Omeprazole 20 Mg Capsules
Out of date information, search another1. NAME OF THE MEDICINAL PRODUCT
Omeprazole 20 mg Capsules
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Each capsule contains omeprazole 20 mg.
For excipients, see section 6.1
3. PHARMACEUTICAL FORM
Capsule, hard containing gastro-resistant granules
Each capsule consists of an orange body and blue cap and contains white to beige granules marked with O20.
4. CLINICAL PARTICULARS
4.1. Therapeutic indications
1. Treatment of reflux oesophagitis disease. In reflux oesophagitis the majority of patients are healed after 4 weeks. Symptom relief is rapid.
2. Treatment of duodenal and benign gastric ulcers including complicating NSAID therapy.
3. Relief of reflux-like symptoms (e.g. heartburn) and/or ulcer-like symptoms (e.g. epigastric pain) associated with acid-related dyspepsia.
4. Treatment and prophylaxis of NSAID-associated benign gastric ulcers, duodenal ulcers and gastroduodenal erosions in patients with a previous history of gastroduodenal lesions who require continued NSAID treatment.
5. Relief of associated dyspeptic symptoms.
5. Helicobacter pylori eradication: When used with in combination with antibiotics, Omeprazole proves effective in the eradication of Helicobacter pylori (Hp) in peptic ulcer disease.
6. Prophylaxis of acid aspiration.
7. Zollinger-Ellison syndrome.
8. Children over 1 year of age and > 10 kg:
Reflux oesophagitis. Symptomatic treatment of heartburn and acid regurgitation in gastroesophageal reflux disease.
4.2 Posology and method of administration
Oesophageal reflux disease including reflux oesophagitis:
The usual starting dose is 20 mg omeprazole taken once a day for 4 weeks. For those patients not fully healed after the initial 4 week course, healing usually occurs during a further 4-8 weeks treatment. Omeprazole has also been used in a dose of 40mg once a day in patients with reflux oesophagitis refractory to other therapy. Healing usually occurred within 8 weeks. Continuation of therapy can be considered at a dosage of 20 mg once daily.
Acid reflux disease:
For long-term management a dose of 10 mg once daily is recommended, increasing to 20 mg if symptoms return.
Duodenal and benign gastric ulcers:
The usual dose is 20 mg omeprazole once daily. With duodenal ulcers the majority of patients usually heal after 4 weeks of treatment. The majority of patients with benign gastric ulcer are healed after 8 weeks. In severe or recurrent cases the dose may be increased to 40mg
omeprazole daily. For patients with a history of recurrent duodenal ulcer long term therapy is
recommended at a dosage of 20 mg omeprazole once daily.
To prevent recurrence in patients with duodenal ulcer the recommended dose is omeprazole 10 mg, once daily, increasing to 20 mg, once daily if symptoms return.
Patients where recurrent ulcer relapse is more likely to occur include: those with Helicobacter pylori infection, younger patients (<60 years), those whose symptoms persist for more than one year and smokers. These patients will require initial long-term therapy with omeprazole 20 mg once daily, reducing to 10 mg once daily, if necessary.
Acid-related dyspepsia:
Usual dosage is 10 mg or 20 mg omeprazole once daily for 2-4 weeks depending on the severity and persistence of symptoms. Should the patient not respond to treatment after 4 weeks or who relapse shortly after treatment, should be investigated.
For the treatment of NSAID-associated gastric ulcers, duodenal ulcers or gastroduodenal erosions: The recommended dosage of omeprazole is 20 mg once daily. Symptom resolution is rapid and in most patients healing occurs within 4 weeks. For those patients who may not be fully healed after the initial course, healing usually occurs during a further 4 weeks treatment.
For the prophylaxis of NSAID-associated gastric ulcers, duodenal ulcers, gastroduodenal erosions and dyspeptic symptoms in patients with a previous history of gastroduodenal lesions who require continued NSAID treatment: The recommended dosage is 20 mg omeprazole taken once a day.
Helicobacter pylori (Hp) eradication regimens in peptic ulcer disease: Omeprazole is recommended at a dose of 40 mg once daily or 20 mg twice daily concomitant with antimicrobial agents as detailed below:
Triple therapy regimens in duodenal ulcer disease:
Omeprazole and the following antimicrobial combinations;
Amoxicillin 500 mg and metronidazole 400 mg both three times a day for one week. or clarithromycin 250 mg and metronidazole 400 mg (or tinidazole 500 mg) both twice a day for one week. or
Amoxicillin1g and clarithromycin 500 mg both twice a day for one week.
