Omeprazole

Pronunciation

(oh ME pray zol)

U.S. Brand Names

Prilosec®; Prilosec OTC™ [OTC]; Zegerid™

Generic Available

Yes

Canadian Brand Names

Losec®

Use

Short-term (4-8 weeks) treatment of active duodenal ulcer disease or active benign gastric ulcer; treatment of heartburn and other symptoms associated with gastroesophageal reflux disease (GERD); short-term (4-8 weeks) treatment of endoscopically-diagnosed erosive esophagitis; maintenance healing of erosive esophagitis; long-term treatment of pathological hypersecretory conditions; as part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence

OTC labeling: Short-term treatment of frequent, uncomplicated heartburn occurring 2 days/week

Use - Unlabeled/Investigational

Healing NSAID-induced ulcers; prevention of NSAID-induced ulcers

Pregnancy Risk Factor

Pregnancy Implications

Crosses the placenta; congenital abnormalities have been reported sporadically following omeprazole use during pregnancy. Based on data collected by the Teratogen Information System (TERIS), it was concluded that therapeutic doses used during pregnancy would be unlikely to pose a substantial teratogenic risk (quantity/quality of data: fair). Because the possibility of harm still exists, the manufacturer recommends use during pregnancy only if the potential benefit to the mother outweighs the possible risk to the fetus. Zegerid™ contains sodium bicarbonate; chronic use may lead to systemic alkalosis, edema, and weight gain; metabolic alkalosis and fluid overload may occur in mother and fetus.

Lactation

Enters breast milk/not recommended

Contraindications

Hypersensitivity to omeprazole, substituted benzimidazoles (ie, esomeprazole, lansoprazole, pantoprazole, rabeprazole), or any component of the formulation

Zegerid™: Also contraindicated with metabolic alkalosis and hypocalcemia (due to sodium bicarbonate content)

Warnings/Precautions

In long-term (2-year) studies in rats, omeprazole produced a dose-related increase in gastric carcinoid tumors. While available endoscopic evaluations and histologic examinations of biopsy specimens from human stomachs have not detected a risk from short-term exposure to omeprazole, further human data on the effect of sustained hypochlorhydria and hypergastrinemia are needed to rule out the possibility of an increased risk for the development of tumors in humans receiving long-term therapy. Bioavailability may be increased in the elderly, Asian population, and with hepatic dysfunction. Use Zegerid™ with caution in patients with Bartter's syndrome, hypokalemia, sodium-restricted diets, and respiratory alkalosis (contains sodium bicarbonate). Safety and efficacy have not been established in children <2 years of age. When used for self-medication (OTC), do not use for >14 days; treatment should not be repeated more often than every 4 months; not approved for OTC use in children <18 years of age.

Adverse Reactions

1% to 10%:

Central nervous system: Headache (7%), dizziness (2%)

Dermatologic: Rash (2%)

Gastrointestinal: Diarrhea (3%), abdominal pain (2%), nausea (2%), vomiting (2%), constipation (1%), taste perversion (<1% to 15%)

Neuromuscular & skeletal: Weakness (1%), back pain (1%)

Respiratory: Upper respiratory infection (2%), cough (1%)

<1%: Abdominal swelling, abnormal dreams, aggression, agranulocytosis, allergic reactions, alopecia, anaphylaxis, anemia, angina, angioedema, anorexia, anxiety, apathy, atrophic gastritis, benign gastric polyps, blurred vision, bradycardia, jaundice, confusion, depression, diaphoresis, double vision, dry mouth, dry skin, epistaxis, erythema multiforme, esophageal candidiasis, fatigue, fecal discoloration, fever, flatulence, glycosuria, gynecomastia, hallucinations, hematuria, hemifacial dysesthesia, hemolytic anemia, hepatic encephalopathy, hepatic failure, hepatic necrosis, hypertension, hypoglycemia, hyponatremia, insomnia, interstitial nephritis, irritable colon, joint pain, leg pain, leukocytosis; liver disease (hepatocellular, cholestatic, mixed); malaise, microscopic pyuria, mucosal atrophy (tongue), muscle cramps, muscle weakness, myalgia, nervousness, neutropenia, ocular irritation, pain, palpitation, pancreatitis, pancytopenia, paresthesia, peripheral edema, pharyngeal pain, phosphatase, proteinuria, pruritus, psychic disturbance, rash, serum alkaline increased, serum creatinine increased, serum transaminases increased, skin inflammation, somnolence, Stevens-Johnson syndrome, tachycardia, testicular pain, thrombocytopenia, tinnitus, toxic epidermal necrolysis, tremor, urinary frequency, urinary tract infection, urticaria, vertigo, weight gain

