Omeprazole is very commonly used drug for the treatment of dyspepsia, peptic ulcer disease(PUD), gastroesophageal reflux disease and etc. Counseling of drugs is one of the important responsibility of pharmacist. This article covers some useful parameters that must be communicated to the patients before dispensing the drugs to them.
Proton pump inhibitor (Anti-ulcer drug)
Counseling for Pharmacokinetics:
Counsel the patient if necessary regarding how this drug will affect his body. Omeprazole is a proton pump inhibitor.It is rapidly absorbed. Following are few parameters that a pharmacist should know.
- ·Bioavailability 35–76%
- Protein binding 95%
- Metabolism Hepatic (CYP2C19, CYP3A4)
- Half-life 1 – 1.2 hours
- Excretion 80% Renal , 20% Faecal
Counseling for Indications:
Before dispensing the drug pharmacist should tell the patient regarding its clinical uses. So that patient should aware that he is taking the right medication. Omeprazole is used in the treatment of duodenal ulcer, Gastric ulcer and Reflux oesophagitis.
Counseling for Routes of Administration and Dosage:
Right drug at right dose is necessary in order to get optimized pharmacotherapy. If dose is less or more it will not be able to produce desired therapeutic effects because the lesser dose will cause therapeutic failure and higher dose will cause toxic effects. It is the duty of the pharmacist to verify the dose against indications. The dose of omeprazole is different in different diseases. Following information on dosage of omeprazole is taken from British National Formulary (BNF).
For Oral Route:
- By mouth, benign gastric and duodenal ulcers, 20 mg once daily for 4 weeks in duodenal ulceration or 8 weeks in gastric ulceration; in severe or recurrent cases increase to 40 mg daily; maintenance for recurrent duodenal ulcer, 20 mg once daily; prevention of relapse in duodenal ulcer, 10 mg daily increasing to 20 mg once daily if symptoms return
- NSAID-associated duodenal or gastric ulcer and gastroduodenal erosions, 20 mg once daily for 4 weeks, continued for further 4 weeks if not fully healed; prophylaxis in patients with a history of NSAID-associated duodenal or gastric ulcers, gastroduodenal lesions, or dyspeptic symptoms who require continued NSAID treatment, 20 mg once daily
- Duodenal or benign gastric ulcer associated with Helicobacter pylori
- Zollinger–Ellison syndrome, initially 60 mg once daily; usual range 20–120 mg daily (above 80 mg in 2 divided doses)
- Gastric acid reduction during general anaesthesia (prophylaxis of acid aspiration), 40 mg on the preceding evening then 40 mg 2–6 hours before surgery
- Gastro-oesophageal reflux disease, 20 mg once daily for 4 weeks, continued for further 4–8 weeks if not fully healed; 40 mg once daily has been given for 8 weeks in gastro-oesophageal reflux disease refractory to other treatment; maintenance 20 mg once daily
- Acid reflux disease (long-term management), 10 mg daily increasing to 20 mg once daily if symptoms return
- Acid-related dyspepsia, 10–20 mg once daily for 2–4 weeks according to response
- Severe ulcerating reflux oesophagitis, child over 1 year, body-weight 10–20 kg, 10 mg once daily increased if necessary to 20 mg once daily for 4–12 weeks; body-weight over 20 kg, 20 mg once daily increased if necessary to 40 mg once daily for 4–12 weeks; to be initiated by hospital paediatrician
For IV Route:
- By intravenous injection over 5 minutes or by intravenous infusion, prophylaxis of acid aspiration, 40 mg completed 1 hour before surgery
- Benign gastric ulcer, duodenal ulcer and gastro-oesophageal reflux, 40 mg once daily until oral administration possible
Counseling for Side effects:
Every drug has some specific side effects that can occur at therapeutic doses. The patient should have all information regarding such effects so that he can continue or discontinue drug immediately when required. Now here comes the expertise of a pharmacist, he should discuss side effects of drugs prescribed by a physician with patient. Some most common side effects that must be communicated to the patient are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps, and water retention occur infrequently. If these side effects occur then stop the drug immediately and visit the doctor.
Counseling for Administration:
Tell the patient that orally omeprazole should be taken atleast 30 minutes before meal in order to get optimum absorption.
Counseling for Contraindications:
It should not be prescribed in some conditions as if the patient has hypersensitivity to the drug, neonates and during lactation.
Counseling for Precautions:
Proton pump inhibitors should be used with great caution in patient suffering from
- Liver disease
- Breast feeding
- Gastric cancer
Pharmacist must ask patient regarding any hepatic problem and respond accordingly.
Counseling for Interactions:
Tell the patient that concomitant use of some drugs with omeprazole should be avoided such as diazepam, warfarin, phenytoin and aminophylline due to toxic effects.
Counseling for storage:
Counsel the patient that store omperazole under specified temperature.
- Capsules should be stored at 15 to 30 Co (59 to 86 F) and tablets at 20 to 25 Co (68 to 77 F).
- It should be kept away from moisture and light.
- Tatro DS, Borgsdorf LR. A to z drug facts. Facts & Comparisons, 2003.
- Committee JF, Britain RPSoG. British National Formulary (BNF) 64. Pharmaceutical Press, 2012.
- Knoben JE, Anderson PO, Watanabe AS. Handbook of clinical drug data. Drug Intelligence Publications Hamilton, IL, 1988.