Dual therapy regimens in duodenal ulcer disease
Omeprazole and amoxicillin 750 mg to 1g twice daily for two weeks. Alternatively, omeprazole and clarithromycin 500 mg three times a day for two weeks.
Dual therapy regimens in gastric ulcer disease:
Omeprazole and amoxicillin 750 mg to 1g twice daily for two weeks.
In each regimen if symptoms return and the patient tests positive for Hp, therapy may be repeated or one of the alternative regimens can be used; if the patient is Hp negative then see dosage instructions for acid reflux disease.
To ensure healing in patients with active peptic ulcer disease, see further dosage recommendations for duodenal and benign gastric ulcer.
Prophylaxis of acid aspiration:
For patients considered to be at risk of aspiration of the gastric contents during general anaesthesia, the recommended dosage is omeprazole 40 mg on the evening before surgery followed by a further 40 mg, 2 - 6 hours prior to surgery.
Zollinger-Ellison syndrome:
The initial starting dose is 60 mg omeprazole once a day. The dosage should be adjusted individually and treatment continued as long as clinically indicated. More than 90% of patients with severe disease and inadequate response to other therapies have been effectively controlled on doses of 20120 mg daily. With doses above 80mg daily, the dose should be divided and given twice daily.
Elderly:
Dose adjustment is not required in the elderly Children
Reflux oesophagitis
The treatment time is 4-8 weeks.
Symptomatic treatment of heartburn and acid regurgitation in gastroesophageal reflux disease
The treatment time is 2-4 weeks. If symptom control has not been achieved after 2-4 weeks the patient should be investigated further.
The dosage recommendations are as follows:
|
Age |
Weight |
Dosage |
|
^ 1 year of age |
10-20 kg |
10 mg once daily. |
|
The dosage can be increased to 20 mg once daily if needed | ||
|
£ 2 years of age |
> 20 kg |
20 mg once daily. |
|
The dosage can be increased to 40 mg once daily if needed. |
Children over 4 years of age
In combination with antibiotics in treatment of duodenal ulcer caused by Helicobacter pylori. When selecting appropriate combination therapy consideration should be given to official local guidance regarding bacterial resistance, duration of treatment (most commonly 7 days but sometimes up to 14 days), and appropriate use of antibacterial agents. The treatment should be supervised by a specialist.
Weight Dosage
15-^ 30 kg Combination with two antibiotics: Omperazole 10 mg, amoxicillin
25mg/kg body weight and clarithromycin 7.5 mg/kg body weight are all administered together 2 times daily for 1 week
30-^ 40 kg Combination with two antibiotics: Omeprazole 20 mg, amoxicillin 750
mg and clarithromycin 7.5 mg/kg body weight are all administered 2 times daily for 1 week.
>40 kg Combination with two antibiotics: Omeprazole 20 mg, amoxicillin 1 g
and clarithromycin 500 mg are all administered 2 times daily for 1 week.
Impaired renal function:
Dose adjustment is not required in patients with impaired renal function.
Impaired hepatic function:
As bioavailability and half-life can increase in patients with impaired hepatic function, the dose requires adjustment with a maximum daily dose 20 mg.
Patients with swallowing difficulties:
The capsules may be opened and the contents either swallowed alone or suspended in a small amount of fruit juice or yoghurt after gentle mixing. Actual capsules may be sucked and then swallowed. It is important that the contents of the capsules should not be crushed or chewed.
4.3 Contraindications
Known hypersensitivity to omeprazole or any of the other constituents of the product
When gastric ulcer is suspected, the possibility of malignancy should be excluded before treatment with Omeprazole 20 mg Capsules is commenced, as treatment may alleviate symptoms and delay diagnosis.
Omeprazole like other PPIs should not be administered with atazanavir (see section 4.5)
4.4 Special warnings and precautions for use
Decreased gastric acidity due to any means, including proton-pump inhibitors, increases gastric counts of bacteria normally present in the gastrointestinal tract. Therefore treatment with acid-reducing drugs may lead to a slightly increased risk of gastrointestinal infections, such as Salmonella and Campylobacter.
