Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Omeprazole may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for The name of your medicine is omeprazole 2mg/ml, powder for oral suspension (called omeprazole oral suspension in this leaflet). Omeprazole oral suspension contains the active substance omeprazole. It belongs to a group of medicines called 'proton pump inhibitors'.They work by reducing the amount of acid that your stomach produces. Omeprazole is commonly used to treat the following conditions: In adults: ■ 'Gastro-oesophageal reflux disease' (GORD).This is where acid from the stomach escapes into the gullet (the tube which connects your throat to your stomach) causing pain, inflammation and heartburn. ■ Ulcers in the upper part of the intestine (duodenal ulcer) In children: Children over 1 month of age: ■ 'Gastro-oesophageal reflux disease' (GORD).This is where acid from the stomach escapes into the gullet (the tube which connects your throat to your stomach) causing pain, inflammation and heartburn. In children, the symptoms of the condition can include the return of stomach contents into the mouth (regurgitation), being sick (vomiting) and poor weight gain. Your doctor will tell you why you have been given this medicine.
e omeprazole oral suspension Do not take omeprazole oral suspension If you are allergic to omeprazole or any of the other ingredients of this medicine (listed in section 6). If you are allergic to medicines containing other proton pump inhibitors (eg pantoprazole, lansoprazole, rabeprazole, esomeprazole). ■ If you are taking a medicine containing nelfinavir (used for HIV infection) Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking omeprazole oral suspension. Warnings and precautions Talk to your doctor or pharmacist before taking omeprazole. Serious skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) have been reported in association with omeprazole treatment. Stop using omeprazole oral suspension and seek medical attention immediately if you notice any of the symptoms related to these serious skin reactions described in section 4. Omeprazole may hide the symptoms of other diseases.Therefore, if any of the following happen to you before you start taking omeprazole oral suspension or while you are taking it, talk to your doctor straight away: ■ You lose a lot of weight for no reason and have problems swallowing. ■ You get stomach pain or indigestion. ■ You begin to vomit food or blood. ■ You pass black stools (blood-stained faeces). ■ You experience severe or persistent diarrhoea, as omeprazole has been associated with a small increase in infectious diarrhoea. ■ You have severe liver problems. ■ You have ever had a skin reaction after treatment with a medicine similar to omeprazole that reduces stomach acid ■ You are due to have a specific blood test (Chromogranin A) If you take omeprazole on a long-term basis (longer than 1 year) your doctor will probably keep you under regular surveillance. You should report any new and exceptional symptoms and circumstances whenever you see your doctor. Taking a proton pump inhibitor like omeprazole, especially over a period of more than one year, may slightly increase your risk of fracture in the hip, wrist or spine.Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis). If you get a rash on your skin, especially in areas exposed to the sun tell your doctor as soon as you can, as you may need to stop your treatment with omeprazole. Remember to also mention any other ill-effects like pain in your joints. When taking omeprazole, inflammation in your kidney may occur. Signs and symptoms may include decreased volume of urine or blood in your urine and/or hypersensitivity reactions such as fever, rash, and joint stiffness.You should report such signs to the treating physician. Children Some children with chronic illnesses may require long-term treatment although it is not recommended. Do not give this medicine to children under 1 month of age. Other medicines and Omeprazole Oral Suspension Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.This includes medicines that you buy without a prescription.This is because Omeprazole can affect the way some medicines work and some medicines can have an effect on Omeprazole. Do not take Omeprazole if you are taking a medicine containing nelfinavir (used to treat HIV infection). Tell your doctor or pharmacist if you are taking any of the following medicines: ■ Ketoconazole, itraconazole, posaconazole or voriconazole (used to treat infections caused by a fungus) ■ Digoxin (used to treat heart problems) ■ Diazepam (used to treat anxiety, relax muscles or in epilepsy) ■ Phenytoin (used in epilepsy). If you are taking phenytoin, your doctor will need to monitor you when you start or stop taking omeprazole ■ Medicines that are used to thin your blood, such as warfarin or other vitamin K blockers.Your doctor may need to monitor you when you start or stop taking omeprazole ■ Rifampicin (used to treat tuberculosis) ■ Atazanavir (used to treat HIV infection) ■ Tacrolimus (in cases of organ transplantation) ■ St John's wort (Hypericum perforatum) (used to treat mild depression) ■ Cilostazol (used to treat intermittent claudication) ■ Saquinavir (used to treat HIV infection) ■ Clopidogrel (used to prevent blood clots (thrombi)) ■ Erlotinib (used to treat cancer) ■ Methotrexate (a chemotherapy medicine used in high doses to treat cancer) – if you are taking a high dose of methotrexate, your doctor may temporarily stop your omeprazole treatment. If your doctor has prescribed the antibiotics amoxicillin and clarithromycin as well as omeprazole to treat ulcers caused by Helicobacter pylori infection, it is very important that you tell your doctor about any other medicines you are taking. Omeprazole oral suspension with food and drink You should take omeprazole oral suspension without food on an empty stomach. Pregnancy, breastfeeding and fertility If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Omeprazole can be used during pregnancy. Omeprazole is excreted in breast milk but is not likely to influence the child when therapeutic doses are used.Your doctor will decide whether you can take omeprazole if you are breastfeeding. Driving and using machines Omeprazole is not likely to affect your ability to drive or use any tools or machines. Side effects such as dizziness and visual disturbances may occur (see section 4). If affected, you should not drive or operate machinery. Omeprazole oral suspension contains maltitol, potassium, sodium, sodium methyl parahydroxybenzoate and sodium benzoate. ■ Maltitol. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. ■ Sodium.This medicine contains 17.2 mg of sodium (main component of cooking/table salt) in each ml or 86 mg of sodium per 5ml dose.This 5ml dose is equivalent to 4.3% of the recommended maximum daily dietary intake of sodium for an adult. ■ Potassium.This medicine contains 1.39 mmol (or 54.3 mg) potassium per ml or 6.95 mmol (or 271.5 mg) potassium per 5ml dose.To be taken into consideration by patients with reduced kidney function or patients on a controlled potassium diet. ■ Sodium methyl parahydroxybenzoate. May cause allergic reactions (possibly delayed). ■ Sodium benzoate.This medicine contains 25 mg sodium benzoate in each 5ml dose. ■ ■
omeprazole oral suspension Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Your doctor will tell you how much medicine to take and how long to take it for.This will depend on your condition and how old you are. The maximum recommended dosing for omeprazole 2 mg/ml oral suspension is 15 mg per day. Another strength of omeprazole oral suspension and other pharmaceutical omeprazole forms are available for the administration of higher omeprazole dosages. For doses of ≤ 15mg, the 2 mg/ml strength is recommended. The recommended dose is given below. Use in adults To treat symptoms of GORD such as heartburn and acid regurgitation: ■ If your doctor has found that your food pipe (gullet) has been slightly damaged, the recommended dose is 20 mg once a day for 4-8 weeks.Your doctor may tell you to take a dose of 40 mg for a further 8 weeks if your gullet has not yet healed. ■ The recommended dose once the gullet has healed is 10 mg once a day. ■ If your gullet has not been damaged, the usual dose is 10 mg once a day. To prevent the duodenal ulcers from coming back: ■ The recommended dose is 10 mg or 20 mg once a day.Your doctor may increase the dose to 40 mg once a day. Use in children and adolescents To treat symptoms of GORD such as heartburn and acid regurgitation: ■ Children over 1 month of age may take omeprazole.The dose for children is based on the child's weight and the doctor will decide the correct dose based on the following*: Age ≥ 1 month
Weight Posology > 5 to 1 mg/kg once daily up to a maximum of 10 mg once daily. Doses above 1.5 mg/kg/day ≤ 10 kg have not been studied. ≥ 1 year of age ** 10-20 kg 10 mg once daily. The dose can be increased to 20 mg once daily if needed.
