Prilosec OTC dosage, forms, and strengths

Prilosec OTC is a brand-name nonprescription medication that reduces stomach acid for people experiencing frequent heartburn. Omeprazole, the active ingredient, is a proton-pump inhibitor (PPI) that blocks the stomach lining’s ability to secrete acid into the stomach. Prilosec OTC is taken as a delayed-release tablet before meals. The treatment schedule consists of taking one tablet daily for 14 days. After this treatment course, Prilosec OTC should not be taken again for another four months to avoid overuse, unless instructed otherwise by your doctor. Your doctor may also prescribe Prilosec for gastric or duodenal ulcers, hypersecretory conditions, or ulcer prophylaxis in someone regularly taking NSAIDs.

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Prilosec dosage, forms, and strengths

Each delayed-release tablet contains 20.6 milligrams (mg) of omeprazole magnesium, the equivalent of 20 mg of omeprazole. Each package of Prilosec OTC contains 14 tablets.

Prilosec is also available as a prescription drug. Prescription Prilosec is sold as a delayed-release capsule (10 mg, 20 mg, or 40 mg) or powder packets for oral suspension (2.5 mg or 10 mg).

Prilosec dosage for adults

Prilosec OTC is an FDA-approved treatment for frequent heartburn as a single daily dose for no longer than 14 days.

• Standard Prilosec dosage for adults: 20 mg once a day for 14 days. 

• Maximum Prilosec dosage for adults: 20 mg once a day for 14 days—no more than one 14-day treatment cycle every four months.

Prilosec dosage for children

Prilosec OTC is approved for adults 18 years of age and older. However, a doctor may prescribe Prilosec or generic omeprazole to children as young as 1 year old to treat symptomatic GERD (gastroesophageal reflux disease) or to maintain healing after treatment of erosive esophagitis.

Prilosec OTC dosage for heartburn

Prilosec OTC is used to treat frequent heartburn that occurs two or more days a week. Prilosec OTC is not a fast relief medication and it is not the best type of medication to treat active heartburn. Instead, it reduces the likelihood of heartburn over time.

• Standard Prilosec OTC dosage for adults: 20 mg taken once a day for 14 days.

• Maximum Prilosec OTC dosage for adults: 20 mg daily for no longer than 14 days; no more than one 14-day treatment cycle every four months.

• Renally impaired patients (kidney disease): No adjustment.

• Hepatically impaired patients (liver disease): Not specified.

Prilosec dosage for H. pylori eradication

Helicobacter pylori (H. pylori) is a bacterial infection of the stomach lining that commonly causes gastritis and stomach ulcers. Prilosec is approved as part of an H. pylori eradication therapy in patients with duodenal ulcer disease. Combined with the antibiotics clarithromycin and amoxicillin (10-day triple therapy), Prilosec helps to prevent gastric and duodenal ulcers as the antibiotics eradicate the H. pylori infection. Because it is sold in packages of 14, 20 mg tablets, Prilosec OTC is sometimes used off-label instead of prescription Prilosec for 10-day triple therapy or 14-day double therapy. A follow-up 14- or 18-day course of Prilosec OTC may be necessary if an active ulcer is present during initial therapy.

• Maximum Prilosec dosage for adults: Not specified, but an additional 20 mg per day for 14-18 days may be necessary if an active ulcer is present. Maximum treatment schedule is 28 days of daily Prilosec OTC.

• Standard Prilosec dosage for adults: 20 mg twice a day for 10-14 days.

• Renally impaired patients (kidney disease): No adjustment.

• Hepatically impaired patients (liver disease): Not specified.

Prilosec OTC dosage for pets

Never give human medicines to animals unless instructed by a veterinarian. Even if the drug is used in both animals and humans, animal versions of the drug are sometimes better formulated for that animal’s digestive system and metabolism. 