Hypomagnesaemia
Severe hypomagnesaemia has been reported in patients treated with PPIs like Omeprazole for at least three months, and in most cases for a year. Serious manifestations of hypomagnesaemia such as fatigue, tetany, delirium, convulsions, dizziness and ventricular arrhythmia can occur but they may begin insidiously and be overlooked. In most affected patients, hypomagnesaemia improved after magnesium replacement and discontinuation of the PPI.
For patients expected to be on prolonged treatment or who take PPIs with digoxin or drugs that may cause hypomagnesaemia (e.g., diuretics), health care professionals should consider measuring magnesium levels before starting PPI treatment and periodically during treatment.
4.5 Interaction with other medicinal products and other forms of interaction
Due to the increased intragastric acidity the absorption of ketoconazole or itraconazole may be reduced during omeprazole treatment as it is during treatment with other acid secretion inhibitors.
As omeprazole is metabolised in the liver through cytochrome P450, it can delay the elimination of diazepam, phenytoin and warfarin and other vitamin K antagonists which are in part substrates for this enzyme. Monitoring of patients receiving phenytoin is recommended and a reduction of the phenytoin dose may be required.
However, concomitant treatment with Omeprazole 20 mg once daily did not change the blood concentration of phenytoin in patients on continuous treatment with phenytoin. In patients receiving warfarin or other vitamin K antagonists, monitoring of INR is recommended and a reduction of the warfarin (or other vitamin K antagonist) dose may be necessary. Similarly, concomitant treatment with Omeprazole 20 mg daily did not change coagulation time in patients on continuous treatment with warfarin.
Plasma concentrations of omeprazole and clarithromycin are increased during concomitant administration. This is considered to be a useful interaction during H. pylori eradication. There is no interaction with metronidazole or amoxicillin. These antimicrobials are used together with omeprazole for eradication of Helicobacter pylori
There is no evidence of an interaction with phenacetin, theophylline, caffeine, propranolol, metoprolol, cyclosporin, lidocaine, quinidine, estradiol, amoxicillin or antacids. The absorption of Omeprazole 20 mg Capsules is not affected by alcohol or food.
There is no evidence of an interaction with piroxicam, diclofenac or naproxen. This is considered useful when patients are required to continue these treatments.
Simultaneous treatment with omeprazole and digoxin in healthy subjects lead to a 10% increase in the bioavailability of digoxin as a consequence of the increased intragastric pH.
Co-administration of omeprazole (40mg once daily) with atazanavir 300 mg/ritonavir 100mg to healthy volunteers resulted in a substantial reduction in atazanavir exposure (approximately 75% decrease in AUC, Cmax, and Cmin). Increasing the atazanavir dose to 400mg did not compensate for the impact of omeprazole on atazanavir exposure. PPIs including omeprazole should not be coadministered with atazanavir (see section 4.3)
Concomitant administration of omeprazole and tacrolimus may increase the serum levels of tacrolimus.
Concomitant administration of omeprazole and a CYP2C19 and CYP3A4 Iinhibitor, voriconazole, resulted in more than doubling of the omeprazole exposure. Omeprazole (40 mg once daily) increased voriconazole (a CYP2C19 substrate) Cmax and AUC by 15% and 41%, respectively. A dose adjustment of omeprazole is not regularly required in either of these situations. However, dose adjustment should be considered in patients with severe hepatic impairment and if long-term treatment is indicated.
4.6 Pregnancy and lactation
Pregnancy
The analysis of the results from three epidemiological studies has revealed no evidence of
adverse events of omeprazole on pregnancy or on the health of the foetus/newborn child. Omeprazole
can be used during pregnancy.
Lactation
Omeprazole is excreted in breast milk but is not likely to influence the child when therapeutic
doses are used.
4.7. Effects on ability to drive and use machines
No forseen effects.
4.8 Undesirable effects
Omeprazole 20 mg Capsules are well tolerated and adverse reactions have generally been
mild and reversible. The following have been reported as adverse events in clinical trials or reported from routine use but in many cases a relationship to treatment with omeprazole has not been established.
