Omeprazole (Prilosec, Losec, Risek) suppresses the secretion of acid in the stomach by inhibiting the Hydrogen (proton) pumps. It is also used as an OTC medicine for heartburn and GERD (gastroesophageal reflux disease).

Omeprazole (Prilosec) Uses:

• Duodenal ulcer (Rx only):

  • In adults, short-term treatment (4-8 weeks) of active duodenal ulcer.

• Gastric ulcer (Rx only):

  • In adultsShort-term treatment (4-8 weeks) of active benign gastric ulcer.

• Gastroesophageal reflux disease (Rx only):

  • Treatment of erosive esophagitis:
    • Due to acid-mediated gastroesophageal reflux disease (GERD) diagnosed by endoscopy in patients ≥1 year, short-term treatment (4 to 8 weeks) of erosive esophagitis (EE).
    • In pediatric patients 1 month to <1 year, short-term treatment (up to 6 weeks) of EE due to acid-mediated GERD.
  • Maintenance healing of erosive esophagitis:
    • In patients ≥1 year, maintenance healing of EE due to acid-mediated GERD.

• Symptomatic gastroesophageal reflux disease:

  • Treatment of heartburn and other symptoms associated with GERD, for up to 4 weeks in patients ≥1 year.

• Heartburn (OTC only):

  • In adults, treatment of frequent, uncomplicated heartburn (occurring ≥2 or more days per week).

• Helicobacter pylori eradication (Rx only):

  • Dual therapy:
    • To eradicate H. pylori in adults, treatment of H. pylori infection & duodenal ulcer disease (active or up to 1year history) in combination with clarithromycin.
  • Triple therapy:
    • To eradicate H. pylori in adults, treatment of H. pylori infection and duodenal ulcer disease (active or up to 1year history) in combination with clarithromycin & amoxicillin.

• Pathological hypersecretory conditions (Rx only):

  • In adults, long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic mastocytosis).

• Off Label Use of Omeprazole in Adults:

  • Dyspepsia.
  • NSAID-induced ulcer prophylaxis.
  • NSAID-induced ulcer treatment.
  • Stress ulcer prophylaxis in critically ill patients.

Omeprazole Dose in Adults

Omeprazole Dose in the treatment of Duodenal ulcer:

• P/O:
  • For 4 weeks, 20 mg once daily.
  • Some patients may need an additional 4 weeks.
  • Up to 40 mg once daily has been used in patients with ulcers refractive to other therapies (eg, H-2 antagonists).

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Omeprazole Dose in the treatment of Dyspepsia (off-label):

• P/O:
  • For up to 4 weeks, 20 mg once daily.

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Omeprazole Dose in the treatment of gastric ulcers:

• P/O:
  • For 4-8 weeks, 40 mg once daily.
  • Healing rates of ulcers ≤1 cm at 4 & 8 weeks were similar between omeprazole 20 mg and 40 mg in clinical trials.
  • Omeprazole 40 mg was significantly more effective at 8 weeks for ulcers >1 cm.

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Omeprazole Dose in the treatment of Gastroesophageal reflux disease (GERD):

Note:

• Administer 30-60 mins before a meal (breakfast is preferred).
• Lifestyle & dietary modifications are also recommended (ACG [Katz 2013]).

• Initial therapy:

  • Mild and intermittent symptoms (<2 episodes/week) & no evidence of erosive esophagitis:

Note:

• Some experts consider PPI use in these patients only if symptoms persist following standard-doses of histamine 2 receptor antagonists.
  • P/O:
  • For 8 weeks, 20 mg once daily.
  • Increase to 40 mg once daily if symptoms persist after 8 weeks.
  • Continue treatment for at least 8 weeks once symptoms are controlled.
  • Discontinue therapy when asymptomatic for 8 weeks with therapy (consider tapering before discontinuing) (Kahrilas 2019).

• Severe or frequent symptoms (≥2 episodes/week), erosive esophagitis or Barrett's esophagus:

  • P/O:
    • 40 mg once daily.
    • Continue treatment for at least 8 weeks once symptoms are controlled.
    • Long-term maintenance therapy with 40 mg once daily is warranted in patients with severe erosive esophagitis or Barrett esophagus.
    • Continue at the lowest dose for the shortest duration appropriate in patients without severe erosive esophagitis or Barrett's esophagus, discontinue therapy in all asymptomatic patients (consider tapering before discontinuing).
    • Note: In Asian patients, consider using 10 mg once daily for the maintenance healing of erosive esophagitis due to increased bioavailability (manufacturer’s labeling).

• Refractory symptoms:

  • Persistent symptoms despite 40 mg once daily dosing regimen:

Note:

• Referral to a specialist is recommended:
  • P/O:
    • 40 mg twice daily (before breakfast and dinner) or some experts consider splitting the 40 mg once daily dose and administering 20 mg twice daily before breakfast and dinner.

• Recurrent symptoms after discontinuing acid suppression:

  • Recurrent symptoms ≥3 months:

    • At the previously effective dose, repeat an 8-week course.

  • Recurrent symptoms <3 months:

    • Long-term maintenance at the lowest effective dose necessary.
    • Upper endoscopy is also recommended (if not already performed).

  • OTC labeling (patient-guided therapy):

    • Heartburn, frequent symptoms (≥2 episodes/week):

      • For 14 days, 20 mg once daily (max: 20 mg/day).
      • Every 4 months may repeat a 14-day course if needed.

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Omeprazole Dose in the treatment of Helicobacter pylori eradication:

P/O:

• Dose of omeprazole varies with the regimen:

  • Manufacturer labeling:

    • Dual therapy:

      • 40 mg once every 24 hours administered with clarithromycin 500 mg 3 times daily for 14 days.
      • Continue omeprazole 20 mg once daily for an additional 14 days after completion of dual therapy in patients with the presence of ulcer at the time of therapy initiation.

    • Triple therapy:

      • 20 mg twice daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 10 days.
      • Continue omeprazole 20 mg once daily for an additional 18 days after completion of triple therapy in patients with the presence of ulcer at the time of therapy initiation.

• American College of Gastroenterology guidelines:

  • Clarithromycin triple regimen:

    • 20-40 mg twice daily in combination with clarithromycin 500 mg twice daily & either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times daily.
    • Continue regimen for 14 days.

Note:

• In patients with risk factors for macrolide resistance avoid use of clarithromycin triple therapy (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%).

  • Bismuth quadruple regimen:

    • In combination with tetracycline 500 mg 4 times daily, 20 mg twice daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120-300 mg 4 times daily or bismuth subsalicylate 300 mg 4 times daily.
    • Continue regimen for 10-14 days.

  • Concomitant regimen:

    • In combination with amoxicillin 1 g twice daily, 20 mg twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily.
    • Continue regimen for 10-14 days.

  • Sequential regimen:

    • For 5-7 days, 20 mg twice daily plus amoxicillin 1 g twice daily.
    • Then continue omeprazole along with clarithromycin 500 mg twice daily & either metronidazole or tinidazole 500 mg twice daily for 5-7 days.