Overdosage/Toxicology

Limited experience with overdose in humans. Symptoms include confusion, drowsiness, blurred vision, tachycardia, nausea, flushing, diaphoresis, headache, dry mouth. Treatment is symptom-directed and supportive.

Zegerid™: Also consider sodium bicarbonate overdose.

Drug Interactions

Substrate of CYP2A6 (minor), 2C8/9 (minor), 2C19 (major), 2D6 (minor), 3A4 (minor); Inhibits CYP1A2 (weak), 2C8/9 (moderate), 2C19 (strong), 2D6 (weak), 3A4 (weak); Induces CYP1A2 (weak)

Benzodiazepines metabolized by oxidation (eg, diazepam, midazolam, triazolam): Esomeprazole and omeprazole may increase levels of benzodiazepines metabolized by oxidation.

Carbamazepine: Esomeprazole and omeprazole may increase carbamazepine levels.

CYP2C8/9 substrates: Omeprazole may increase the levels/effects of CYP2C8/9 substrates. Example substrates include amiodarone, fluoxetine, glimepiride, glipizide, nateglinide, phenytoin, pioglitazone, rosiglitazone, sertraline, and warfarin.

CYP2C19 inducers: May decrease the levels/effects of omeprazole. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.

CYP2C19 substrates: Omeprazole may increase the levels/effects of CYP2C19 substrates. Example substrates include citalopram, diazepam, methsuximide, phenytoin, propranolol, and sertraline.

Itraconazole and ketoconazole: Proton pump inhibitors may decrease the absorption of itraconazole and ketoconazole.

Phenytoin: Elimination of phenytoin may be prolonged; monitor. Phenytoin may decrease omeprazole levels/effects.

Protease inhibitors: Proton pump inhibitors may decrease absorption of some protease inhibitors (atazanavir and indinavir).

Warfarin: Elimination of warfarin may be prolonged; monitor.

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may cause gastric mucosal irritation).

Food: Food delays absorption. When Zegerid™ is given 1 hour after a meal, absorption is reduced.

Herb/Nutraceutical: St John's wort may decrease omeprazole levels.

Stability

Store at 15°C to 30°C (59°F to 86°F).

Mechanism of Action

Suppresses gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump

Pharmacodynamics/Kinetics

Onset of action: Antisecretory: ~1 hour

Peak effect: 2 hours

Duration: 72 hours

Protein binding: 95%

Metabolism: Extensively hepatic to inactive metabolites

Bioavailability: Oral: 30% to 40%; increased in Asian patients and with hepatic dysfunction

Half-life elimination: 0.5-1 hour

Excretion: Urine (77% as metabolites, very small amount as unchanged drug); feces

Dosage

Oral:

Children 2 years: GERD or other acid-related disorders:

<20 kg: 10 mg once daily

20 kg: 20 mg once daily

Adults:

Active duodenal ulcer: 20 mg/day for 4-8 weeks

Gastric ulcers: 40 mg/day for 4-8 weeks

Symptomatic GERD: 20 mg/day for up to 4 weeks

Erosive esophagitis: 20 mg/day for 4-8 weeks

Helicobacter pylori eradication: Dose varies with regimen: 20 mg once daily or 40 mg/day as single dose or in 2 divided doses; requires combination therapy with antibiotics

Pathological hypersecretory conditions: Initial: 60 mg once daily; doses up to 120 mg 3 times/day have been administered; administer daily doses >80 mg in divided doses

Frequent heartburn (OTC labeling): 20 mg/day for 14 days; treatment may be repeated after 4 months if needed

Dosage adjustment in hepatic impairment: Specific guidelines are not available; bioavailability is increased with chronic liver disease

Administration

Capsule: Should be swallowed whole; do not chew, crush, or open. Best if taken before breakfast. May be opened and contents added to applesauce. Administration via NG tube should be in an acidic juice.

