Names and pronunciation
Lovaza, many brands available
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Drug reference
Lovaza, many brands available
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Func. class.: Antilipemic, fatty acid Func. class.: Antiulcer, proton pump inhibitor
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USES: To reduce triglyceride levels ≥500 mg/dL as adjunct to diet USES: Gastroesophageal reflux dis- ease (GERD), severe erosive esophagi- tis, poorly responsive systemic GERD, pathologic hypersecretory conditions (Zollinger-Ellison syndrome, systemic mastocytosis, multiple endocrine ade- nomas); treatment of active duodenal ulcers with/without antiinfectives for Helicobacter pylori
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Chem. class.: Benzimidazole
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Do not confuse: PriLOSEC/Prinivil/PROzac/predniSONE/ Pristiq omeprazole/fomepizole aripiprazole
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ACTION: Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cells; characterized as gastric acid pump inhibi- tor because it blocks the final step of acid production
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Unlabeled uses: Dyspepsia
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CONTRAINDICATIONS Hypersensitivity CONTRAINDICATIONS: Hyper- sensitivity to this product or benzimidazoles Precautions: Pregnancy; breastfeeding; children; Asian, black patients, hepatic disease
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SIDE EFFECTS CNS: Headache, dizziness, asthenia GI: Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation, abdominal swelling, anorexia, irritable colon, esophageal can- didiasis, dry mouth, hepatic failure, Clos- tridium difficile–associated diarrhea (CDAD) INTEG: Rash, dry skin, urticaria, pruri- tus, alopecia MISC: Back pain, fever, fatigue, malaise RESP: Upper respiratory infections, cough, epistaxis, pneumonia
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INTERACTIONS Increase: bleeding—warfarin Increase: serum levels of diazePAM, phe- nytoin, flurazepam, triazolam, cycloSPO- RINE, disulfiram, digoxin, benzodiazepines, methotrexate; saquinavir, tacrolimus, voriconazole Decrease: effect of iron salts, ketocon- azole, cyanocobalamin, calcium carbon- ate, ampicillin, indinavir, gefitinib, ampi- cillin, azoles, biphosphates Drug/Herb Decrease: omeprazole level— St. John's wort Drug/Food Decrease: vitamin B12 absorption if omeprazole is used long term Drug/Lab Test Increase: alk phos, AST, ALT, bilirubin, gastrin Decrease: vitamin B12, sodium, glucose
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DOSAGE AND ROUTES Adult: PO 2 or 4 g daily (oh-mep′ray-zole) Losec , Olex , PriLOSEC, PriLOSEC OTC DOSAGE AND ROUTES Active duodenal ulcers • Adult: PO 20 mg/day × 4-8 wk GERD without esophageal lesions • Adult: PO (del rel cap/del rel susp) 20 mg/day × 4-8 wk • Child 1-16 yr, ≥20 kg: PO 20 mg daily × 4 wk Child 1-16 yr, 10-20 kg: PO 10 mg daily × 4 wk Pathologic hypersecretory conditions (Zollinger-Ellison syndrome) • Adult: PO 60 mg/day; may increase to 120 mg tid; daily doses >80 mg should be divided Gastric ulcer • Adult: PO 40 mg/day 4-8 wk Heartburn (OTC) • Adult: PO 1 del rel tab (20 mg)/day be- fore AM meal with glass of water × 14 days H. pylori infection, duodenal ulcer disease • Adult: PO 40 mg every AM with clar- ithromycin 500 mg tid × 14 days
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Available forms: Del rel caps 10, 20, 40 mg; del rel tabs 20 mg; granules for oral susp 2.5, 10 mg (del rel)
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Administer: • Capsules and tablets are not bioequiva- lent • Swallow caps whole; do not crush or chew; caps may be opened and sprinkled over applesauce • Before eating, usually in the AM, sepa- rate with other medications • Oral susp powder: give on empty stom- ach ≥1 hr before food; if there is NG or O enteral feeding tube, do not feed 3 hr be- fore or 1 hr after giving product: contents of packet should be mixed with 1-2 tbsp wa- ter; add 20 mL water for NG tube; for oral, stir well, drink, add more water, and drink
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Assess: • GI system: bowel sounds, abdomen for pain, swelling, anorexia, blood in stools, diarrhea, emesis • Clostridium difficile–associated diarrhea (CDAD): assess for fever, abdominal pain, bloody stool; may occur up to several weeks after conclusion of therapy; report to the prescriber immediately • Electrolyte imbalances: hyponatremia; hypomagnesemia in patients using prod- uct 3 mo-1 yr; if hypomagnesemia occurs, use of magnesium supplements may be sufficient; if severe, discontinue product • Vitamin B12: Assess vitamin B12 level if on long-term treatment; dyspnea, weak- ness, anorexia, palpitations may occur if vitamin B12 is low • Hepatic enzymes: AST, ALT, alkaline phosphatase during treatment; blood studies: CBC, differential during treatment, blood dyscrasias may occur; vitamin B12 in long-term treatment, serum magnesium • Fractures: use over 1 yr has been as- sociated with fractures • Beers: avoid scheduled use >8 wk in patients with hypersecretory condition, esophagitis, risk of Clostridium diffi- cile, and fractures • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excreted in breast milk
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Evaluate: • Therapeutic response: absence of epi- gastric pain, swelling, fullness, bleeding; decreased GERD, esophagitis symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report severe diarrhea; black, tarry stools; abdominal cramps/pain; or continu- ing headache; product may have to be dis- continued • That, if diabetic, hypoglycemia may occur • To avoid hazardous activities because dizziness may occur • To avoid alcohol, salicylates, NSAIDs; may cause GI irritation • To take as directed, even if feeling bet- ter; to take missed dose as soon as re- membered; not to double; PriLOSEC OTC takes up to 4 days for full effect • Not to use OTC, prescription, or herbal products without prescriber’s consent • To take as directed at lowest dose pos- sible for shortest time needed • To report if pregnancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS Bioavailability 30%-40%; peak 1⁄2-31⁄2 hr; half-life 1⁄2-1 hr; protein binding 95%; eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased, bioavailability increased; metabolized by CYP2C19 enzyme system; some Asian, black, and Caucasian patients are poor metabolizers
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• Adult: PO 20 mg/day × 4-8 wk GERD without esophageal lesions
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• Adult: PO (del rel cap/del rel susp) 20 mg/day × 4-8 wk
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• Child 1-16 yr, ≥20 kg: PO 20 mg daily × 4 wk Child 1-16 yr, 10-20 kg: PO 10 mg daily × 4 wk Pathologic hypersecretory conditions (Zollinger-Ellison syndrome)
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• Adult: PO 60 mg/day; may increase to 120 mg tid; daily doses >80 mg should be divided Gastric ulcer
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• Adult: PO 40 mg/day 4-8 wk Heartburn (OTC)
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• Adult: PO 1 del rel tab (20 mg)/day be- fore AM meal with glass of water × 14 days H. pylori infection, duodenal ulcer disease
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• Adult: PO 40 mg every AM with clar- ithromycin 500 mg tid × 14 days
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