  • Hybrid regimen:

    • For 7 days, 20 mg twice daily plus amoxicillin 1 g twice daily.
    • Then continue omeprazole and amoxicillin along with clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 7 days.

  • Levofloxacin triple regimen:

    • In combination with amoxicillin 1 g twice daily, 20 mg twice daily and levofloxacin 500 mg once daily.
    • Continue regimen for 10-14 days.

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Omeprazole Dose in the prophylaxis of NSAID-induced ulcer (off-label):

• P/O:
  • For up to 6 months, 20 mg once daily.

Omeprazole Dose in the treatment of NSAID-induced ulcer (off-label):

• P/O:
• Initial:
  • For 4-8 weeks, 20 mg once daily.
• Maintenance:
  • For up to 6 months, 20 mg once daily (Bianchi 1998; Hawkey 1998; Yeomans 1998).

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Omeprazole Dose in the treatment of Pathological hypersecretory conditions:

• P/O:
• Initial:
  • 60 mg once daily.
  • Doses up to 120 mg 3 times daily have been administered.
  • In divided doses, administer daily doses >80 mg.
  • Treat as long as clinically indicated.
  • Some patients have been treated continuously for >5 years.

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Omeprazole Dose in the treatment of stress ulcer prophylaxis in critically ill patients (off-label):

• P/O or via NG tube:

  • Daily 40 mg once or may administer 40 mg loading dose followed by 20-40 mg once daily.

Note:

• • Intended for patients with associated risk factors (eg, coagulopathy, mechanical ventilation for >48 hours, sepsis/septic shock).
  • Once risk factors have resolved, discontinue use. Omeprazole 20 mg via NG tube once daily may be less effective in some critically-ill populations compared to 40 mg via NG tube once daily.

  • Discontinuation of therapy:

  • P/O:
    • In order to avoid worsening or rebound symptoms, some experts recommend a step-down approach.
    • One strategy is to decrease the dose by 50% over 2-4 weeks.
    • Alternate-day therapy may be considered if the patient is already on the lowest possible dose.
    • Patients should be reevaluated if symptoms worsen during treatment or after discontinuation.

Omeprazole Dose in Childrens

Omeprazole Dose in the treatment of Erosive esophagitis:

Note:

• Duration of therapy is dependent on age:
• Infant duration is up to 6 weeks & children and adolescent duration is 4-8 weeks.
• Treatment may continue to an additional 4 weeks in children and adolescents with no response at 8 weeks.
• An additional 4- to 8-weeks course may be considered for recurrence of erosive esophagitis or gastroesophageal reflux disease (GERD) symptoms (eg, heartburn).

  • Infants, Children, and Adolescents:

  • P/O:

    • 3 to <5 kg:
      • 2.5 mg once daily.
    • 5 kg to <10 kg:
      • 5 mg once daily.
    • 10 kg to <20 kg:
      • 10 mg once daily.
    • ≥20 kg:
      • 20 mg once daily.

• Maintenance of healing:

  • Children and Adolescents:

  • P/O:

    • 5 kg to <10 kg:
      • 5 mg once daily.
    • 10 kg to <20 kg:
      • 10 mg once daily.
    • ≥20 kg:
      • 20 mg once daily.

Omeprazole Dose in the treatment of Gastroesophageal reflux disease (GERD):

• Note:
  • Guidelines recommend a 4-8-week treatment course.
  • Consider possible wean if improvement seen after 4-8 weeks.
  • Reevaluate diagnosis and consider referral to pediatric GI specialist if no response after 4 to 8 weeks.

• Fixed dosing: Children and Adolescents:

• P/O:

  • 5 kg to <10 kg:
    • 5 mg once daily.
  • 10 kg to <20 kg:
    • 10 mg once daily.
  • ≥20 kg:
    • 20 mg once daily.

• Weight-based dosing:

  • P/O:
    • 0.7-4 mg/kg/day.
    • The dose most frequently reported to provide healing of esophagitis & relief of GERD symptoms is 1 mg/kg/day.
  • Max daily dose:
    • 40 mg/day.

Omeprazole Dose in the treatment of Helicobacter pylori eradication: P/O:

• Children and Adolescents:

Note:

• As part of triple therapy, usual duration of therapy is 14 days.
• Use in combination with 2 antimicrobials (eg, clarithromycin, metronidazole, amoxicillin); preferred agents determined by susceptibility.
• If resistance is present or susceptibility is unknown, bismuth may be added to regimens as an alternative.
  • 15 to <25 kg:
    • 20 mg twice daily.
  • 25 to 34 kg:
    • 30 mg twice daily.
  • >34 kg:
    • 40 mg twice daily.

• Discontinuation of therapy:

  • P/O:
    • Some experts recommend a step-down approach in order to avoid worsening or rebound symptoms, based on experience in adults.
    • One recommendation is to decrease the dose by 50% over 2-4 weeks.
    • Alternate day therapy may be considered if the patient is already on the lowest possible dose.
    • Patient should be reevaluated if symptoms worsen during treatment or after discontinuation.

Omeprazole Pregnancy Risk Category: C

• Data on pregnancy have not shown an increase in the risk of major birth defects due to maternal use of Omeprazole.
• Recommendations for treating GERD in pregnancy are available.
• Lifestyle modification and other medications are the first treatment options for pregnant patients.
• Based on the available data, PPIs can be used when they are clinically indicated.

Omeprazole use during breastfeeding:

• Breast milk contains Omeprazole.
• The relative infant dose (RID), of omeprazole, is 0.2% to0.43%.
• This was calculated using the highest breast milk concentration and compared with an infant therapeutic dose between 0.7 and 1.5 mg/kg/day.
• When the RID is less than 10%, breastfeeding is acceptable.
• The RID of Omeprazole was calculated by using the highest milk concentration (20.03 mg/L), which gives an estimated daily infant dose via breastmilk of 0.003mg/day.
• This was achieved after maternal chronic oral omeprazole 20mg/day administration.
• The peak concentration in breast milk occurred three hours after the last dose.
• One infant was not adversely affected by omeprazole after being given oral omeprazole 20mg/day for three months by its mother.
• The case report's authors noted that omeprazole ingested by infants who are breastfed may be inactivated by the acidic stomach of these babies.
• When deciding whether to discontinue or continue breastfeeding during therapy, it is important to consider the risks to infants, the benefits to the infant and the benefits to the mother.

Omeprazole Dose in Kidney Disease:

• No dosage adjustment necessary.

Omeprazole Dose in Liver Disease:

• Mild to severe impairment (Child-Pugh class A, B, or C):

  • 10 mg once daily when used for maintenance of healing of erosive esophagitis.
  • For the other indications, there are no dosage adjustments provided.
  • A max dose of 20 mg/day regardless of indication, has been recommended alternately (Losec Canadian product labeling).
  • In a very small study, in patients with mild to severe hepatic impairment, omeprazole systemic exposure and half-life increased ~2- and ~3-fold respectively.