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If you stop taking omeprazole oral suspension Do not stop taking omeprazole without first talking to your doctor or pharmacist. If you have further questions on the use of this medicine, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everybody gets them. If you notice any of the following rare but serious side effects, stop taking omeprazole oral suspension and contact a doctor immediately: ■ Sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties in swallowing (severe allergic reaction). ■ Reddening of the skin with blisters or peeling.There may also be severe blisters and bleeding in the lips, eyes, mouth, nose and genitals.This could be 'Stevens-Johnson syndrome' or 'toxic epidermal necrolysis'. ■ Widespread rash, high body temperature and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome). ■ A red, scaly widespread rash with bumps under the skin and blisters accompanied by fever.The symptoms usually appear at the initiation of treatment (acute generalized exanthematous pustulosis). ■ Yellow skin, dark urine and tiredness which can be symptoms of liver problems. Other side effects include: Common side effects (may affect up to 1 in 10 people) ■ Headache. ■ Effects on your stomach or gut: diarrhoea, stomach pain, constipation, wind (flatulence). ■ Feeling sick (nausea) or being sick (vomiting). ■ Benign polyps in the stomach. Uncommon side effects (may affect up to 1 in 100 people) ■ Swelling of the feet and ankles. ■ Disturbed sleep (insomnia). ■ Dizziness, tingling feelings such as "pins and needles", feeling sleepy. ■ Spinning feeling (vertigo). ■ Changes in blood tests that check how the liver is working. ■ Skin rash, lumpy rash (hives) and itchy skin. ■ Generally feeling unwell and lacking energy. Rare side effects (may affect up to 1 in 1,000 people) ■ Blood problems such as a reduced number of white cells or platelets.This can cause weakness, bruising or make infections more likely. ■ Allergic reactions, sometimes very severe, including swelling of the lips, tongue and throat, fever, wheezing. ■ Low levels of sodium in the blood.This may cause weakness, being sick (vomiting) and cramps. ■ Feeling agitated, confused or depressed. ■ Taste changes. ■ Eyesight problems such as blurred vision. ■ Suddenly feeling wheezy or short of breath (bronchospasm). ■ Dry mouth. ■ An inflammation of the inside of the mouth. ■ An infection called "thrush" which can affect the gut and is caused by a fungus. ■ Liver problems, including jaundice which can cause yellow skin, dark urine, and tiredness. ■ Hair loss (alopecia). ■ Skin rash on exposure to sunshine. ■ Joint pains (arthralgia) or muscle pains (myalgia). ■ Severe kidney problems (interstitial nephritis). ■ Increased sweating. Very rare side effects (may affect up to 1 in 10,000 people) ■ Changes in blood count including agranulocytosis (lack of white blood cells). ■ Aggression. ■ Seeing, feeling or hearing things that are not there (hallucinations). ■ Severe liver problems leading to liver failure and inflammation of the brain. ■ Sudden onset of a severe rash or blistering or peeling skin.This may be associated with a high fever and joint pains (Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis). ■ Muscle weakness. ■ Enlarged breasts in men. Not known (frequency cannot be estimated from the available data) ■ Inflammation in the gut (leading to diarrhoea). ■ If you are on omeprazole for more than three months it is possible that the levels of magnesium in your blood may fall. Low levels of magnesium can be seen as fatigue, involuntary muscle contractions, disorientation, convulsions, dizziness or increased heart rate. If you get any of these symptoms, please tell your doctor promptly. Low levels of magnesium can also lead to a reduction in potassium or calcium levels in the blood.Your doctor may decide to perform regular blood tests to monitor your levels of magnesium. ■ Rash, possibly with pain in the joints. Omeprazole oral suspension may in very rare cases affect the white blood cells leading to immune deficiency. If you have an infection with symptoms such as fever with a severely reduced general condition or fever with symptoms of a local infection such as pain in the neck, throat or mouth or difficulties in urinating, you must consult your doctor as soon as possible so that a lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important for you to give information about your medicine at this time. Reporting of side effects If you get any side effects, talk to your doctor or pharmacist.This includes any possible side effects not listed in this leaflet.You can also report side effects directly via theYellow Card Scheme. Website: www.mhra.gov.uk/yellowcard or search for MHRAYellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
omeprazole oral suspension ■ ■ ■ ■
■ ■
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton after EXP.The expiry date refers to the last day of that month. Dry Powders: Do not store above 25°C. Store in the original foil pouch in order to protect from light and moisture. Following constitution: Store in a refrigerator (2°C – 8°C). Store in the original container in order to protect from light. Keep the bottle tightly closed.The constituted suspension has a shelf life of 28 days. After this time, any remaining suspension should be discarded. For up to 2 days the suspension may be stored below 25°C. Do not use omeprazole oral suspension if you notice anything wrong with the appearance of the medicine (See section 6). Tell your pharmacist. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use.These measures will help to protect the environment.