Omeprazole, the active ingredient in Prilosec OTC, is approved for use in veterinary practice. In dogs, it is used to treat gastric ulcers, duodenal ulcers, erosive esophagitis, H. pylori infection, Zollinger-Ellison syndrome (gastrinoma), and to prevent ulcers when dogs are given ulcer-causing medications such as NSAIDs. Cats, horses, pigs, and other animals are also given omeprazole for stomach or duodenal ulcers.

Most veterinarians will base the dose on the animal’s weight, but some vets will prescribe a fixed dose similar to a human prescription. Each daily dose is given to the animal as an oral paste, tablet, or capsule once a day for a limited time, usually four weeks but up to 90 days for horses. 

How to take Prilosec OTC

Prilosec OTC is taken as a tablet. To get the most benefit from Prilosec OTC, remember a few tips when taking this medication:

• Always take Prilosec OTC before meals.

• Your doctor will tell you what time of day to take the daily dose.

• Take one tablet daily before eating in the morning.

• Swallow the tablet whole with a glass of water. 

• Do not crush or chew the tablet.

• Take one tablet every day for 14 days. Take the medicine for the full 14 days even if you begin to feel better. 

• Do not use Prilosec OTC for more than 14 days.

• You can repeat the 14-day treatment every f months unless instructed otherwise by a doctor.

• This medicine should come with instructions and warnings. Please read these before taking Prilosec OTC.

• Store Prilosec tablets at room temperature (59-86 degrees Fahrenheit).

• Set an alarm to go off at the scheduled dosing time every day so that you don’t miss a dose.

• To help with heartburn, antacids may be taken with Prilosec OTC.

Prilosec dosage FAQs

How long does it take Prilosec to work?

It will take one to four days to begin noticing the effects of Prilosec, although some people may notice a benefit after the first dose. Take the medication for the full 14 days to realize the greatest benefit.

How long does Prilosec stay in your system?

Omeprazole has a half-life of 30 minutes to one hour and completely clears from the body in three to four hours. Delayed-release formulations usually reach peak effectiveness in two hours. The decrease in the amount of acid in the stomach, however, lasts longer. Omeprazole typically inhibits stomach acid for around 72 hours. Normal stomach acid secretion does not return to normal until three to five days after Prilosec OTC has been discontinued.

What happens if I miss a dose of Prilosec?

Take the missed dose as soon as you remember. If it is almost time for your next dose, do not take the missed dose. Wait until the next scheduled dose and take it on time. Do not take extra medicine to make up for a missed dose.

How do I stop taking Prilosec?

Prilosec OTC can be safely stopped after 14 days without causing problems or withdrawal symptoms.

It is not recommended to take Prilosec OTC or any similar drug long term unless prescribed by your physician or provider. Discontinuing Prilosec OTC after long-term, chronic use may cause rebound heartburn that may be worse than the original problem. If Prilosec OTC is being used more frequently than the recommended 14-day treatment every four months, talk to a doctor, pharmacist, or other healthcare professional about how to discontinue the medication.

Prilosec OTC may not be the appropriate medication if frequent heartburn has lasted for more than three months or is accompanied by the following symptoms:

• Chest pain

• Stomach pain

• Lightheadedness

• Unexplained weight loss

• Nausea or vomiting

• Black stool

• Food getting stuck when you swallow

These are all indications of a potentially more serious health problem, so talk to a doctor before treating heartburn with Prilosec OTC or any other over-the-counter medication.

When taking Prilosec OTC on the 14-day schedule, discontinue the medication and seek professional medical advice if:

• Heartburn or stomach acid problems worsen

• Diarrhea occurs while taking the drug

• Joint pain begins to develop

• The 14-day treatment did not reduce the incidence of heartburn

• Signs of an allergic or hypersensitivity reaction appear such as a rash, trouble breathing, or blisters

What can be used instead of Prilosec?

Prilosec OTC isn’t the only solution for frequent heartburn nor is it always the appropriate medication. Other stomach acid reducers, antacids, dietary changes, and lifestyle changes may be the right way to go for patients who cannot take Prilosec OTC or who have mild, occasional heartburn. 