Side Effects of Omeprazole:

• Central Nervous System:

  • Headache
  • Dizziness

• Dermatologic:

  • Skin Rash

• Gastrointestinal:

  • Abdominal Pain
  • Diarrhea
  • Nausea
  • Flatulence
  • Vomiting
  • Acid Regurgitation
  • Constipation

• Neuromuscular & Skeletal:

  • Back Pain
  • Weakness

• Respiratory:

  • Upper Respiratory Infection
  • Cough

Contraindications to Omeprazole:

• Hypersensitivity, such as anaphylaxis or anaphylactic shock, bronchospasms, interstitial Nephritis, urticaria, and omeprazole to omeprazole or other substituted benzimidazole pron pump inhibitors, can occur when there is a component in the formulation.
• Concomitant use with products that contain rilpivirine.

OTC labeling

• If you are using OTC for self-medication, do not swallow food if you experience pain or difficulty.
• You can also vomit with blood or stool that is bloody or black.
• Heartburn that causes lightheadedness, dizziness or sweating.
• Chest or shoulder pain, shortness of breathing, sweating, pain spreading into arms or neck, or lightheadedness.
• Frequent chest pain.

Warnings and precautions

• Carcinoma

  • In long-term (2-year-old) experiments in rats, Omeprazole caused a dose-related rise in gastric cancerous tumors.
  • To rule out the possibility that prolonged hypochlorhydria and hypergastrinemia may increase the risk of the development of cancer in patients receiving long-term treatment, further human data are required.
  • However, endoscopic evaluations and histologic examinations of biopsy specimens taken from human stomachs have not shown any evidence of a short-term exposure of omeprazole.

• Clostridium difficile-associated diarrhea (CDAD), formerly Clostridium, is now Clostridioides

  • Use of proton pump inhibitors (PPIs), especially in patients who are hospitalized, may increase the likelihood of developing CDAD.
  • Consider CDAD diagnosis for patients suffering from persistent diarrhea that doesn't improve.
  • Use the lowest possible dose and the shortest duration of PPI therapy, depending on the condition being treated.

• Cutaneous and systemic Lupus Erythematosus

  • This has been described as an exacerbation or new onset of an existing autoimmune disorder.
  • Most cases involved cutaneous lupus erythematosus, or CLE. However, most often subacute CLE occurs within weeks to years of continuous therapy.
  • SLE is less common and usually occurs in young adults.
  • Refer to a specialist if you notice any signs or symptoms of CLE/SLE.
  • Most patients feel better within 4-12 weeks after stopping omeprazole.

• Fractures

  • Proton pump inhibitor (PPI), therapy may increase the incidence of osteoporosis-related fractures of bones of the hip, spine and wrist.
  • It is important to examine patients on long-term (>=1-year) or high-dose (multiple daily dosages) therapy.
  • Use the lowest possible dose for the shortest time. Take vitamin D and calcium supplements and follow the appropriate guidelines to reduce fracture risk in patients at high risk.

• Polyps of the fundic gland:

  • Proton pump inhibitors (PPIs), especially if used for a long time of more than one year, can increase the risk of fundic gland polyps.
  • It may be without any symptoms, but it can cause nausea, vomiting, and abdominal pain.
  • Anemia and GI bleeding may occur in patients with ulcerated polyps.
  • A diagnosis of polyps can increase the likelihood of small intestinal obstruction.
  • The best PPI therapy for your condition is the one that has the lowest dosage and longest duration.

• Hypomagnesemia:

  • Rarely reported, often with prolonged PPI use >=3 months (most patients >1 year).
  • Patients can be either symptomatic, or asymptomatic.
  • Severe cases may cause tetany, seizures & cardiac arrhythmias.
  • Consider obtaining serum magnesium levels before you begin long-term treatment, particularly if you are taking digoxin, diuretics or any other drugs that can cause hypomagnesemia.
  • Also, periodically thereafter.
  • It is possible to discontinue omeprazole, but Hypomagnesemia can be treated with magnesium supplementation.
  • Magnesium levels usually return to normal within a week.

• Interstitial nephritis:

  • Patients who have taken PPIs have been shown to develop acute interstitial Nephritis.
  • It can occur during therapy at any time and is usually due to an idiopathic allergic reaction.
  • If acute interstitial Nephritis occurs, discontinue use.

• Vitamin B deficiency:

  • Vitamin B malabsorption may occur if prolonged treatment is continued for more than 3 years.
  • The severity of the deficiency depends on the dose. It is more severe in women than in those who are younger (30 years).
  • The prevalence of the disease is reduced after discontinuation.

• Gastric cancer:

  • Gastric malignancy can still be present despite symptoms being relieved.

• Gastrointestinal infection (eg, Salmonella, Campylobacter):

  • These infections may be more likely if you use PPIs.

• Hepatic impairment

  • Patients with hepatic impairment (Child Puugh class A, C, or B) are more likely to be exposed to omeprazole.
  • It is advised to reduce dosage.

