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# Sompraz HP (Omeprazole)
## Overview
Omeprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Peptic ulcer disease (gastric and duodenal ulcers)
* Eradication of *Helicobacter pylori* (in combination with antibiotics)
* Zollinger-Ellison syndrome
* Prevention of NSAID-induced gastric ulcers
## Adult Dosing
* **GERD/Erosive Esophagitis:** 20 mg orally once daily. May increase to 40 mg once daily if needed.
* **Healing of Duodenal Ulcers:** 20 mg orally once daily.
* **Healing of Gastric Ulcers:** 20 mg orally once daily.
* ***H. pylori* Eradication (Triple Therapy):** 20 mg orally twice daily (with amoxicillin 1000 mg twice daily and clarithromycin 500 mg twice daily) for 10-14 days.
* **Zollinger-Ellison Syndrome:** Starting dose is typically 60 mg orally once daily. Doses may range from 20 mg to 120 mg daily, divided into 2 doses if exceeding 80 mg daily.
## Pediatric Dosing
* **GERD (ages 1-16 years):** 10 mg orally once daily for 4-8 weeks. Higher doses (e.g., 20 mg) may be considered for severe disease, but specific guidelines vary.
* **GERD (infants < 1 year):** Dosing is highly variable and often weight-based, typically starting at 0.5 mg/kg/day to 1 mg/kg/day, divided once or twice daily. Precise dosing should be guided by specialist recommendations.
## Dose Adjustments
* **Hepatic Impairment:** Consider reducing the dose, particularly in patients with severe hepatic impairment. Maximum daily dose typically 20 mg.
## Contraindications
* Known hypersensitivity to omeprazole or other substituted benzimidazoles.
## Adverse Effects
Common: Headache, diarrhea, nausea, vomiting, abdominal pain, constipation.
Serious: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, fundic gland polyps.
## Key Drug Interactions
* **Clopidogrel:** Omeprazole may reduce the efficacy of clopidogrel (a prodrug) due to CYP2C19 inhibition. Consider alternative PPIs with less CYP2C19 interaction or separate administration if possible.
* **Certain Antiretrovirals (e.g., ritonavir-boosted protease inhibitors):** Absorption may be affected.
* **Methotrexate:** PPIs can increase methotrexate levels, potentially leading to toxicity.
* **Drugs requiring gastric acid for absorption (e.g., ketoconazole, itraconazole, iron salts):** Omeprazole can decrease absorption.
## Monitoring
* Magnesium levels, especially with prolonged use (typically >1 year) or concurrent diuretic/digoxin use.
* Bone mineral density with long-term therapy.
* Clinical response for indication being treated.
## Clinical Pearls
* Administer orally once daily before a meal, preferably breakfast.
* Capsules should be swallowed whole. If unable to swallow, open capsules and mix contents with applesauce or yogurt and consume immediately. Do not crush or chew the granules.
* IV formulation is available for patients unable to take oral medications.
* Long-term PPI use is associated with increased risks of fractures, *C. difficile* infection, vitamin B12 deficiency, and hypomagnesemia. Consider the lowest effective dose for the shortest duration necessary.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete and up-to-date details before making any clinical decisions.