The following definitions of frequencies are used: Common > 1/100
Uncommon > 1/1000 and < 1/100
Rare < 1/1000
headache
Common Central and peripheral nervous system
diarrhoea, constipation, abdominal pain, nausea/vomiting and
Gastrointestinal
flatulence
Uncommon Central and peripheral nervous system dizziness, paraesthesia,
Light Headedness, feeling faint, somnolence, insomnia and
vertigo
Hepatic
increased liver enzymes
Skin
pruritus.
rash,dermatitis and/or Urticaria
Musculoskeletal
Other
Fracture of the hip, wrist or spine (see section 4.4)
Malaise
Rare Central and peripheral nervous system reversible mental
confusion, agitation,
aggression, depression
and hallucinations,
predominately in severely ill patients
Endocrine Gynaecomastia
Gastrointestinal dry mouth,
stomatitis and gastrointestinal candidiasis
Haematological Leucopenia,
thrombocytopenia, agranulocytosis and pancytopenia
Hepatic
failure
Musculoskeletal
weakness
Encephalopathy in patients with preexisting severe liver
disease; hepatitis with or without jaundice, hepatic
Arthritic and myalgic symptoms and muscular
Reproductive system and breast disorders Impotence
Skin Photosensitivity, bullous
eruption, erythema multiforme, Stevens-Johnson
Syndrome, toxic epidermal necrolysis
(TEN), alopecia
Metabolic and nutritional disorders
Frequency not known: hypomagnesaemia
[See Special warnings and
precautions for use (4.4)]
Other hypersensitivity reactions e.g.
angioedema, fever, broncho-spasm, interstitial nephritis
and anaphylactic shock. Increased
sweating, peripheral oedema,
blurred vision, taste disturbance and
hyponatraemia.
The safety of omeprazole has been assessed in a total of 310 children aged 0 to 16 years with acid-related disease. There are limited long term safety data from 46 children who received maintenance therapy of omeprazole during a clinical study for severe erosive oesophagitis for up to 749 days. The adverse event profile was generally the same as for adults in short- as well as in long-term treatment. There are no long term data regarding the effects of omeprazole treatment on puberty and growth.
4.9 Overdose
Rare reports have been received of overdosage with omeprazole. In the literature, doses of up to 560 mg have been described and occasional reports have been received when single oral doses have reached up to 2400 mg omeprazole (120 times the usual recommended clinical dose). Nausea, vomiting, dizziness, abdominal pain, diarrhoea and headache have been reported from overdosage with omeprazole. Also apathy, depression and confusion have been described in single cases.
The symptoms described in connection to omeprazole overdosage have been transient, and no serious outcome due to omeprazole has been reported. The rate of elimination was unchanged (first order kinetics) with increased doses and no specific treatment has been needed.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
A TC code: A02B CO I - Drugs for peptic ulcers and gastro-oesophageal reflux disease - Proton Pump inhibitors.
Omeprazole reduces gastric acid secretion through a unique mechanism of action. It is a specific inhibitor of the gastric proton pump in the parietal cell. It is rapidly acting and produces reversible control of gastric acid secretion with once daily dosing.
An oral dose of 20 mg once a day produces a rapid and effective inhibition of gastric acid secretion with maximum effect being achieved within 4 days of treatment. In duodenal ulcer patients, a mean decrease of approximately 80% in 24-hour intragastric acidity is then maintained, with the mean decrease in peak acid output after pentagastrin stimulation being about 70%, twenty-four hours after dosing with Omeprazole 20 mg Capsules.
Clinical data for omeprazole in the prophylaxis of NSAID induced gastroduodenal lesions are derived from clinical studies of up to 6 months duration.
Helicobacter pylori (Hp) is associated with acid peptic disease including duodenal ulcer (DU) and gastric ulcer (GU) in which about 95% and 80% of patients respectively are infected with this bacterium. Hp is implicated as a major contributing factor in the development of gastritis and ulcers in such patients. Recent evidence also suggests a causative link between Hp and gastric carcinoma.
Omeprazole has been shown to have a bactericidal effect on Hp in vitro.
Eradication of Hp with omeprazole and antimicrobials is associated with rapid symptom relief, high rates of healing of any mucosal lesions, and long-term remission of peptic ulcer disease thus reducing complications such as gastrointestinal bleeding as well as the need for prolonged antisecretory treatment.
In recent clinical data in patients with acute peptic ulcer omeprazole Hp eradication therapy improved patients' quality of life.
During long-term treatment an increased frequency of gastric glandular cysts have been reported. These changes are a physiological consequence of pronounced inhibition of acid secretion. The cysts are benign and appear to be reversible. No other treatment related mucosal changes have been observed in patients treated continuously with omeprazole for periods up to 5 years.
