Prilosec: Effective Prescription-Strength Acid Reduction for GERD
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Prilosec (omeprazole) is a proton pump inhibitor (PPI) indicated for the short-term treatment of gastroesophageal reflux disease (GERD), including erosive esophagitis, and other acid-related conditions. As a first-in-class therapy, it works by directly inhibiting the proton pumps in the stomach lining, the final step of acid production. This guide provides a comprehensive, evidence-based overview for healthcare professionals and informed patients, detailing its mechanism, appropriate use, and essential safety information to support clinical decision-making and patient counseling.
Features
- Active ingredient: Omeprazole 20 mg (delayed-release tablets)
- Mechanism: Irreversible inhibition of H+/K+ ATPase (proton pump) in gastric parietal cells
- Formulation: Delayed-release, enteric-coated tablets for targeted intestinal absorption
- Administration: Oral, once daily before a meal
- Available in 14-day and 28-day course packs
- Requires acid-resistant coating to prevent degradation in stomach
Benefits
- Provides sustained, dose-dependent suppression of gastric acid secretion for up to 72 hours
- Promotes healing of erosive esophagitis with demonstrated efficacy in clinical trials
- Reduces heartburn frequency and severity, improving quality of life in GERD patients
- May decrease the risk of NSAID-induced gastric ulcers in high-risk patients
- Allows for once-daily dosing due to prolonged duration of action
- Available in both prescription and non-prescription (OTC) strengths with appropriate guidance
Common use
Prilosec is primarily indicated for the short-term treatment (4-8 weeks) of active duodenal ulcer, active benign gastric ulcer, erosive esophagitis, and symptomatic GERD. It is also used in combination with antibiotics for Helicobacter pylori eradication in duodenal ulcer disease. Maintenance therapy for healed erosive esophagitis may be considered, though the lowest effective dose should be used for the shortest duration. Some off-label uses include prevention of upper GI bleeding in critically ill patients and management of Zollinger-Ellison syndrome, though higher doses are typically required for these conditions.
Dosage and direction
For most adults with GERD or erosive esophagitis: 20 mg once daily before a meal for 4-8 weeks. For H. pylori eradication: 20 mg twice daily combined with appropriate antibiotics for 10-14 days. Tablets should be swallowed whole with water; they should not be crushed, chewed, or split as this compromises the enteric coating. For patients with difficulty swallowing, the capsule may be opened and sprinkled on applesauce, but the granules must not be chewed or crushed. Dosage adjustment may be necessary in patients with severe hepatic impairment.
Precautions
Long-term use (beyond one year) requires periodic evaluation of patient need due to potential risks. Use the lowest effective dose for the shortest duration appropriate to the condition being treated. Monitor for signs and symptoms of magnesium deficiency (e.g., muscle spasms, arrhythmias), particularly with concomitant diuretic use or prolonged therapy. Exercise caution in patients with osteoporosis or risk factors for fracture, as proton pump inhibitors may be associated with increased risk of fractures of the hip, wrist, and spine. Consider periodic magnesium, calcium, and vitamin B12 monitoring in patients on long-term therapy.
Contraindications
Hypersensitivity to omeprazole, substituted benzimidazoles, or any component of the formulation. Concomitant use with rilpivirine-containing products due to potential for reduced antiviral efficacy. Should not be used in patients receiving clopidogrel due to potential drug interaction that may reduce antiplatelet activity (though this remains controversial in current guidelines). Not recommended for immediate relief of heartburn symptoms as onset of action may take 1-4 days.
Possible side effect
Common (≥1/100 to <1/10): headache, abdominal pain, diarrhea, flatulence, nausea, vomiting, constipation. Uncommon (≥1/1,000 to <1/100): dizziness, rash, sleep disturbance, elevated liver enzymes. Rare (<1/1,000): anaphylaxis, angioedema, interstitial nephritis, hypomagnesemia, vitamin B12 deficiency, Clostridium difficile-associated diarrhea, cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus. Long-term use associations: increased risk of bone fractures, fundic gland polyps (benign).
Drug interaction
Omeprazole may alter the absorption of drugs requiring acidic gastric pH (e.g., ketoconazole, iron salts, digoxin, mycophenolate mofetil). Inhibits CYP2C19, potentially increasing concentrations of diazepam, warfarin, phenytoin, and clopidogrel (clinical significance varies). May interact with methotrexate (increased toxicity), saquinavir (reduced levels), and tacrolimus (increased levels). St. John’s wort, rifampin, and other CYP inducers may decrease omeprazole concentrations.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. Consistency in daily dosing before a meal provides optimal acid control. For patients on twice-daily regimens for H. pylori eradication, maintain as regular intervals as possible to ensure consistent antibiotic coverage.
Overdose
Experience with omeprazole overdose is limited. Doses up to 2,400 mg (120 times the usual dose) have been reported with variable effects. Potential manifestations may include confusion, drowsiness, blurred vision, tachycardia, nausea, diaphoresis, flushing, headache, and dry mouth. Omeprazole is not dialyzable. Treatment should be symptomatic and supportive. No specific antidote exists. Contact a poison control center for current recommendations.
Storage
Store at room temperature (20-25°C or 68-77°F); excursions permitted to 15-30°C (59-86°F). Keep container tightly closed to protect from moisture. Keep out of reach of children. Do not use if the blister pack is broken or tablets show signs of damage to the enteric coating. Dispense in original container with desiccant to maintain stability.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Prilosec is a prescription medication in its 20 mg strength and should be used only under the supervision of a healthcare professional. OTC Prilosec OTC is indicated for frequent heartburn (2 or more days per week) and should not be used for more than 14 days without medical consultation. Patients should consult their healthcare provider for diagnosis and appropriate treatment recommendations. Serious conditions may present with heartburn-like symptoms and require different management.
Reviews
Clinical trials demonstrate healing of erosive esophagitis in approximately 85% of patients after 8 weeks of therapy with 20 mg daily. Systematic reviews confirm superiority to H2-receptor antagonists for healing and symptom relief in GERD. Patient-reported outcomes show significant improvement in quality of life measures related to GERD symptoms. Some real-world evidence suggests variable response rates, with a subset of patients requiring alternative dosing or additional therapies. Long-term observational studies continue to evaluate the risk-benefit profile in chronic users.