Omeprazole: Drug Interaction

Risk Factor C (Monitor therapy)
Amphetamine	Proton Pump Inhibitors may increase the absorption of Amphetamine.
Antihepaciviral Combination Products	May decrease the serum concentration of Omeprazole.
Bisphosphonate Derivatives	Proton Pump Inhibitors may diminish the therapeutic effect of Bisphosphonate Derivatives.
Capecitabine	Proton Pump Inhibitors may diminish the therapeutic effect of Capecitabine.
Cefpodoxime	Proton Pump Inhibitors may decrease the serum concentration of Cefpodoxime.
CloBAZam	Omeprazole may increase serum concentrations of the active metabolite(s) of CloBAZam.
CloZAPine	Omeprazole may decrease the serum concentration of CloZAPine. Omeprazole may increase the serum concentration of CloZAPine.
CycloSPORINE (Systemic)	Omeprazole may increase the serum concentration of CycloSPORINE (Systemic).
CYP2C19 Inducers (Moderate)	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers).
Cysteamine (Systemic)	Proton Pump Inhibitors may diminish the therapeutic effect of Cysteamine (Systemic).
Darunavir	May decrease the serum concentration of Omeprazole.
Dexmethylphenidate	Proton Pump Inhibitors may increase the absorption of Dexmethylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption.
Dextroamphetamine	Proton Pump Inhibitors may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing.
Doxycycline	Proton Pump Inhibitors may decrease the bioavailability of Doxycycline.
Fluconazole	May increase the serum concentration of Proton Pump Inhibitors.
Fosphenytoin	Omeprazole may increase the serum concentration of Fosphenytoin. Fosphenytoin may decrease the serum concentration of Omeprazole.
Indinavir	Proton Pump Inhibitors may decrease the serum concentration of Indinavir.
Iron Salts	Proton Pump Inhibitors may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose.
Lumacaftor	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers).
Methotrexate	Proton Pump Inhibitors may increase the serum concentration of Methotrexate.
Methylphenidate	Proton Pump Inhibitors may increase the absorption of Methylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Proton Pump Inhibitors may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased.
Mycophenolate	Proton Pump Inhibitors may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced.
Nalmefene	Omeprazole may decrease the serum concentration of Nalmefene.
Phenytoin	May decrease the serum concentration of Omeprazole. Omeprazole may increase the serum concentration of Phenytoin.
Raltegravir	Proton Pump Inhibitors may increase the serum concentration of Raltegravir.
Riociguat	Proton Pump Inhibitors may decrease the serum concentration of Riociguat.
Saquinavir	Proton Pump Inhibitors may increase the serum concentration of Saquinavir.
SORAfenib	Proton Pump Inhibitors may decrease the absorption of SORAfenib.
Tipranavir	May decrease the serum concentration of Proton Pump Inhibitors. These data are derived from studies with Ritonavir-boosted Tipranavir.
Vitamin K Antagonists (eg, warfarin)	Omeprazole may increase the serum concentration of Vitamin K Antagonists.
Voriconazole	May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may increase the serum concentration of Voriconazole. Management: In patients receiving omeprazole 40 mg/day or greater, reduce omeprazole dose by half when initiating voriconazole.
Risk Factor D (Consider therapy modification)
Atazanavir	Proton Pump Inhibitors may decrease the serum concentration of Atazanavir. Management: See full drug interaction monograph for details.
Bosutinib	Proton Pump Inhibitors may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors, such as short-acting antacids or histamine-2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib.
Cefditoren	Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs). Consider alternative methods to minimize/control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of PPIs can not be avoided.
Cilostazol	CYP2C19 Inhibitors may increase the serum concentration of Cilostazol. Management: Consider reducing the cilostazol dose to 50 mg twice daily in patients who are also receiving inhibitors of CYP2C19.
Citalopram	Omeprazole may increase the serum concentration of Citalopram. Management: Limit citalopram dose to a maximum of 20 mg/day if used with omeprazole.
Clopidogrel	Omeprazole may diminish the antiplatelet effect of Clopidogrel. Omeprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Clopidogrel labeling recommends avoiding concurrent omeprazole due to a possible decrease in clopidogrel effectiveness. Rabeprazole or pantoprazole may be lower-risk alternatives to omeprazole.
CYP2C19 Inducers (Strong)	May increase the metabolism of CYP2C19 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Dabrafenib	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C19 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Enzalutamide	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C19. Management: Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C19 substrate should be performed with caution and close monitoring.
Escitalopram	Omeprazole may increase the serum concentration of Escitalopram. Management: Monitor for increased escitalopram toxicity with concomitant use of omeprazole. Recommendations for management of this interaction found in product labeling may differ by country. Consult appropriate labeling.
Gefitinib	Proton Pump Inhibitors may decrease the serum concentration of Gefitinib. Management: Avoid use of proton pump inhibitors (PPIs) with gefitinib when possible. If required, administer gefitinib 12 hours after administration of the PPI or 12 hours before the next dose of the PPI.
Itraconazole	Proton Pump Inhibitors may increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any proton pump inhibitors (PPIs). Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction.
Ketoconazole (Systemic)	Proton Pump Inhibitors may decrease the serum concentration of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Proton Pump Inhibitors. Management: Avoid concomitant administration of proton pump inhibitors (PPIs) and ketoconazole when possible due to the risk of ketoconazole therapeutic failure. Administration of ketoconazole with an acidic beverage (eg, cola) may facilitate ketoconazole absorption.
Ledipasvir	Proton Pump Inhibitors may decrease the serum concentration of Ledipasvir. Management: PPI doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Administration with higher doses of PPIs, 2 hours after a PPI, or in combination with food and PPIs may reduce ledipasvir bioavailability.
Mesalamine	Proton Pump Inhibitors may diminish the therapeutic effect of Mesalamine. Proton pump inhibitor-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose proton pump inhibitors (PPIs) with sustainedrelease mesalamine products.
Nilotinib	Proton Pump Inhibitors may decrease the serum concentration of Nilotinib. Management: Avoid this combination when possible since separation of doses is not likely to be an adequate method of minimizing the interaction.
Posaconazole	Proton Pump Inhibitors may decrease the serum concentration of Posaconazole.
Risedronate	Proton Pump Inhibitors may diminish the therapeutic effect of Risedronate. Proton Pump Inhibitors may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate.
Secretin	Proton Pump Inhibitors may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details.
Tacrolimus (Systemic)	Proton Pump Inhibitors may increase the serum concentration of Tacrolimus (Systemic). Management: Tacrolimus dose adjustment may be required. Rabeprazole, pantoprazole, or selected H2-receptor antagonists (i.e., ranitidine or famotidine) may be less likely to interact. Genetic testing may predict patients at highest risk.
Risk Factor X (Avoid combination)
Acalabrutinib	Proton Pump Inhibitors may decrease the serum concentration of Acalabrutinib.
Cefuroxime	Proton Pump Inhibitors may decrease the absorption of Cefuroxime.
Dacomitinib	Proton Pump Inhibitors may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with proton pump inhibitors. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA.
Dasatinib	Proton Pump Inhibitors may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of the proton pump inhibitor if some acid-reducing therapy is needed.
Delavirdine	Proton Pump Inhibitors may decrease the serum concentration of Delavirdine. Management: Chronic therapy with proton pump inhibitors (PPIs) should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI therapy with delavirdine is uncertain, but such therapy should be undertaken with caution.
Erlotinib	Proton Pump Inhibitors may decrease the serum concentration of Erlotinib.
Nelfinavir	Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Proton Pump Inhibitors may decrease the serum concentration of Nelfinavir.
Neratinib	Proton Pump Inhibitors may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption.
PAZOPanib	Proton Pump Inhibitors may decrease the serum concentration of PAZOPanib.
Pexidartinib	Proton Pump Inhibitors may decrease the serum concentration of Pexidartinib. Management: If acid-reduction is needed, consider administering an antacid 2 hours before or after pexidartinib, or administer pexidartinib 2 hours before or 10 hours after an H2 receptor antagonist.
RifAMPin	May decrease the serum concentration of Omeprazole.
Rilpivirine	Proton Pump Inhibitors may decrease the serum concentration of Rilpivirine.
St John's Wort	May decrease the serum concentration of Omeprazole.
Velpatasvir	Proton Pump Inhibitors may decrease the serum concentration of Velpatasvir.

Monitoring Parameters:

• In patients who fail H. pylori-eradication regimen susceptibility testing is recommended.
• Magnesium levels (prior to initiation of therapy and periodically thereafter).

How to administer Omeprazole?

 

P/O

• Take the medication 30-60 minutes before you eat.
• Best if taken before breakfast.
• If you are giving two doses daily, the first should be taken before breakfast. The second should be taken before dinner.