Powder for oral suspension (Zegerid™): Administer 1 hour before a meal. Mix with 2 tablespoons of water; stir well and drink immediately. Rinse cup with water and drink.

Dietary Considerations

Should be taken on an empty stomach; best if taken before breakfast.

Zegerid™: Take 1 hour before a meal; contains sodium bicarbonate 1680 mg (20 mEq), equivalent to sodium 460 mg (20 mEq) per dose

Patient Education

Take as directed, before eating. Do not crush or chew capsules. Capsule may be opened and contents added to applesauce. Avoid alcohol. You may experience anorexia; small, frequent meals may help to maintain adequate nutrition. Report changes in urination or pain on urination, unresolved severe diarrhea, testicular pain, or changes in respiratory status. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.

Anesthesia and Critical Care Concerns/Other Considerations

A 2 mg/mL oral omeprazole solution (Simplified Omeprazole Solution) can be prepared with five omeprazole 20 mg capsules and 50 mL 8.4% sodium bicarbonate. Empty capsules into beaker. Add sodium bicarbonate solution. Gently stir (about 15 minutes) until a white suspension is formed. Transfer to amber-colored syringe or bottle. Stable for 14 days at room temperature or for 30 days under refrigeration.

DiGiancinto JL, Olsen KM, Bergman KL, et al, "Stability of Suspension Formulations of Lansoprazole and Omeprazole Stored in Amber-Colored Plastic Oral Syringes," Ann Pharmacother , 2000, 34:600-5.

Quercia R, Fan C, Liu X, et al, "Stability of Omeprazole in an Extemporaneously Prepared Oral Liquid," Am J Health Syst Pharm , 1997, 54:1833-6.

Sharma V, "Comparison of 24-hour Intragastric pH Using Four Liquid Formulations of Lansoprazole and Omeprazole," Am J Health Syst Pharm , 1999, 56(Suppl 4):S18-21.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Taste perversion, dry mouth, esophageal candidiasis, and mucosal atrophy (tongue).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause dizziness; may rarely cause sedation

Mental Health: Effects on Psychiatric Treatment

May inhibit the metabolism of diazepam; monitor for increased sedation

Dosage Forms

Capsule, delayed release: 10 mg, 20 mg

Prilosec®: 10 mg, 20 mg, 40 mg

Prilosec OTC™: 20 mg

Powder for oral suspension (Zegerid™): 20 mEq/packet (30s) [contains sodium bicarbonate 1680 mg, equivalent to sodium 460 mg]

Extemporaneously Prepared

DiGiancinto JL, Olsen KM, Bergman KL, et al, "Stability of Suspension Formulations of Lansoprazole and Omeprazole Stored in Amber-Colored Plastic Oral Syringes," Ann Pharmacother , 2000, 34:600-5.

Quercia R, Fan C, Liu X, et al, "Stability of Omeprazole in an Extemporaneously Prepared Oral Liquid," Am J Health Syst Pharm , 1997, 54:1833-6.

Sharma V, "Comparison of 24-hour Intragastric pH Using Four Liquid Formulations of Lansoprazole and Omeprazole," Am J Health Syst Pharm , 1999, 56(Suppl 4):S18-21.

Extemporaneous preparation for NG administration (Prilosec®): The manufacturer recommends the use of an acidic juice for preparation to administer via nasogastric (NG) tube. Alternative methods have been described as follows. NG tube administration for the prevention of stress-related mucosal damage in ventilated, critically-ill patients. The manufacturer makes no judgment regarding the safety or efficacy of these practices.

The contents of one or two 20 mg omeprazole capsules were poured into a syringe; 10-20 mL of an 8.4% sodium bicarbonate solution was withdrawn in the syringe; 30 minutes were allowed for the enteric-coated omeprazole granules to break down. The resulting milky substance was shaken prior to administration. The NG tube was then flushed with 5-10 mL of water then clamped for at least 1 hour. Patients received omeprazole 40 mg once, then 40 mg 6-8 hours later, then 20 mg once daily using this technique.

