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Omeprazole Nursing Considerations & Implications | Bioavailable

Compound database
Proton pump inhibitors
Omeprazole

OmeprazoleNursing considerations

Known brand names include Prilosec.

A proton pump inhibitor that sharply lowers stomach acid. It treats GERD and erosive esophagitis, heals duodenal and gastric ulcers, helps clear H. pylori with antibiotics, and controls rare acid-overproducing conditions such as Zollinger-Ellison syndrome.

Nursing implications

Hold parameters

Stop and evaluate if acute tubulointerstitial nephritis is suspected
Stop at the first sign of a severe skin reaction or other hypersensitivity
Stop and refer if signs of cutaneous or systemic lupus appear
Stop at least 14 days before a chromogranin A test for neuroendocrine tumors
Do not give with rilpivirine; avoid with clopidogrel

Sources: [1][2][3][4][5][6]

Administration

Give before meals
Swallow capsules whole; do not chew or crush
If the patient cannot swallow a capsule: open it, sprinkle all pellets on 1 tablespoon of soft, cool applesauce, and swallow right away with cool water; do not save the mixture
Antacids may be used at the same time
Use the lowest dose and shortest course that fits the condition

Sources: [1][2]

Assess and report

Side effects by what to assess

GI

Headache (7%), abdominal pain (5%), nausea and diarrhea (4% each)
Fundic gland polyps with long-term use (serious)

General

Vomiting and flatulence (3% each), constipation, dizziness, rash

Stool pattern

C. difficile-associated diarrhea, especially in hospitalized patients (serious)

Renal function

Acute tubulointerstitial nephritis (serious)

Bone health

Hip, wrist, or spine fractures with high-dose or long-term use (serious)

Labs

Hypomagnesemia with tetany, arrhythmias, or seizures, usually after prolonged use (serious)
Vitamin B12 deficiency with long-term use (serious)

Skin and allergy

Severe skin reactions (SJS, TEN, DRESS) and cutaneous or systemic lupus (serious)

Sources: [1][2][3][4][5][6][7][8][9]

Labs and vitals

INR (prothrombin time)

Why: Warfarin interaction
When: When omeprazole is started or stopped in a patient on warfarin
Act on: Adjust warfarin to keep INR in the target range
Normal: INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Magnesium

Why: PPI-associated hypomagnesemia
When: Before starting and periodically in prolonged therapy or with digoxin or diuretics
Act on: Replace magnesium; consider stopping the PPI
Normal: 1.7 to 2.2 mg/dL.

Sources: [1][2]

Vitamin B12

Why: Deficiency from long-term acid suppression
When: When symptoms suggest deficiency during long-term use
Normal: 299 to 1054 pg/mL.

Sources: [1][2]

Safety

High-alert status

Omeprazole is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote. Treat overdose with symptomatic and supportive care. Omeprazole is highly protein bound, so dialysis does not remove it well.

Sources: [1]

Patient teaching

Take before a meal and swallow the capsule whole
Missed dose: take it as soon as you remember unless the next dose is due; never take two at once
Report watery diarrhea that does not get better
Report rash, joint pain, decreased urination, muscle cramps or spasms, irregular heartbeat, or seizures
Tell the prescriber before starting clopidogrel, St. John's Wort, rifampin, or high-dose methotrexate

Sources: [1][2][3]

Sound-alike and look-alike names

omeprazole and fomepizole
PriLOSEC and Pristiq
PriLOSEC and PROzac

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

Active duodenal ulcer: 20 mg once daily for 4 weeks; some patients need another 4 weeks.
H. pylori, triple therapy: Omeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, each twice daily for 10 days. If an ulcer is present, continue omeprazole 20 mg daily for 18 more days.
H. pylori, dual therapy: For 14 days: omeprazole 40 mg once daily with clarithromycin 500 mg three times daily. If an ulcer is present, continue omeprazole 20 mg daily for 14 more days.
Active benign gastric ulcer: 40 mg once daily for 4 to 8 weeks.
Symptomatic GERD: 20 mg once daily for up to 4 weeks.
Erosive esophagitis: Healing: 20 mg once daily for 4 to 8 weeks, with 4 more weeks if no response. Maintenance: 20 mg once daily (studied to 12 months).
Pathologic hypersecretory conditions: Start 60 mg once daily and adjust to need. Split daily doses above 80 mg; doses up to 120 mg three times daily have been used.

Sources: [1]

Renal adjustment

None. Bioavailability rises only slightly in chronic renal impairment, which is not clinically meaningful.

Sources: [1]

Hepatic adjustment

Exposure rises substantially in Child-Pugh A, B, or C. For maintenance of erosive esophagitis healing, use 10 mg once daily. The same reduction applies to Asian patients, who have about four-fold higher exposure.

Sources: [1][2]

How it works

Mechanism

Irreversibly blocks the H+/K+ ATPase (proton pump) on the secretory surface of gastric parietal cells, the last step in acid production. It suppresses both basal and stimulated acid secretion, whatever the stimulus. It is cleared mainly by CYP2C19, with a smaller CYP3A4 share.

Sources: [1][2]