Capsule

• Take it all in.
• Do not chew, crush or crush.
• You can open the capsule and mix 1 tablespoon of applesauce with the contents.
• Take a glass of chilled water and immediately swallow.
• You should not chew, crush, heat, or save the mixture for future use.

Oral suspension:

• After reconstitution, allow the suspension to thicken for 2-3 minutes and then administer it within 30 minutes.
• Add more water to dissolve any remaining material after administration. Stir and then administer immediately.

Tablet

• Take a glass of water with you before your morning meal.
• Do not chew or crush.

Administration via Nasogastric tube or Gastric tube

 

• Oral suspension (using packets):

  • Add 5mL water to a catheter-tipped syringe and then add the contents of a 2.5mg packet or 15mL water for the 10mg packet.
  • Give the syringe a quick shake and allow it to thicken for about 2 minutes.
  • Give the syringe a second shake and within 30 minutes, administer via NG tube or gastric tube (French size 6 and larger).
  • Fill the syringe again with water. Shake and flush any remaining contents through the NG or gastric tube.

• Oral suspension (using capsules):

  • The manufacturer of Prilosec has not provided any recommendations regarding the extemporaneous preparation and administration of omeprazole capsules to NG/OG administration.
  • Consider using the packets for oral suspension.
  • If packets are not available, we have described methods of making capsules for NG/OG administration.
  • A suspension prepared extemporaneously with extended stability can also be used.

Mechanism of action of Omeprazole:

• It acts as a proton pump inhibitor.
• Inhibiting the H+/K+ATP pump in parietal cells, stimulates acid secretion and suppresses gastric basal.

Notice:

• Half-life and AUC for omeprazole suspension were significantly lower than those obtained from a commercially available capsule.

The onset of action:

Antisecretory:

• ~1 hour

Peak effect:

• Within 2 hours

Duration:

• Up to 72 hours.
• 50% of the max effect at 24 hours.
• After stopping treatment, secretory activity gradually returns over 3-5 days

Max secretory inhibition:

• 4 days

Absorption:

• Rapid

Protein binding:

• ~95%

Metabolism:

• Hepatic via CYP2C19 primarily & (to a lesser extent) via 3A4 to hydroxy, desmethyl, and sulfone metabolites (all inactive).
• Saturable first-pass effect

Bioavailability:

• P/O:
  • ~30%-40%.
• Hepatic dysfunction:
  • ~100%.
• Asians:
  • AUC increased up to fourfold compared to Caucasians
• Half-life elimination:
  • 0.5-1 hour.
• Hepatic impairment:
  • ~3 hours

• Time to peak plasma concentration:

  • 0.5-3.5 hours

• Excretion:

  • Urine (~77% as metabolites, very small amount as unchanged drug).
  • Feces

• Clearance:

  • 500-600 mL/min.
• Chronic hepatic disease:
  • 70 mL/min

International Brands of Omeprazole:

• PriLOSEC
• PriLOSEC OTC
• APO-Omeprazole
• Auro-Omeprazole
• BIO-Omeprazole
• DOM-Omeprazole DR
• JAMPOmeprazole DR
• Losec
• MYLAN-Omeprazole
• NAT-Omeprazole DR
• Omeprazole-20
• PMSOmeprazole
• PMS-Omeprazole DR
• Priva-Omeprazole
• RAN-Omeprazole
• RATIO-Omeprazole
• RIVA-Omeprazole DR
• SANDOZ Omeprazole
• SANDOZ Omperazole
• TEVA-Omeprazole
• VAN-Omeprazole
• Acidcare
• Acifre
• Acimax
• Aleprozil
• Amelxess
• Antra
• Arapride
• Aulcer
• Azoran
• Baromezole
• Benzol
• Crismel
• Desec
• Domer
• Dudencer
• Duogas
• Epirazole
• Eupept
• Ezrazole
• Gasec
• Gasec Gastrocaps
• Gastec
• Gastop
• Gastracid
• Gastrofer
• Gemzole
• Getzone
• Healor
• Helizol
• Hyposec
• Inhibitron
• Inhipump
• Lensor
• Locid
• Logastric
• Lokev
• Lokit
• Lomac
• Lomex
• Lopraz
• Losamel
• Losec
• Losec MUPS
• Loseprazol
• Luodan
• Madiprazole
• Maxor
• Medoprazole
• Mepha Gasec
• Mepracid
• Minisec
• Miracid
• Mopral
• Nocid
• Ocid
• Ogal
• Olexin
• Olit
• Om
• Omed
• Omedar
• Omegut
• Omelon
• Omep
• OMEP
• Omepra
• Omepradex
• Omepradex-Z
• Omepral
• Omeprazon
• Omepril
• Omeq
• Omesec
• Omesel
• Omex
• Omezol
• Omezole
• Omezzol
• Omicap
• Omilock
• Omipin
• Omisec
• Omiz
• Omizac
• Omizec
• OMP
• Ompranyt
• Omprazole
• OMZ
• Onic
• Opal
• Opel
• Oprax
• Oprazole
• Orazole
• Ortanol
• Ozmep
• Parizac
• Penrazole
• Peptaz
• Peptizole
• Prazidec
• Prazole
• Prenome
• Probitor
• Proceptin
• Promezol
• Protonix
• Pumpitor
• Pumpitor DI
• Qrazol

Omeprazole Brand Names in Pakistan:

Omeprazole Injection 20 mg
Zolpro	Safe Pharmaceutical (Pvt) Ltd.

 

Omeprazole Injection 40 mg
Benzim	Wilshire Laboratories (Pvt) Ltd.
Bromep	Wellborne Pharmachem And Biologicals
Dysozol	Dyson Research Laboratories
Eselan	A.J. & Company.
Loprot	Nabiqasim Industries (Pvt) Ltd.
Macomez	Macquins International
Mepragen	Fassgen Pharmaceuticals
Omedoc	Martin Dow Pharmaceuticals (Pak) Ltd.
Omep Mine	English Pharmaceuticals Industries
Omez	Adcare Pharma
Omnat	Accurate Medical Suppliers
Ozowin	Wns Field Pharmaceuticals
Rapid	Vision 2000 Plus
Secomep	Biocare Pharmaceutical
Vify	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Zegrid	Shaigan Pharmaceuticals (Pvt) Ltd
Zolpro	Safe Pharmaceutical (Pvt) Ltd.

 

Omeprazole Injection 40 mg
Faast	Consolidated Chemical Laboratories (Pvt) Ltd.
In Helezol	Biogenics Pakistan (Pvt) Ltd.
Losec	Barrett Hodgson Pakistan (Pvt) Ltd.
Medizole	Mediate Pharmaceuticals (Pvt) Ltd
Omefill Infusion	Mediceena Pharma (Pvt) Ltd.
Omega	Ferozsons Laboratoies Ltd.
Omezol	Bosch Pharmaceuticals (Pvt) Ltd.
Risek	Getz Pharma Pakistan (Pvt) Ltd.
Ruling	High - Q International
Teph	Sami Pharmaceuticals (Pvt) Ltd.
Zolat	English Pharmaceuticals Industries

 

Omeprazole syrup 20 mg/5ml
Opalex	Hataf Pharma

 

Omeprazole 20 mg sachet 20 mg
Acizol	Cirin Pharmaceuticals (Pvt) Ltd.
Bold	Scotmann Pharmaceuticals
Meprazole	Welwrd Pharmaceuticals

 

Omeprazole 20 mg Tablets
Adzol	Glitz Pharma
Amop	Alliance Pharmaceuticals (Pvt) Ltd.
Dantone	Danas Pharmaceuticals (Pvt) Ltd
Formaga	Webros Pharmaceuticals
Homze	Honig Pharmaceuticals Laboratories
Hypocid	Semos Pharmaceuticals (Pvt) Ltd.
K-Om	Caylex Pharmaceuticals (Pvt) Ltd.
Linopra	Linear Pharma
Magser	Panacea Pharmaceuticals
Meprazol	Werrick Pharmaceuticals
Mepsal	Goodman International,
Neusac	Neutra Soft Health Care
O-Lex	English Pharmaceuticals Industries
Ognen	Fassgen Pharmaceuticals
Omeneu	Neutro Pharma (Pvt) Ltd.
Omepraval	Valor Pharmaceuticals
Omeprazen	Paramount Pharmaceuticals
Omeprval	Valor Pharmaceuticals
Ometro	Caraway Pharmaceuticals
Omeyz	Shawan Pharmaceuticals
Omp	Genesis Pharmaceuticals (Pvt) Ltd.
Ompizol	Regent Laboratories Ltd.
Omrpa-T	Ferroza International Pharmaceuticals (Pvt) Ltd.
Opera	Crown Pharmaceuticals
Oprime	Shazals Pharmaceuticals
Pixel	Bloom Pharmaceuticals (Pvt) Ltd.
Re-Zool	Qintar Pharmacuticals
Relevole	Pfizer Laboratories Ltd.
Ulsive	Don Valley Pharmaceuticals (Pvt) Ltd.
Winpro	Wns Field Pharmaceuticals
Zulcid	Shrooq Pharmaceuticals

 

Omeprazole 40 mg Tablets
Benzim	Wilshire Laboratories (Pvt) Ltd.
K-Om	Caylex Pharmaceuticals (Pvt) Ltd.
Magser	Panacea Pharmaceuticals
Magser	Panacea Pharmaceuticals
Mepsal	Goodman International,
Omnia	Genome Pharmaceuticals (Pvt) Ltd
Relevole	Pfizer Laboratories Ltd.

 

Omeprazole 10 mg Capsules
Meprazol	Werrick Pharmaceuticals
Omezol	Bosch Pharmaceuticals (Pvt) Ltd.

 

