Proton Pump Inhibitor (PPI) Pregnancy: Compatible — substantial evidence of safety in pregnancy

Omeprazole (Paediatric — GORD/Peptic)

Brand names: Losec, Mepradec

Adult dose

Dose: 20–40 mg OD

Route: Oral

Frequency: OD before breakfast

Max: 40 mg OD

Full adult dosing in GI section

Paediatric dose

Route: Oral (capsule, MUPS tablet, liquid)

Frequency: Once daily before breakfast

Max: 40 mg OD

Concentration: Losec MUPS 10 mg, 20 mg tablets (dispersible); 2 mg/mL oral suspension mg/ml

BNF for Children: age/weight-banded dosing — infants ≥1 month: 0.7–1.4 mg/kg OD (up to 2.8 mg/kg if needed); children <20 kg: 10 mg OD; ≥20 kg: 20 mg OD; ≥12 yrs: 20–40 mg OD. MUPS tablets dissolve in 10 mL water (use within 30 min). H. pylori: triple therapy (omeprazole + amoxicillin + clarithromycin). Source: BNF for Children 2024; NICE NG1; ESPGHAN GORD Guidelines

Dose adjustments

Renal

No dose adjustment required

Hepatic

Maximum 20 mg OD in hepatic impairment

Clinical pearls

GORD in infants: reassure parents most infant reflux resolves by 12 months; PPIs not routinely recommended for 'silent reflux' without symptoms
MUPS tablet: disperses in 10 mL non-carbonated water — use within 30 min; do not crush enteric-coated granules as they will be destroyed
Long-term PPI in children: ongoing indication review essential — avoid chronic use without clear indication
Hypomagnesaemia monitoring: important in children on other Mg2+-lowering medications

Contraindications

Concomitant atazanavir (HIV antiretroviral)

Side effects

Headache
GI disturbance
Hypomagnesaemia (long-term)
C. diff risk (long-term)
Interstitial nephritis (rare)

Interactions

Clopidogrel — pantoprazole preferred to avoid CYP2C19 interaction
Methotrexate — increased MTX toxicity
Antiretrovirals (atazanavir, nelfinavir) — reduced absorption

Monitoring

Symptom response
Magnesium (long-term use)
Review ongoing indication at least annually

Reference: BNF for Children; NICE NG1 GORD; ESPGHAN GORD Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways