Omeprazole

Omeprazole Side Effects: Omeprazole, originally marketed as Prilosec, was the first of a new class of medications known as the proton pump inhibitors that are used to treat acid dyspeptic disorders . These medications were revolutionary in that they nearly completely turned off the gastric parietal cells production of hydrochloric acid and so made the stomach contents nearly neutral. As such omeprazole side effects are in large part related to the lack of acidity of the stomach juices and the consequences result of this lack of acidity. Typical omeprazole dosage starts at 20 mg daily usually in the morning before the first meal of the day, but can be increased to 40 mg daily or 20 mg twice a day. Indications for omeprazole include gastroesophageal reflux disease (GERD), erosive esophagitis, treatment of gastric ulcer, treatment of duodenal ulcer, in combination with various multiple antibiotic regimens for treatment of H. pylori infection, prevention of gastric ulcer in combination with nonsteroidal anti-inflammatory medications, and in other hypersecretory conditions such as Zollinger-Ellison syndrome.

Common Omeprazole Side Effects:  Fortunately most known omeprazole side effects are uncommon but can manifest as several gastrointestinal symptoms including abdominal pain, nausea, vomiting, flatulence, and diarrhea. Headache is a fairly common omeprazole side effect and in recent years is become increasingly important to recognize the rebound hyperacidity that can occur after prolonged omeprazole therapy. Pediatric patients can develop fever and upper respiratory infections as common omeprazole side effects.

Serious Omeprazole Side Effects:  Fortunately serious omeprazole side effects are quite uncommon. Dermatologic conditions including Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme are documented. Pancreatitis, interstitial nephritis, blood dyscrasias, and hepatic impairment have been noted as serious omeprazole side effects. The lack of stomach hyperacidity can lead to poor calcium absorption and the resultant fractures can be a serious omeprazole slot side effect. Long-term use can lead to atrophic gastritis as well as hypomagnesemia.

Cautions and Drug Interactions: Omeprazole use is contraindicated in combination with several HIV drugs. These include atazanavir, nelfinavir, rilpifirine and other combination HIV drugs. Alternatives should be considered for numerous medications. The drugs listed here are just a few of the list of medications in this category that are more commonly used in include clopidogrel (Plavix), diazepam, the azole antifungal products, warfarin, naproxen, and St. John’s wort. Treatment may need to be modified with citalopram, digoxin, all diuretics, the phenytoin class of drugs, sucralfate, and cyclosporine. Caution may be needed with a long list of medications of which only a few will be mentioned. These include disulfiram, fluvastatin, the clarithromycin’s, and numerous herbal products including Ginger and goldenseal. Many of these drug interactions are related to the extensive liver metabolism using several of the CYP 450 pathways. The primary pathways the 2C19 pathway, but omeprazole is a 3A4 substrate as well as an inhibitor of the 2C19 pathway.

Pregnancy and Lactation: Omeprazole is pregnancy category C and is considered probably safe during lactation.

Further Considerations: As the first of the proton pump inhibitor class of medications to be brought to market omeprazole is also the first become available as a generic. It is now also available as an off-the-shelf a product available without prescription as Prilosec OTC as well as multiple store brands. Prolonged use of a proton pump inhibitor without physician monitoring or evaluation is not encouraged as potentially serious and life-threatening conditions can mimic simple heartburn or other reasons the patient might take omeprazole with good relief for some time. In addition with prolonged use omeprazole can lead to rebound hyper acidity on discontinuation of the medication making the acid dyspeptic symptoms initially noted even more severe after discontinuation of the omeprazole. Prolonged use should be avoided without a strong indication for continued therapy. Patient should definitely consult a physician before considering long-term use of omeprazole any PPI.

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