CLINICAL USE

Gastric acid suppression

DOSE IN NORMAL RENAL FUNCTION

Oral: 10–120 mg daily IV: 40 mg once daily for up to 5 days Patients with recent bleeding on endoscopy: 80 mg stat followed by 8 mg/hour for 72 hours (British Society of Gastroenterology)

PHARMACOKINETICS

  • Molecular weight                           :345.4
  • %Protein binding                           :95
  • %Excreted unchanged in urine     : Minimal
  • Volume of distribution (L/kg)       :0.3
  • half-life – normal/ESRD (hrs)      :0.5–3/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Dose as in normal renal function
  • HD                     :Not dialysed. Dose as in normal renal function
  • HDF/high flux   :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD      :Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anticoagulants: effect of coumarins possibly enhanced
  • Anti-epileptics: effects of phenytoin possibly enhanced
  • Antivirals: reduced atazanavir concentration – avoid concomitant use; AUC of saquinavir increased by 82% (increased risk of toxicity)
  • Ciclosporin: variable response; mostly increase in ciclosporin levelCilostazol: increased cilostazol concentration – avoid concomitant use
  • Tacrolimus: may increase tacrolimus concentration

    ADMINISTRATION

    Reconstition

    5 mL solvent provided per 40 mg vial

    Route

    Oral, IV

    Rate of Administration

    Bolus: over 5 minutes Infusion: 40 mg over 20–30 minutes Continuous infusion: 8 mg/hour

    Comments

    Add to 100 mL sodium chloride 0.9% or glucose 5%Once diluted stable for 12 hours in sodium chloride 0.9% and 3 hours in glucose 5%Use oral as soon as possible 200 mg in 50 mL for 8 mg/hour infusion. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)

    OTHER INFORMATION

    Omeprazole clearance is not limited by renal disease.

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