However, this association is controversial. In most cases, patients can be reassured that a balanced diet, including essential elements and minerals e. Long-term PPI use has been associated with a small increase in fracture risk. An increased risk of osteoporosis should be considered in post-menopausal females who are taking PPIs long-term, especially if they have other risk factors, e. Severe hypomagnesaemia has been associated with the use of PPIs , in a limited number of patients, which resolved when PPI treatment was withdrawn.
Omeprazole, 20 — 40 mg per day, was the dosage most frequently associated with these deficiencies. Patients with a history of excessive alcohol use, who are taking a PPI, have an increased risk of developing hypomagnesaemia due to the additive effects of chronic ethanol exposure on metabolic function.
The use of diuretics, ciclosporin or aminoglycosides with PPIs increases the risk of hypomagnesaemia occurring. Symptoms of hypomagnesaemia are non-specific and may include muscle cramps, weakness, irritability or confusion. Routine testing of magnesium levels in patients taking PPIs is generally not recommended. However, if a patient has been taking a PPI long-term and they present with unexplained symptoms that are consistent with hypomagnesaemia, consider requesting a serum magnesium level.
Increased dietary intake of magnesium rich foods, e. For some patients the PPI will need to be stopped; if the indication for using the PPI is strong, a re-challenge while monitoring magnesium can be undertaken. Vitamin B12 deficiency has been associated with the use of PPIs in older patients.
Hyponatraemia has been associated with the use of PPIs in a very small number of patients. The patient should be referred to a Nephrologist for assessment. To confirm a diagnosis of interstitial nephritis a renal biopsy is required.
Concerns of a possible interaction between omeprazole and clopidogrel are unlikely to be clinically significant. MARC assessed the evidence of an interaction between PPIs and clopidogrel and concluded that while there was evidence that PPIs may affect clopidogrel activity ex vivo, the available evidence suggested that this would not translate to clinically significant adverse outcomes.
However, if considering prescribing a PPI at the same time as clopidogrel then pantoprazole is the recommended choice. Pantoprazole is known to have less of an inhibitory effect on the CYP2C19 enzyme compared with omeprazole or lansoprazole. PPIs can cause a minor increase in the anticoagulant effect of warfarin or a decrease when the PPI is stopped. Patients taking warfarin should have their INR measured more frequently following the initiation, or discontinuation of PPIs to ensure they do not experience a clinically significant interaction.
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Click here to register ». Forgot your login? Login to my bpac. Remember me. Gastroenterology Medicines management. Proton pump inhibitors: When is enough, enough?
When can you consider stopping treatment with a PPI? How safe are proton pump inhibitors? References In this article. Use of PPIs in New Zealand The treatment of symptoms caused by gastric acid dates backs to the ancient Greeks, who used coral powder calcium carbonate to alleviate dyspepsia. When, and how, is it appropriate to prescribe a proton pump inhibitor? The pharmacology of proton pump inhibitors PPIs are prodrugs, i.
Gastro-oesophageal reflux disease Proton pump inhibitors are indicated in the treatment of suspected or confirmed GORD. Eradication treatment for H. For example, a seven day course of: 4 Omeprazole 20 mg, twice daily; and Clarithromycin mg, twice daily; and Amoxicillin 1 g, twice daily or metronidazole mg, twice daily, if allergic to penicillin Other regimens using different dosing intervals or other PPIs, e.
The risk of infection is increased Gastric acid suppression with PPIs increases the risk of infection with gastrointestinal or respiratory pathogens, although the absolute risk to most patients remains low. Malabsorption of nutrients may occur Acid in the gut increases the solubility of elements, e.
Interactions with other medicines Concerns of a possible interaction between omeprazole and clopidogrel are unlikely to be clinically significant. References Dutta U, Moayyedi P. Management of reflux-related symptoms. Best Pract Res Clin Gastroenterol ;— Available from: www. Ministry of Health MoH.
Pharmaceutical collection. NZF v Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis. World J Gastroenterol ;— Safety of proton pump inhibitor exposure.
Gastroenterology ;— New Zealand Guidelines Group. Ask your doctor if you have any questions. Take omeprazole capsules or delayed-release capsules before a meal, preferably in the morning. Omeprazole tablets may be taken with food or on an empty stomach. Take omeprazole powder for oral suspension on an empty stomach at least 1 hour before a meal. For patients receiving continuous feeding through a tube, feeding should be temporarily stopped about 3 hours before and 1 hour after administration of omeprazole powder for oral suspension.
It may take several days before this medicine begins to relieve stomach pain. To help relieve this pain, antacids may be taken with omeprazole, unless your doctor tells you otherwise. If you are taking this medicine to treat an ulcer that is associated with an H. Swallow the capsule and tablet forms of omeprazole whole. Do not open the capsule. Do not crush, break, or chew the capsule or the tablet.
If you cannot swallow the omeprazole delayed-release capsules, you may open it and sprinkle the pellets contained in the capsule on one tablespoon of applesauce. This mixture must be swallowed immediately with a glass of cool water. The applesauce should not be hot and should be soft enough to be swallowed without chewing.
Do not chew or crush the pellets. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label.
The following information includes only the average doses of this medicine. The colour of omeprazole capsules will be changing. From 1 August , the colour and packaging for omeprazole capsules will be changing.
They are still made by the same company Actavis and the formulation remains the same. Omeprazole 10 mg and 20 mg — the capsules and bottles for are changing. Omeprazole 40 mg — the capsules remain the same, but the bottles will have a new look. Read more about omeprazole changes. Stomach upset, feeling sick Feeling bloated, gas in your abdomen tummy Loose stool mild diarrhoea Constipation.
These are quite common when you first start taking omeprazole. Tell your doctor if troublesome. Signs of low magnesium, such as muscle cramps, weakness, tiredness, feeling irritable and changes in your heartbeat.
Increase your intake of magnesium-rich foods such as wholegrain cereals, green leafy vegetables spinach, parsley, cabbage , peas, lean meats, nuts, seeds and bananas. Tell your doctor if troublesome — you may need a magnesium supplement. Omeprazole can increase the chance of getting severe diarrhoea which may be caused by bacteria called clostridium difficle.
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