Another study used a different technique. The omeprazole capsule (20 mg or 40 mg) was opened; then the intact granules were poured into a container holding 30 mL of water. With the plunger removed, ¹ /3 to ¹ /2 of the granules were then poured into a 30 mL syringe which was attached to a nasogastric tube (NG). The plunger was replaced with 1 cm of air between the granules and the plunger top while the plunger was depressed. This process was repeated until all the granules were flushed, then a final 15 mL of water was flushed through the tube. Patients who received omeprazole 40 mg in this manner had a more predictable increase in intragastric pH than patients who received omeprazole 20 mg.

References

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Balian JD, Sukhova N, Harris JW, et al, "The Hydroxylation of Omeprazole Correlates With S-Mephenytoin Metabolism: A Population Study," Clin Pharmacol Ther , 1995, 57(6):662-9.

Berardi RR and Dunn-Kucharski VA, "Omeprazole: Defining Its Role in Gastroesophageal Reflux Disease," Hosp Formul : 1995, 30:216-25.

Beutler M, Hartmann K, Kuhn M, et al, "Arthralgias on Omeprazole," BMJ , 1994, 309(6969):1620.

Broussard CN and Richter JE, "Treating Gastro-oesophageal Reflux Disease During Pregnancy and Lactation: What are the Safest Therapy Options?" Drug Saf , 1998, 19(4):325-37.

Carulli MT, Epstein O, and Black CM, "Small Bowel Bacterial Overgrowth and Omeprazole in Patients With Systemic Sclerosis," Br J Rheumatol , 1995, 34(Suppl 1):67.

Carvajal A and Martin Arias LH, "Gynecomastia and Sexual Disorders After the Administration of Omeprazole," Am J Gastroenterol , 1995, 90(6):1028-9.

Cockayne SE, Glet RJ, Gawkrodger DJ, et al, "Severe Erythrodermic Reactions to the Proton Pump Inhibitors Omeprazole and Lansoprazole," Br J Dermatol ,1999, 141(1):173-5.

Coulter DM, "Monitoring of Omeprazole," N Z Family Physician , 1995, 22:76-7.

Epelde Gonzalo FD, Boada Montagut L, and Tomas Vecina S, "Exfoliative Dermatitis Related to Omeprazole," Ann Pharmacother , 1995, 29(1):82-3.

Friedman G, "Omeprazole," Am J Gastroenterol , 1987, 82(3):188-91.

Gunasekaran TS and Hassall EG, "Efficacy and Safety of Omeprazole for Severe Gastroesophageal Reflux in Children," J Pediatr , 1993, 123(1):148-54.

Jung R and MacLaren R, "Proton-Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients," Ann Pharmacother , 2002, 36(12):1929-37.

Kane DL, "Administration of Omeprazole (Prilosec®) in the Atypical Patient," Int J Pharm Compounding , 1997, 1(1):13.

Kato S, Ebina K, Fujii K, et al, "Effect of Omeprazole in the Treatment of Refractory Acid-Related Diseases in Childhood: Endoscopic Healing and Twenty-Four Hour Intragastric Acidity," J Pediatr , 1996, 128(3):415-21.

Kaye SA, Lim SG, Taylor M, et al, "Small Bowel Bacterial Overgrowth in Systemic Sclerosis: Detection Using Direct and Indirect Methods and Treatment Outcome," Br J Rheumatol , 1995, 34(3):265-9.

Kraus A and Flores-Suarez LF, "Acute Gout Associated With Omeprazole," Lancet , 1995, 345(8947):461-2.

Larner AJ and Lendrum R, "Oesophageal Candidiasis After Omeprazole Therapy," Gut , 1992, 33(6):860-1.

Lau JY, Sung JJ, Lee KK, et al, "Effect of Intravenous Omeprazole on Recurrent Bleeding After Endoscopic Treatment of Bleeding Peptic Ulcers," N Engl J Med , 2000, 343(5):310-6.

Lin HJ, Lo WC, Lee FY, et al, "A Prospective Randomized Comparative Trial Showing That Omeprazole Prevents Rebleeding in Patients With Bleeding Peptic Ulcer After Successful Endoscopic Therapy," Arch Intern Med , 1998, 158(1):54-8.

Lindquist M and Edwards IR, "Endocrine Adverse Effects of Omeprazole," Br Med J , 1992, 305(6851):451-2.

