 mg, or tinidazole 500 mg), both three times a day for one week. Treatment of NSAID-associated gastric and duodenal ulcers — 20 mg once daily for four weeks (further four weeks if needed). Prevention of NSAID-associated ulcers in patients at risk (age over 60, previous ulcer or upper GI bleeding history) — 20 mg once daily. Reflux oesophagitis — 20 mg once daily for four weeks (further four weeks if needed); severe oesophagitis — 40 mg once daily, healing usually within eight weeks. Long-term management of healed reflux oesophagitis — 10 mg once daily, increased to 20-40 mg once daily if needed. Symptomatic GORD — 20 mg daily; some patients respond to 10 mg daily; if symptoms are not controlled after four weeks on 20 mg daily, further investigation is recommended. Zollinger-Ellison syndrome — individually adjusted; recommended initial dose 60 mg daily; over 90% of patients maintained on 20-120 mg daily; when the dose exceeds 80 mg daily it should be divided and given twice daily. Hepatic impairment: the SPC text is truncated in the source bundle at 'In patients with impaired hepatic function a daily dose of 10-20 ...' — verify the full statement against the SPC. Paediatric population (children over 1 year of age and at least 10 kg) — reflux oesophagitis and symptomatic heartburn/acid regurgitation in GORD: age 1 year and over weighing 10-20 kg, 10 mg once daily, increased to 20 mg once daily if needed; age 2 years and over weighing over 20 kg, 20 mg once daily, increased to 40 mg once daily if needed. Treatment time 4-8 weeks for reflux oesophagitis and 2-4 weeks for symptomatic heartburn/acid regurgitation. Children and adolescents over 4 years of age — H. pylori-associated duodenal ulcer, specialist-supervised: 15-30 kg, omeprazole 10 mg with amoxicillin 25 mg/kg and clarithromycin 7.5 mg/kg, all twice daily for one week; 31-40 kg, omeprazole 20 mg with amoxicillin 750 mg and clarithromycin 7.5 mg/kg, all twice daily for one week; over 40 kg, omeprazole 20 mg with amoxicillin 1 g and clarithromycin 500 mg, all twice daily for one week. Verify all paediatric dosing against a children's formulary.