6. Further Information Information for the pharmacy/healthcare professionals Instructions for initial constitution. Combination of powder in cap and bottle ■ Shake the bottle for 10 seconds to loosen the powder. ■ Twist the red cap anti-clockwise (see arrow on cap) until the seal is broken to release the powder in the red cap into the bottle. ■ Twist the red cap back to the original position, securely fastening the red cap onto the bottle. Constitution of the powder ■ Shake the bottle vigorously for ten seconds to mix the powders. ■ Tap the base of the bottle three times on a hard horizontal surface to make sure all powder is in the bottle and not in the cap. ■ Remove the red cap from the bottle. ■ Add 64ml of water by using a suitable measuring device up to the line on the label. ■ Securely fasten the red cap onto the bottle and shake vigorously for 30 seconds. Placement of syringe adaptor ■ Remove the red cap and red ring and throw away. ■ Insert the colourless, transparent Bottle Adaptor and replace the red cap with the grey plastic screw-cap. ■ Leave for fifteen minutes for product to reach final consistency. Measuring your dose Instructions for use of the syringe 1. Shake for 20 seconds immediately prior to each use 2. To open the bottle, press the grey cap down and turn it anti-clockwise (Figure 1). Do not remove the white cap portion. 3. Take the syringe and put it into the adaptor opening (Figure 2). 4. Turn the bottle upside down (Figure 3). 5. Fill the syringe with a small amount of suspension by pulling the plunger down (Figure 4A).Then push the plunger upward in order to remove any possible bubbles (Figure 4B). Finally, pull the plunger down to the graduation mark corresponding to the quantity in millilitres (ml) prescribed by your doctor.The top flat edge of the piston should be in line with the graduation mark you are measuring to (Figure 4C). 6. Turn the bottle the right way up (Figure 5A). 7. Remove the syringe from the adaptor (Figure 5B). 8. Put the end of the syringe into the mouth of the patient and push the plunger slowly back in to take the medicine.The suspension will be released slowly while the last portion will be released faster due to reduced resistance in the tip of the syringe. 9. Wash the syringe with water and let it dry before you use it again (Figure 6). 10. Close the bottle with the grey plastic screw cap – leave the bottle adaptor in the bottle. Note: It is normal to have the red plastic disc in the suspension during use; do not attempt to remove it. What omeprazole oral suspension contains ■ The active substance is omeprazole. Each ml of oral suspension contains 2mg of omeprazole ■ The other ingredients are Sodium hydrogen carbonate (E500), Potassium hydrogen carbonate (E501), Sodium alginate (E401), Maltitol (E965), Mannitol (E421), Sucralose (E955), Xanthan gum (E415), Natural Vanilla Flavouring containing Maltodextrin (Maize) and Natural Mint Flavouring containing Gum Arabic / Acacia Gum (E414), Titanium dioxide (E171), Sodium benzoate (E211), Sodium methyl parahydroxybenzoate (E219) What omeprazole oral suspension looks like and contents of the pack Before constitution: White / off-white / slightly yellow powder in a cap attached to a bottle containing white / off-white / slightly yellow powder, which may contain dark specks due to sweetener. After constitution: White / off-white / brownish oral suspension. May contain dark specks due to sweetener. Pack: Amber plastic (PET) bottle with powder fitted with a red Polypropylene (PP) closure cap and a red Polypropylene (PP) mixing disk assembly containing powder, all enclosed in an aluminium foil pouch. Each bottle contains 47 g of powder for oral suspension. Once constituted the bottle contains 90 ml of oral suspension, of which at least 75 ml is intended for dosing and administration. Each pack also contains an opaque PP oral dosing syringe (5 ml, graduated at each 1ml and intermediate marks every 0.1ml) with white HDPE plunger, colourless, transparent LDPE press-in bottle adaptor and grey PP replacement cap. Pack: 1 or 2 bottles. Not all pack sizes may be marketed. Marketing Authorisation Holder Xeolas Pharmaceuticals Limited, Hamilton Building, DCU, Glasnevin, Dublin 9, IRELAND. Manufacturer Xeolas Pharmaceuticals Limited, Unit 80a, Grange Way, Baldoyle Industrial Estate, Dublin 13, IRELAND Manufacturer and Distributor : Rosemont Pharmaceuticals Ltd Rosemont House,Yorkdale Industrial Park, Braithwaite Street, Leeds, LS11 9XE, UK. Other sources of information This leaflet is also available in other formats for blind and partially-sighted patients. For large print and Braille, please go to www.medicines.org.uk This leaflet was last revised in January 2026
L5VG7RBJB6 V2 XEOLT13-2
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JOB INFORMATION
Omeprazole 2mg/ml, Powder for Oral Suspension (Wasdell)
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Omeprazole 2 mg/ml, Powder for Oral Suspension comes as oral solution containing 2mg/ml. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Omeprazole 2 mg/ml, Powder for Oral Suspension is omeprazole.