Natsch S, Vinks MH, Voogt AK, et al, "Anaphylactic Reactions to Proton-Pump Inhibitors," Ann Pharmacother , 2000, 34(4):474-6.

Ottervanger JP, Stricker BH, Kappelle JW, et al, "Omeprazole-Associated Agranulocytosis," Eur J Haematol , 1995, 54(4):279-80.

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International Brand Names

Acimax® (AU); Airomet-Aom® (TH); Alboz® (MX); Aleprozil® (MX); Amanol® (CH); Antra® [inj.] (CH, DE, IT); Antra® (IT); Antra MUPS® (CH, DE); Audazol® (ES); Aulcer® (ES); Belmazol® (ES, PT, RO); Biocid® (IN); Bioprazol® (PL); Ceprandal® (ES); Contral® (ID); Criogel® (EC); Danlox® (AR); Demeprazol® (TR); Desec® (TH); Dosate® (TH); Dudencer® (ID); Duogas® (TH); Elgam® (ES); Emeproton® (ES); Epirazole® (JO, KW, LB); Erbolin® (TR); Erradic® (BR); Etiprazol® (DO); Eucid® (TH); Exter® (PL); Fabrazol® (AR); Fendiprazol® (AR); Fendiprazol® [inj.] (AR); Fordex® (CR, DO, GT, HN, PA, SV); Gasec® (CZ, EC, PT); Gasec Gastrocaps® (CY, EG, JO, KW, LB, PL); Gaspiren® (BR); Gastec® (AR); Gaster® (TH); Gastracid® (DE); Gastrazole® (RO); Gastrimut® (DO, ES, GT, PA, SV); Gastrium® (BR); Gastromax-EP® (TR); Gastroprazol® (CH); Gastrotem® (AR); Gertalgin® (RO); Glaveral® (RO); Gomec® (TH); Groprazol® (PL); Helicid® (CZ, PL, RU); Helveprazol® (CH); H-Etom® (CO); Indurgan® (ES); Inhibitron® (MX); Inhipump® (ID); Klispel® (BR); Lensor® (LU); Logastric® (BE); Logastric I.V.® (BE); Loklor® (ID); Lomac® (CZ, IN, TH); Lomepral® (BR); Lomex® (CL); Losamel® (IE); Losaprol® (BR); Losar® (BR); Losec® (AR, AT, AU, BG, BR, CA, CL, CR, CY, CZ, DK, DO, ES, FI, GB, GT, HK, HN, HU, ID, IE, IL, IT, KW, LB, LU, MT, MX, NL, NO, NZ, PA, PL, PT, RU, SV, TH, YU, ZA); Losec® [inj.] (AR, AT, AU, BE, CL, CZ, DK, EC, ES, FI, GB, ID, IT, MX, NL, NO, SE, SG, TR); Losec Mups® (AR, BE, BR, EC, GB, IE, PL); Losec® Mups® (RO); Losec Mups® (SE, SG, TH); Losectil® (BD); Loseprazol® (CZ); Lozap® (BR); Madiprazole® (TH); Maxor® (AU); Meiceral® (TH); Meisec® (ID); Mepha Gasec® (CR, GT, HN, PA, SV); Mepral® [inj.] (IT); Mepral® (IT); Mepraz® (BR, PT); Meprox® (CO); Merck-Omeprazole® (BE); Metsec® (TH); Micromex® (CL); Miol® (ES); Miracid® (TH); Mopral® (ES, FR); Morecon® (ID); MTW-Omeprazol® (DE); Nocid® (TH); Norpramin® (ES); Norsec® (ID); Nuclosina® (ES, PT, YU); Ocid® (IN, RO, RU, SG, ZA); Odasol® (RO); Ogal® (CO); Olexin® (MX); Olit® (TH); Omapren® (ES); Omar® (PL); Omebeta® (DE); Omec® (AT); Omecidol® (EC); Omed® (CH); Omedec® (EC); Omegamma® (DE); Omegastrol® (BR); Omegast® (RU, TR); OmeLich® (DE); Omelind® (DE); OME-nerton® (DE); Omep-20® (BD); OMEP® (DE); Omepirex® (CZ); Omep® (PL); Omepra-basan® (CH); Omepral® (GT, JP); Omepra® (PT); Omeprasec® (AR, BR); Omeprax® (CL, CO); Omeprazen® [inj.] (IT); Omeprazen® (IT); Omeprazid® (TR); Omeprazol 1A Pharma® (DE); Omeprazol-20 Ratio® (DO); Omeprazol AbZ® (DE); Omeprazol Acyfabrik® (ES); Omeprazol AL® (CZ, DE); Omeprazol Alter® (ES, PT); Omeprazol Aphar® (ES); Omeprazol® (AR); Omeprazol Arrow® (SE); Omeprazol AWD® (DE); Omeprazol AZU® (DE); Omeprazol Basics® (DE); Omeprazol Bayvit® (ES); Omeprazol Bexal® (ES); Omeprazol Biochemie® (CO, DK, SE); Omeprazol Biocrom® (AR); Omeprazol (BR, CL, DO, EC, NO, PL, RO, RU, YU); Omeprazol Ciclum® (PT); Omeprazol Cinfa® (ES); Omeprazol Cinfamed® (ES); Omeprazol Cuve® (ES); Omeprazol Davur® (ES); Omeprazol Denver® (AR); Omeprazol dura® (DE); 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Ome-Puren® (DE); Ome-Q® (DE); Omeran® (RO); Omesan® (DO); Omesec® (SG); Omesek® (TR); Ometid® (BD); Ometon® (PT); Omezolan® (PT); Omezol® (CO, IN, RU, YU); Omezole® (SG); Omezol-Mepha® (CH); Omez® (RO, RU, TH); Omezzol® (EC); Omisec® (JO); Omizac® (RU); Ompranyt® (ES); OMZ® (ID); Onexal® (CO); Onic® (ID); OPM® (ID); Oprazol® (CH); Oprazole Atlantic® (TH); Oprazole® (EG, JO, KW, LB, SY); Orazole® (CO); Ortanol® (CZ, HR, PL, RO, SI); O-Sid® (TH); Osiren® (MX); Ozid® (ID); Parizac® (ES); Penrazole® (SG); Peprazol® (BR); Pepticum® (EC, ES, RU); Pepticus® (AR); Peptidin® (CO); Pilorfast® (EC); Polprazol® (PL); Pravil Duncan® (AR); Prazidec® (MX); Prazogas® (DO, HN); Prazolene® (PT); Prazolen® (GT, HN, PA, SV); Prazolit® (MX); Prazolo® (CL); Prazol® (PL); Presec® (BD); Probitor® (BD, TH); Procelac® (AR); Proceptin® (BD); Proclor® (PT); Prohibit® (ID); Prosek® (TR); Protacid® (SV); Proton® (PT); Protop® (ID); Prysma® (ES); Pumpitor® (ID); Pylobact® (RU); Redusec® (ID); Regasec® (ID); Regulacid® (AR); Risek® (EC, RO); Rocer® (ID); Romesec® (RU, SG); Roweprazol® (CR, DO, EC, HN, PA, SV); Sanamidol® (ES); Seclo® (BD); Secrepina® (ES); Severon® (TH); Socid® (ID); Stomacer® (ID); Stomec® (TH); Target plus® (HR); Tarzol® (CO); Timezol® (AR); Togran® (CL); Trofaron® (CL); Ulcefor® (BR); Ulcelac® (CL); Ulceral® (ES); Ulcesep® (ES); Ulcidex® (EC); Ulcid® (IE); Ulcometion® (ES); Ulc-Out® (CL); Ulcozol® (AR, BR, CO); Ulcuprazol® (CR, DO, GT, HN, PA, SV); Ulnor® (DE); Ulprazol® (DO); Ulprazole® (TH); Ulsen® (DO, MX, SV); Ultop® (CZ, HR, RO, SI); Ulzol® (HR, ID, IN, PL); Upral® (DO, GT, HN, SV); Victrix® (BR); Xeldrin® (BD); Xilapen® (DO); Zatrol® (CL); Zefxon® (TH); Zenpro® (SG); Zepral® (ID); Zerocid® (RU); Zimor® (DO, ES, GT, PA, SG, SV, TH); Zollocid® (ID); Zoltenk® (AR); Zoltum® (FR); Zomepral® (CL)

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