Paediatric data
In a non-controlled study in children (1 to 16 years of age) with severe reflux oesophagitis, omeprazole at doses of 0.7 to 1.4 mg/kg improved oesophagitis level in 90 % of the cases and significantly reduced reflux symptoms. In a single-blind study, children aged 0-24 months with clinically diagnosed GERD were treated with 0.5, 1.0 or 1.5 mg omeprazole/kg. The frequency of vomiting/regurgitation episodes decreased by 50 % after 8 weeks of treatment irrespective of the dose.
Eradication of Helicobacter pylori in children:
A randomised, double blind clinical study (Heliot study) has concluded to the efficacy and an acceptable safety for omeprazole associated to two antibiotics (amoxicillin and clarithromycin) in the treatment of Helicobacter pylori infection in children of 4 years old and above with a gastritis: Helicobacter pylori eradication rate: 74.2% (23/31 patients) with omeprazole + amoxicillin + clarithromycin versus 9.4% (3/32 patients) with amoxicillin + clarithromycin. However, there was no evidence of clinical benefit demonstrated regarding dyspeptic symptoms. This study does not support any information for children aged less than 4 years old.
Site and mechanism of action
Omeprazole is a weak base and is concentrated and converted to the active form in the acid environment of the intracellular canaliculi within the parietal cell, where it inhibits the enzyme H+ K-ATPase - the proton pump. This effect on the final step of the gastric acid formation process is dose-dependent and provides for effective inhibition of both basal acid secretion and stimulated acid secretion irrespective of the stimulus.
All pharmacodynamic effects observed are explained by the effect of omeprazole on acid secretion.
Absorption and distribution
Omeprazole is acid labile and is administered orally as enteric-coated granules in capsules. Absorption takes place in the small intestine and is usually completed within 3-6 hours. The systemic bioavailability of omeprazole from a single oral dose is approximately 35%. After repeated once-daily administration, the bioavailability increases to about 60%. Concomitant intake of food has no influence on the bioavailability. The plasma protein binding of omeprazole is about 95%.
Elimination and metabolism
The average half-life of the terminal phase of the plasma concentration-time curve is approximately 40 minutes. There is no change in half-life during treatment. The inhibition of acid secretion is related to the area under the plasma concentration-time curve (AUC) but not to the actual plasma concentration at a given time. Omeprazole is entirely metabolised, mainly in the liver. Identified metabolites in plasma are the sulphone, the sulphide and hydroxy-omeprazole, these metabolites have no significant effect on acid secretion. About 80% of the metabolites are excreted in the urine and the rest in the faeces. The two main urinary metabolites are hydroxy-omeprazole and the corresponding carboxylic acid.
The systemic bioavailability of omeprazole is not significantly altered in patients with reduced renal function. The area under the plasma concentration-time curve is increased in patients with impaired liver function, but no tendency to accumulation of omeprazole has been found.
Children
Available data from children (1 year and older) suggest that the pharmacokinetics within the recommended doses are similar to those reported in adults. At steady state, lower plasma levels of omeprazole were seen in some children.
5.3. Preclinical safety data
Animal toxicity:
Gastric ECL-cell hyperplasia and carcinoids, have been observed in life-long studies in rats treated with omeprazole or subjected to partial fundectomy. These changes are the result of sustained hypergastrinaemia secondary to acid inhibition, and not from a direct effect of any individual drug.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Sugar spheres Sodium starch glycolate Sodium lauryl sulfate Povidone Potassium oleate Oleic acid Hypromellose
Methacrylic acid - ethyl acrylate copolymer (1:1)
Triethyl citrate Titanium dioxide Talc Capsule Gelatin
Titanium dioxide (E 171)
Quinoline yellow (E104)
Indigo carmine (El32)
Erythrosine (E 127) Printing ink Shellac
Polyvinylpyrrolidone Sodium hydroxide Titanium dioxide (E171) Propylene glycol
6.2. Incompatibilities
Not applicable.
6.3 Shelf life
2 years
6.4. Special precautions for storage
Do not store above 30°C.
Store in the original package. Keep the bottle tightly closed.
6.5. Nature and contents of container
HDPE bottle and polypropylene cap with integral silica gel desiccant Each pack contains 28 capsules.
6.6. Instruction for use and handling
No special instructions.
7. MARKETING AUTHORISATION HOLDER
Relonchem Limited 27 Old Gloucester Street London WC1 3XX United Kingdom
8. MARKETING AUTHORISATION NUMBER
PL 20395/0017
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
16th May 2005
10 DATE OF REVISION OF THE TEXT
28/08/2012