Omeprazole 20 mg Capsules
Acezole	Tg Pharma
Acidrin	Zephyr Pharmatec (Pvt) Ltd.
Aksozol	Akson Pharmaceuticals (Pvt) Ltd.
Alomep	Alson Pharmaceuticals
Alpazol	Medicaids Pakistan (Pvt) Ltd.
Amazole	Medera Pharmaceuticals (Pvt) Ltd.
Anmol	Roryan Pharmaceutical Industries (Pvt) Ltd
Antra	Medera Pharmaceuticals (Pvt) Ltd.
Anzo	Searle Pakistan (Pvt.) Ltd.
Azitrix	Caraway Pharmaceuticals
Benzim	Wilshire Laboratories (Pvt) Ltd.
Beprazole	Bio Labs (Pvt) Ltd.
Berizole	Jayson Pharmaceuticals, Dhaka-Bangladesh
Bold	Scotmann Pharmaceuticals
Brizole	Crest Pharmaceuticals
Bromep	Wellborne Pharmachem And Biologicals
Capzol	Benson Pharamceuticals.
Cibra	Cibex (Private) Limited
Cidpro	Indus Pharma (Pvt) Ltd.
Cipro	Indus Pharma (Pvt) Ltd.
Cisec	Standpharm Pakistan (Pvt) Ltd.
Coozip	Nexus Pharma (Pvt) Ltd
Delproz	Delta Pharma (Pvt) Ltd.
Delser	Delux Chemical Industries
Dinaar	Ambrosia Pharmaceuticals
Dysozol	Dyson Research Laboratories
Efome	Efroze Chemical Industries (Pvt) Ltd.
Emperole	Raazee Theraputics (Pvt) Ltd.
Encid	Wilsons Pharmaceuticals
Epent	Eros Pharmaceuticals
Epra	Gray`S Pharmaceuticals
Eselan	A.J. & Company.
Esowin	Wns Field Pharmaceuticals
Etipro	Ici Pakistan Ltd.
Farmpra	Un Pharma International
Fedazol	Fedro Pharmaceutical
Fegran	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Fortify	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Fymezole	Fynk Pharmaceuticals
Gamp	Panacea Pharmaceuticals
Garazole	Pulse Pharmaceuticals
Gard	Epoch Pharmaceutical
Glaveral	R.Y. International
Hamazol	Hamaz Pharmaceutical (Pvt) Ltd.
Hansol	Hansel Pharmacueutical Pvt (Ltd)
Hansol	Hansel Pharmacueutical Pvt (Ltd)
Hanzol	Hansel Pharmacueutical Pvt (Ltd)
Healer	Pulse Pharmaceuticals
Helezol	Biogenics Pakistan (Pvt) Ltd.
Hupra	Linear Pharma
Ingis	Kobec Pharmacals
Irzazole	Irza Pharma (Pvt) Ltd.
Izmepra	Epharm Laboratories
Karzole	Delta Pharma (Pvt) Ltd.
Klofix	Himont Pharmaceuticals (Pvt) Ltd.
Lapizole	Dr. Raza Pharma (Private) Limited
Loc-H	Reko Pharmacal (Pvt) Ltd.
Locorex	Rex Pharmaceuticals Pakistan
Lomper	Siza International (Pvt) Ltd.
Loprot	Nabiqasim Industries (Pvt) Ltd.
Losec	Barrett Hodgson Pakistan (Pvt) Ltd.
Lozal	Novartis Pharma (Pak) Ltd
Lozamep	Rakaposhi Pharmaceutical (Pvt) Ltd.
Lozena	Helicon Pharmaceutek Pakistan (Pvt) Ltd.
Lozip	Medipak Limited
Maag	Webros Pharmaceuticals
Macomez	Macquins International
Mark	Axis Pharmaceuticals
Mebrazole	Jawa Pharmaceuticals(Pvt) Ltd.
Mediprzole	Mediate Pharmaceuticals (Pvt) Ltd
Megazole	Mega Pharmaceuticals (Pvt) Ltd
Mepra	Nimrall Laboratories
Meprascot	Scotmann Pharmaceuticals
Meprawin	Wns Field Pharmaceuticals
Meprazol	Werrick Pharmaceuticals
Meprolive	Olive Pharmaceuticals
Mepzan	Medisave Pharmaceuticals
Metzan	Medizan Labs (Pvt) Ltd
Mopirixl	Unipharma (Pvt) Ltd.
Nafzole	Cherwel Pharmaceuticals (Pvt) Ltd
Nensec	Nenza Pharmaceuticals (Pvt) Limited
Neusec	Biorex Pharmaceuticals
Nilcid	Pharmedic (Pvt) Ltd.
Noazol	Noa Hemis Pharmaceuticals
Noctis	Saffron Pharmaceutical Company
Noncid	Ferroza International Pharmaceuticals (Pvt) Ltd.
Noran	Akson Pharmaceuticals (Pvt) Ltd.
Norani	Siam Pharmaceuticals
Noul	Semos Pharmaceuticals (Pvt) Ltd.
Novisac	Novins International
Nurzol	Lowitt Pharmaceuticals (Pvt) Ltd
O-Carb	Wns Field Pharmaceuticals
O-Cid	Life Pharmaceutical Company
Obsozole	Obsons Pharmaceuticals
Ohab	Everest Pharmaceuticals
Oltrix	Nawan Laboratories (Pvt) Ltd.
Om	Unimark Pharmaceuticals
Omak	Healers Laboratories
Omapren	Fynk Pharmaceuticals
Omatole	Advanced Pharmaceuticals
Omcap	Platinum Pharmaceuticals (Pvt.) Ltd.
Omcool	Alkemy Pharmaceutical Laboratories (Private) Ltd.
Omcura	Maple Pharmaceuticals (Pvt) Ltd
Ome Med	Medicure Laboratories
Omebrain	Winbrain Research Laboratories
Omec	Aries Pharmaceuticals (Pvt) Ltd
Omec	Aries Pharmaceuticals (Pvt) Ltd
Omecer	P.D.H. Pharmaceuticals (Pvt) Ltd.
Omed	Medicraft Pharmaceuticals (Pvt) Ltd.
Omefill Capsule	Mediceena Pharma (Pvt) Ltd.
Omega	Ferozsons Laboratoies Ltd.
Omegut	Medifine Laboratories
Omegut	Medifine Laboratories
Omeheim	Pakheim Internanational Pharma
Omel	Lotus Pharmaceuticals (Pvt) Ltd
Omelcid	Merck Private Ltd.
Omelinz	Linz Pharmaceuticals (Pvt) Ltd.
Omenza	Danas Pharmaceuticals (Pvt) Ltd
Omepak	Lawari International
Omepec	Epla Laboratories (Pvt) Ltd.
Omepeflore	Florence Farmaceuticals (Pvt) Ltd
Omepragen	Genera Pharmaceuticals
Omepral	Amson Vaccines & Pharma (Pvt) Ltd.
Omepraval	Valor Pharmaceuticals
Omeprazal	Searle Pakistan (Pvt.) Ltd.
Omeprazole	Millinium Pharmaceutical Company
Omeprowan	Swan Pharmaceuticals(Pvt) Ltd
Omepza	Simz Pharmaceuticals
Omera	Tabros Pharma
Omerown	Crown Pharmaceuticals
Omesec	Brookes Pharmaceutical Laboratories (Pak.) Ltd.
Omestock	Usawa Pharmaceuticals
Ometon	Navegal Laboratories
Ometor	Envoy Pharma
Omezol	Bosch Pharmaceuticals (Pvt) Ltd.
Omezoman	Medimarkers Pharmaceuticals
Omigood	Goodman Laboratories
Omit	Ideal Pharmaceutical Industries
Omol	Pakheim Internanational Pharma
Omper	Focus & Rulz Pharmaceuticals
Ompil	Zanctok Pharmaceuticals
Omragil	Genome Pharmaceuticals (Pvt) Ltd
Omrazo	Xenon Pharmaceuticals (Pvt) Ltd.
Omrazole	Winilton Pharmaceuticals (Pvt) Ltd
Omrel	Well & Well Pharma (Pvt) Ltd
Omsod	Reliance Pharma
Omze	Jawa Pharmaceuticals(Pvt) Ltd.
Opara Cap	Albro Pharma
Opicap	Don Valley Pharmaceuticals (Pvt) Ltd.
Opra	Heal Pharmaceuticals Pvt Ltd
Oprazole	Hizat Pharmaceutical Industries (Pvt) Ltd.
Opril	Tagma Pharma (Pvt) Ltd.
Opza	Davis Pharmaceutical Laboratories
Orcap	Orta Labs. (Pvt) Ltd.
Osyd-20	Saydon Pharmaceutical Industries (Pvt) Ltd.
Owel	Spl Pharmaceuticals (Pvt) Ltd
Ozem	Polyfine Chempharma (Pvt) Ltd.
Ozker	Lexicon Pharmaceuticals (Pvt) Ltd.
Ozop	Zephyr Pharmatec (Pvt) Ltd.
Peprazole	Prays Pharmaceuticals
Pepzol	Mass Pharma (Private) Limited
Perl	Stanley Pharmaceuticals (Pvt) Ltd.
Poami	Pliva Pakistan (Pvt) Limited
Pp. Zole	Rakaposhi Pharmaceutical (Pvt) Ltd.
Ppi-20	Caylex Pharmaceuticals (Pvt) Ltd.
Prazol	Pharmatec Pakistan (Pvt) Ltd.
Prezit	Friends Pharma (Pvt) Ltd
Prisma	Rasco Pharma
Pro Hibit	Libra Pharmaceuticals (Pvt) Ltd
Probiotor	Neutro Pharma (Pvt) Ltd.
Probitor	Neutro Pharma (Pvt) Ltd.
Proced	Allmed Labs
Proceptin	Bex Pharma (Pvt) Ltd.
Proloc	Consolidated Chemical Laboratories (Pvt) Ltd.
Promy	Askari Pharmaceuticals.
Propi	Jafson Pharmaceuticals (Pvt) Ltd.
Proprazol	Hygeia Pharmaceuticals
Protole	Global Pharmaceuticals
Protole	Global Pharmaceuticals
Protole	Global Pharmaceuticals
Proza	Ferroza International Pharmaceuticals (Pvt) Ltd.
Pymer	Ideal Pharmaceutical Industries
Pzole	Reliance Pharma
Ramezol	Akhai Pharmaceuticals.
Raxar	Kinsa Pharmaceuticals
Razole	Medicon Pharmaceuticals Industries (Pvt) Ltd
Razomep	Zinta Pharmaceuticals Industries
Redulex	Hataf Pharma
Retrot	Libra Pharmaceuticals (Pvt) Ltd
Rezal	Wise Pharmaceuticals (Pvt) Ltd
Risek	Getz Pharma Pakistan (Pvt) Ltd.
Romeprazole	Arsons Pharmaceuticals Industries (Pvt) Ltd
Ruling	High - Q International
Safomep	Saaaf Pharmaceuticals
Sanamidol	Swiss Pharmaceuticals (Pvt) Ltd.
Sante	Macter International (Pvt) Ltd.
Segazole	Star Laboratories (Pvt) Ltd.
Stomep	Gillman Pharmaceuticals
Sunder	Robins Pharmaceutical Industries
Sydrol	Sayyed Pharmaceuticals
Synzole	Medisynth Pharmaceuticals
Temerol	Leads Pharma (Pvt) Ltd
Teph	Sami Pharmaceuticals (Pvt) Ltd.
Timezol	Rotex Medica Pakistan (Pvt) Ltd
Troloc	Flow Pharmaceuticals (Pvt) Ltd.
Ul-Rid	Z-Jans Pharmaceutical (Pvt) Ltd.
Ulsazole	Bloom Pharmaceuticals (Pvt) Ltd.
Uniprazole	Tg Pharma
Uzol	Alina Combine Pharmaceuticals (Pvt) Ltd.
Valuprazole	Glaxosmithkline
Vapra	Vega Pharmaceuticals Ltd.
Vinzole	Obsons Pharmaceuticals
Weprazol	Warafana Pharmaceuticals
Wisprazol	Pharmawise Labs. (Pvt) Ltd.
Wisprazol	Pharmawise Labs. (Pvt) Ltd.
Wizol	Wise Pharmaceuticals (Pvt) Ltd
Xerosec	Sanofi Aventis (Pakistan) Ltd.
Xopra	Medisure Laboratories Pakistan (Pvt.) Ltd.
Z-Pral	Derma Techno Pakistan
Zalaim	Farm Aid Group Pak Ltd.
Zampra	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Zaprole	Adamjee Pharmaceuticals (Pvt) Ltd.
Zepep	Bryon Pharmaceuticals (Pvt) Ltd.
Zes	Rock Pharmaceuticals
Zoger	Shaheen Pharmaceuticals
Zogital	Welmark Pharmaceuticals
Zoglit	Glitz Pharma
Zolacid	Geofman Pharmaceuticals
Zolapt	Aptcure Private Limited
Zolat	English Pharmaceuticals Industries
Zolbi	Continental Chemical Company (Pvt) Ltd.
Zolcare	Csh Pharmaceuticals-North (Pvt) Ltd
Zolcer	Breeze Pharma (Pvt) Ltd
Zolomp	Hamaz Pharmaceutical (Pvt) Ltd.
Zolpro	Safe Pharmaceutical (Pvt) Ltd.
Zoltar	Pharmevo (Pvt) Ltd.
Zoprol	Schazoo Zaka
Zoral	City Pharma