This leaflet reproduces the patient information leaflet approved for Omeprazole 2 mg/ml, Powder for Oral Suspension, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Omeprazole oral suspension is indicated for:
Adults
• Prevention of relapse of duodenal ulcers
• Long-term management of patients with healed reflux esophagitis
• Treatment of symptomatic gastro-esophageal reflux disease
Paediatric use
Children over 1 month of age
• Treatment of reflux esophagitis
• Symptomatic treatment of heartburn and acid regurgitation in gastro-esophageal reflux disease
The maximum recommended dosing for omeprazole 2 mg/ml oral suspension is 15 mg per day. Another strength of omeprazole oral suspension and other pharmaceutical omeprazole forms should be used for the administration of higher omeprazole dosages.
Posology in adults
Prevention of relapse of duodenal ulcers
For the prevention of relapse of duodenal ulcer in H. pylori negative patients or when H. pylori eradication is not possible the recommended dose is omeprazole 20 mg once daily. In some patients a daily dose of 10 mg may be sufficient. In case of therapy failure, the dose can be increased to 40 mg.
Long-term management of patients with healed reflux esophagitis
For the long-term management of patients with healed reflux esophagitis the recommended dose is omeprazole 10 mg once daily. If needed, the dose can be increased to omeprazole 20-40 mg once daily.
Treatment of symptomatic gastro-esophageal reflux disease
The recommended dose is omeprazole 20 mg daily. Patients may respond adequately to 10 mg daily, and therefore individual dose adjustment should be considered.
If symptom control has not been achieved after four weeks treatment with omeprazole 20 mg daily, further investigation is recommended.
Paediatric population
Children over 1 month of age
Treatment of reflux esophagitis
Symptomatic treatment of heartburn and acid regurgitation in gastro-esophageal reflux disease
The posology recommendations are as follows*:
Age
Weight
Posology
≥ 1 month
> 5 to ≤ 10 kg
1 mg/kg once daily up to a maximum of 10 mg once daily. Doses above 1.5 mg/kg/day have not been studied.
≥ 1 year of age**
10-20 kg
10 mg once daily. The dose can be increased to 20 mg once daily if needed.
* Individual dose measurements ≤ 2ml are not indicated
** The 2 mg/ml omeprazole oral suspension can be used in patients to administer up to 15 mg omeprazole per day in order to provide sufficient buffering capacity and absorption. Other pharmaceutical omeprazole forms should be used for the administration of higher omeprazole dosages.
Reflux esophagitis: The treatment time is 4-8 weeks.
Symptomatic treatment of heartburn and acid regurgitation in gastro-esophageal 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.
Special populations
Renal impairment
Dose adjustment is not needed in patients with impaired renal function (see section 5.2).
Hepatic impairment
Dose adjustment is not needed in patients with impaired hepatic function (see section 5.2).
Elderly (> 65 years old)
Dose adjustment is not needed in the elderly (see section 5.2).
Method of administration
Omeprazole oral suspension should be taken on an empty stomach, at least 30 minutes before a meal.
In order to aid administration of the product to infants, administration with a small quantity of milk (not more than 10-15 ml) is possible.
Precautions to be taken before handling or administering the medicinal product
Omeprazole powder for oral suspension requires reconstitution prior to oral administration. For instructions on reconstitution of the medicinal product before administration, see section 6.6.
For instruction for administration via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes, see section 6.6
Hypersensitivity to the active substance, substituted benzimidazoles or to any of the excipients listed in section 6.1.
Omeprazole like other proton pump inhibitors (PPIs) must not be used concomitantly with nelfinavir (see section 4.5).
In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment may alleviate symptoms and delay diagnosis.
Co-administration of atazanavir with proton pump inhibitors is not recommended (see section 4.5). If the combination of atazanavir with a proton pump inhibitor is judged unavoidable, close clinical monitoring (e.g virus load) is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; omeprazole 20 mg should not be exceeded.
Omeprazole, as all acid-blocking medicines, may reduce the absorption of vitamin B12 (cyanocobalamin) due to hypo- or achlorhydria. This should be considered in patients with reduced body stores or risk factors for reduced vitamin B12 absorption on long-term therapy.
Omeprazole is a CYP2C19 inhibitor. When starting or ending treatment with omeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. An interaction is observed between clopidogrel and omeprazole (see section 4.5). The clinical relevance of this interaction is uncertain. As a precaution, concomitant use of omeprazole and clopidogrel should be discouraged.
Severe hypomagnesaemia has been reported in patients treated with proton pump inhibitors (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), healthcare professionals should consider measuring magnesium levels before starting PPI treatment and periodically during treatment.
Proton pump inhibitors, especially if used in high doses and over long durations (>1 year), may modestly increase the risk of hip, wrist and spine fracture, predominantly in the elderly or in presence of other recognised risk factors. Observational studies suggest that proton pump inhibitors may increase the overall risk of fracture by 10-40%. Some of this increase may be due to other risk factors. Patients at risk of osteoporosis should receive care according to current clinical guidelines and they should have an adequate intake of vitamin D and calcium.
Severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP), which can be life-threatening or fatal, have been reported very rarely and rarely, respectively in association with omeprazole treatment.
Renal impairment
Acute tubulointerstitial nephritis (TIN) has been observed in patients taking omeprazole and may occur at any point during omeprazole therapy (see section 4.8). Acute tubulointerstitial nephritis can progress to renal failure.
Omeprazole should be discontinued in case of suspected TIN, and appropriate treatment should be promptly initiated.
Subacute cutaneous lupus erythematosus (SCLE)
Proton pump inhibitors are associated with very infrequent cases of SCLE. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly and the health care professional should consider stopping omeprazole. SCLE after previous treatment with a proton pump inhibitor may increase the risk of SCLE with other proton pump inhibitors.
Interference with laboratory tests
Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, omeprazole treatment should be stopped for at least 5 days before CgA measurements (see section 5.1). If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of proton pump inhibitor treatment.
Some children with chronic illnesses may require long-term treatment although it is not recommended.
Treatment with proton pump inhibitors may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and, in hospitalised patients, possibly also Clostridium difficile (see section 5.1).
As in all long-term treatments, especially when exceeding a treatment period of 1 year, patients should be kept under regular surveillance.
This medicinal product contains 17.2 mg (0.75 mmol) of sodium per ml or 86 mg (3.75 mmol) of sodium per 5 ml dose, equivalent (for 5 ml dose) to 4.3 % of the WHO recommended maximum daily intake of 2 g sodium for an adult.
This medicine contains 54.3 mg (1.39 mmol) potassium per ml or 271.5 mg (6.95 mmol) of potassium per 5 ml dose. To be taken into consideration by patients with reduced kidney function or patients on a controlled potassium diet.
This medicinal product contains sodium methyl para hydroxybenzoate, which may cause allergic reactions (possibly delayed).
This medicine contains 5 mg sodium benzoate in each 1ml.
This product contains maltitol. Patients with rare hereditary problems of fructose intolerance should not take this medicine.
Effects of omeprazole on the pharmacokinetics of other active substances
Active substances with pH dependent absorption
The decreased intragastric acidity during treatment with omeprazole might increase or decrease the absorption of active substances with a gastric pH dependent absorption.
Nelfinavir, atazanavir
The plasma levels of nelfinavir and atazanavir are decreased in case of co-administration with omeprazole.
Concomitant administration of omeprazole with nelfinavir is contraindicated (see section 4.3). Co-administration of omeprazole (40 mg once daily) reduced mean nelvinavir exposure by ca. 40% and the mean exposure of the pharmacologically active metabolite M8 was reduced by ca. 75 –90%. The interaction may also involve CYP2C19 inhibition.
Concomitant administration of omeprazole with atazanavir is not recommended (see section 4.4). Concomitant administration of omeprazole (40 mg once daily) and atazanavir 300 mg/ritonavir 100 mg to healthy volunteers resulted in a 75% decrease of the atazanavir exposure. Increasing the atazanavir dose to 400 mg did not compensate for the impact of omeprazole on atazanavir exposure. The co-administration of omeprazole (20 mg once daily) with atazanavir 400 mg/ritonavir 100 mg to healthy volunteers resulted in a decrease of approximately 30% in the atazanavir exposure as compared to atazanavir 300 mg/ritonavir 100 mg once daily.
Digoxin
Concomitant treatment with omeprazole (20 mg daily) and digoxin in healthy subjects increased the bioavailability of digoxin by 10%. Digoxin toxicity has been rarely reported. However caution should be exercised when omeprazole is given at high doses in elderly patients. Therapeutic drug monitoring of digoxin should be then be reinforced.
Clopidogrel
Results from studies in healthy subjects have shown a pharmacokinetic (PK)/pharmacodynamic (PD) interaction between clopidogrel (300 mg loading dose/75 mg daily maintenance dose) and omeprazole (80 mg p.o. daily) resulting in a decreased exposure to the active metabolite of clopidogrel by an average of 46% and a decreased maximum inhibition of (ADP induced) platelet aggregation by an average of 16%.
Inconsistent data on the clinical implications of a PK/PD interaction of omeprazole in terms of major cardiovascular events have been reported from both observational and clinical studies. As a precaution, concomitant use of omeprazole and clopidogrel should be discouraged (see section 4.4).
Other active substances
The absorption of posaconazole, erlotinib, ketoconazole and itraconazole is significantly reduced and thus clinical efficacy may be impaired. For posaconazole and erlotinib concomitant use should be avoided.
Active substances metabolised by CYP2C19
Omeprazole is a moderate inhibitor of CYP2C19, the major omeprazole metabolising enzyme. Thus, the metabolism of concomitant active substances also metabolised by CYP2C19, may be decreased and the systemic exposure to these substances increased. Examples of such drugs are R-warfarin and other vitamin K antagonists, cilostazol, diazepam and phenytoin.
Cilostazol
Omeprazole, given in doses of 40 mg to healthy subjects in a cross-over study, increased Cmax and AUC for cilostazol by 18% and 26% respectively, and one of its active metabolites by 29% and 69% respectively.
Phenytoin
Monitoring phenytoin plasma concentration is recommended during the first two weeks after initiating omeprazole treatment and, if a phenytoin dose adjustment is made, monitoring and a further dose adjustment should occur upon ending omeprazole treatment.
Unknown mechanism
Saquinavir
Concomitant administration of omeprazole with saquinavir/ritonavir resulted in increased plasma levels up to approximately 70% for saquinavir associated with good tolerability in HIV-infected patients.
Tacrolimus
Concomitant administration of omeprazole has been reported to increase the serum levels of tacrolimus. A reinforced monitoring of tacrolimus concentrations as well as renal function (creatinine clearance) should be performed, and dosage of tacrolimus adjusted if needed.
Methotrexate
When given together with proton-pump inhibitors, methotrexate levels have been reported to increase in some patients. In high-dose methotrexate administration a temporary withdrawal of omeprazole may need to be considered.
Effects of other active substances on the pharmacokinetics of omeprazole
Inhibitors CYP2C19 and/or CYP3A4
Since omeprazole is metabolised by CYP2C19 and CYP3A4, active substances known to inhibit CYP2C19 or CYP3A4 (such as clarithromycin and voriconazole) may lead to increased omeprazole serum levels by decreasing omeprazole's rate of metabolism. Concomitant voriconazole treatment resulted in more than doubling of the omeprazole exposure. As high doses of omeprazole have been well-tolerated adjustment of the omeprazole dose is not generally required. However, dose adjustment should be considered in patients with severe hepatic impairment and if long-term treatment is indicated.
Inducers of CYP2C19 and/or CYP3A4
Active substances known to induce CYP2C19 or CYP3A4 or both (such as rifampicin and St John's wort) may lead to decreased omeprazole serum levels by increasing omeprazole's rate of metabolism.