Stomach acid reducers are divided into two types: proton pump inhibitors (PPIs), like Prilosec OTC, and H2 histamine blockers. PPIs such as Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Aciphex (rabeprazole) work pretty much the same way as Prilosec OTC. H2 histamine blockers work differently, and so they are not quite as potent as the PPIs in reducing stomach acid. These drugs include Tagamet (cimetidine), Pepcid AC (famotidine), and Axid AR. Zantac (ranitidine) is also in this category, but was recently taken off the market.

Antacids work by neutralizing the acid produced by the stomach. Tums (calcium carbonate), Milk of Magnesia (magnesium hydroxide), and Pepto-Bismol (bismuth subsalicylate) are all over-the-counter antacids that work quickly to relieve mild heartburn symptoms.

Finally, dietary and lifestyle changes are a proven sustainable treatment for heartburn or GERD. There is no universal diet for heartburn or GERD. Rather, dietary changes required to control heartburn will vary from person to person. It is generally recommended to eat small, frequent meals, avoid eating late at night, and avoid foods that have caused heartburn in the past (common culprits include spicy foods, chocolate, pasta sauce, onions, peppermint). A healthcare professional can help design an appropriate elimination diet.

RELATED: Treating heartburn and GERD

What is the maximum dosage for Prilosec?

The manufacturer has set a maximum dosage for Prilosec OTC, which is to be taken as a daily 20 mg dose for 14 days. Only one 14-day treatment cycle is recommended every four months.

Long-term use of Prilosec OTC and the other PPIs have been associated in some studies with various health problems such as:

• Bone fracture: Prilosec OTC  may reduce calcium in the bloodstream leading to osteoporosis (bone loss) and an increased risk of bone fracture.

• Clostridium difficile infection: Prilosec OTC  may raise the risk of a potentially hazardous C. difficile infection of the large intestine, a condition marked by severe diarrhea and fever.

• Gastritis: Overuse of Prilosec OTC can result in chronic swelling and irritation of the stomach lining.

• Low magnesium: Over time, Prilosec OTC can lower magnesium in the body, causing tremors, weakness, or heart problems.

• Low vitamin B-12 levels 

• Fundic gastric polyps on the stomach lining

It should be noted that the PPIs have not been conclusively shown in well designed studies to cause these health problems, but these problems may be associated with their use. Consult a doctor or other healthcare professional if Prilosec OTC doesn’t help with heartburn. There may be more suitable alternatives.

What interacts with Prilosec?

Foods do not interfere with the absorption of Prilosec OTC; however, the medicine should be taken 30 to 60 minutes prior to a meal for it to be the most effective.  

Prilosec OTC (Omeprazole) may have significant drug interactions:

• Blood thinners: Prilosec OTC raises the risk of bleeding problems when taken with certain blood-thinning drugs such as warfarin, Plavix (clopidogrel), or Pletal (cilostazol).

• Cancer drugs: Prilosec OTC raises the toxicity or risk of side effects of certain anticancer drugs (methotrexate, tacrolimus, or mycophenolate mofetil), ADHD medications (methylphenidate, dexmethylphenidate, or dextroamphetamine), benzodiazepine sedatives (diazepam), or digoxin.

• HIV medications: Prilosec OTC may reduce the effectiveness of HIV medications (rilpivirine, atazanavir, or nelfinavir).

• Antifungal drugs: Prilosec OTC may reduce the effectiveness of antifungal medications (itraconazole, ketoconazole, and fluconazole).

• Others: Some drugs reduce the effectiveness of Prilosec OTC including some antibiotics (rifampin, rifamycin, rifaximin, or rifapentine), certain types of anticonvulsants (phenytoin, fosphenytoin, or carbamazepine), and St. John’s wort.

If you are taking any of these drugs, talk to a doctor before taking Prilosec OTC. 

Resources:

• Prilosec OTC

• Prilosec OTC dosing

• Omeprazole

• Prilosec OTC label

• Omeprazole compound summary

• Prescribing information of Prilosec

• The role of diet in the development and management of GERD