 

Omeprazole 30 mg Capsules
Crizol	Candid Pharmaceuticals
Vinzole	Obsons Pharmaceuticals

 

Omeprazole 40 mg Capsules
Acezole	Tg Pharma
Aimpra	Aims Traders
Anmol	Roryan Pharmaceutical Industries (Pvt) Ltd
Antra	Medera Pharmaceuticals (Pvt) Ltd.
Anzo	Searle Pakistan (Pvt.) Ltd.
B Cap	Bio Labs (Pvt) Ltd.
Benzim	Wilshire Laboratories (Pvt) Ltd.
Beprazole	Bio Labs (Pvt) Ltd.
Berizole	Jayson Pharmaceuticals, Dhaka-Bangladesh
Capzol	Benson Pharamceuticals.
Cidpro	Indus Pharma (Pvt) Ltd.
Cimozol	Karachi Pharmaceutical Laboratory
Cipro	Indus Pharma (Pvt) Ltd.
Cisec	Standpharm Pakistan (Pvt) Ltd.
Encid	Wilsons Pharmaceuticals
Epra	Gray`S Pharmaceuticals
Esowin	Wns Field Pharmaceuticals
Helezol	Biogenics Pakistan (Pvt) Ltd.
Mark	Axis Pharmaceuticals
Mebrazole	Jawa Pharmaceuticals(Pvt) Ltd.
Mepcid	Excel Healthcare Laboratories (Pvt.) Ltd.
Meprazol	Werrick Pharmaceuticals
Meprolive	Olive Pharmaceuticals
Mepzan	Medisave Pharmaceuticals
Noazol D	Noa Hemis Pharmaceuticals
Noran	Akson Pharmaceuticals (Pvt) Ltd.
Novisac	Novins International
O-Cid	Life Pharmaceutical Company
O-Maag	Panacea Pharmaceuticals
Om	Unimark Pharmaceuticals
Omced-S	Shrooq Pharmaceuticals
Omcura	Maple Pharmaceuticals (Pvt) Ltd
Omec	Aries Pharmaceuticals (Pvt) Ltd
Omega	Ferozsons Laboratoies Ltd.
Omel	Lotus Pharmaceuticals (Pvt) Ltd
Omep	Weather Folds Pharmaceuticals
Omepraval	Valor Pharmaceuticals
Omeprazal	Searle Pakistan (Pvt.) Ltd.
Omeprowan	Swan Pharmaceuticals(Pvt) Ltd
Omera	Tabros Pharma
Omezol	Bosch Pharmaceuticals (Pvt) Ltd.
Omezoman	Medimarkers Pharmaceuticals
Omigood	Goodman Laboratories
Omragil	Genome Pharmaceuticals (Pvt) Ltd
Omrel	Well & Well Pharma (Pvt) Ltd
Prisma	Rasco Pharma
Protole	Global Pharmaceuticals
Protole	Global Pharmaceuticals
Ramezol	Akhai Pharmaceuticals.
Razole Plus	Medicon Pharmaceuticals Industries (Pvt) Ltd
Rezal	Wise Pharmaceuticals (Pvt) Ltd
Risek	Getz Pharma Pakistan (Pvt) Ltd.
Safomep	Saaaf Pharmaceuticals
Sante	Macter International (Pvt) Ltd.
Stomep	Gillman Pharmaceuticals
Synzole	Medisynth Pharmaceuticals
Teph	Sami Pharmaceuticals (Pvt) Ltd.
Timezol	Rotex Medica Pakistan (Pvt) Ltd
Welpo	Welwrd Pharmaceuticals
Wizol	Wise Pharmaceuticals (Pvt) Ltd
Xempra	Genome Pharmaceuticals (Pvt) Ltd
Xopac	Medisure Laboratories Pakistan (Pvt.) Ltd.
Xopra Plus	Medisure Laboratories Pakistan (Pvt.) Ltd.
Zaprole Plus	Adamjee Pharmaceuticals (Pvt) Ltd.
Zepmol	Universal Pharmaceuticals (Pvt) Ltd
Zoglit	Glitz Pharma
Zolbi	Continental Chemical Company (Pvt) Ltd.
Zolcare	Csh Pharmaceuticals-North (Pvt) Ltd
Zoral	City Pharma