Pregnancy
Results from three prospective epidemiological studies (more than 1000 exposed outcomes) indicate no adverse effects of omeprazole on pregnancy or on the health of the foetus/newborn child. Omeprazole can be used during pregnancy.
Breast-feeding
Omeprazole is excreted in breast milk but is not likely to influence the child when therapeutic doses are used.
Fertility
Animal studies with the racemic mixture omeprazole, given by oral administration do not indicate effects with respect to fertility.
Omeprazole oral suspension is not likely to affect the ability to drive or use machines. Adverse drug reactions such as dizziness and visual disturbances may occur (see section 4.8). If affected, patients should not drive or operate machinery.
Summary of the safety profile
The most common side effects (1-10% of patients) are headache, abdominal pain, constipation, diarrhoea, flatulence and nausea/vomiting.
Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) have been reported in association with omeprazole treatment (see section 4.4).
Tabulated list of adverse reactions
The following adverse drug reactions have been identified or suspected in the clinical trials programme for omeprazole and post-marketing. None was found to be dose-related. Adverse reactions listed below are classified according to frequency and System Organ Class (SOC). Frequency categories are defined according to the following convention: Very common (≥ 1/10), Common (≥ 1/100 to < 1/10), Uncommon (≥ 1/1,000 to < 1/100), Rare (≥ 1/10,000 to < 1/1,000), Very rare (< 1/10,000), Not known (cannot be estimated from the available data).
SOC/frequency
Adverse reaction
Blood and lymphatic system disorders
Rare:
Leukopenia, thrombocytopenia
Very rare:
Agranulocytosis, pancytopenia
Immune system disorders
Rare:
Hypersensitivity reactions e.g. fever, angioedema and anaphylactic reaction/shock
Metabolism and nutrition disorders
Rare:
Hyponatraemia
Not known:
Hypomagnesaemia; severe hypomagnesaemia may result in hypocalcaemia.
Hypomagnesaemia may also be associated with hypokalaemia.
Psychiatric disorders
Uncommon:
Insomnia
Rare:
Agitation, confusion, depression
Very rare:
Aggression, hallucinations
Nervous system disorders
Common:
Headache
Uncommon:
Dizziness, paraesthesia, somnolence
Rare:
Taste disturbance
Eye disorders
Rare:
Blurred vision
Ear and labyrinth disorders
Uncommon:
Vertigo
Respiratory, thoracic and mediastinal disorders
Rare:
Bronchospasm
Gastrointestinal disorders
Common:
Abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting, fundic gland polyps (benign)
Rare:
Dry mouth, stomatitis, gastrointestinal candidiasis
Not known:
Microscopic colitis
Hepatobiliary disorders
Uncommon:
Increased liver enzymes
Rare:
Hepatitis with or without jaundice
Very rare:
Hepatic failure, encephalopathy in patients with pre-existing liver disease
Skin and subcutaneous tissue disorders
Uncommon:
Dermatitis, pruritus, rash, urticaria
Rare:
Alopecia, photosensitivity, acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS)
Very rare:
Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN)
Not known:
Subacute cutaneous lupus erythematosus (see section 4.4)
Musculoskeletal and connective tissue disorders
Uncommon:
Fracture of the hip, wrist or spine
Rare:
Arthralgia, myalgia
Very rare:
Muscular weakness
Renal and urinary disorders
Rare:
Tubulointerstitial nephritis (with possible progression to renal failure)
Reproductive system and breast disorders
Very rare:
Gynaecomastia
General disorders and administration site conditions
Uncommon:
Malaise, peripheral oedema
Rare:
Increased sweating
Paediatric population
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 esophagitis 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.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
There is limited information available on the effects of overdoses of omeprazole in humans. 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 2,400 mg omeprazole (120 times the usual recommended clinical dose). Nausea, vomiting, dizziness, abdominal pain, diarrhoea and headache have been reported. Also apathy, depression and confusion have been described in single cases.
The symptoms described have been transient, and no serious outcome has been reported. The rate of elimination was unchanged (first order kinetics) with increased doses. Treatment, if needed, is symptomatic.
Medicines sold in Romania with the same active substance: Cunoscut în România ca
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →
Medicines sold in Poland with the same active substance: W Polsce znany jako
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →
Ask anything about Omeprazole 2 mg/ml, Powder for Oral Suspension. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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