Prilosec dosage, forms, and strengths

Prilosec (active ingredient: omeprazole) is a brand-name stomach acid reducer available by prescription and over the counter. Omeprazole, the active ingredient in Prilosec, is a proton pump inhibitor that blocks the stomach’s acid production.

Prescription Prilosec is FDA approved to treat heartburn and other symptoms of gastroesophageal reflux disease (GERD), erosive esophagitis, active duodenal and stomach ulcers, Helicobacter pylori (H. pylori) infections of the stomach, and medical conditions that cause the stomach to secrete an excess amount of acid. Prilosec may also be used off-label to prevent gastric ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin. 

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Prilosec dosage forms and strengths

Prescription-strength Prilosec is taken as a delayed-release capsule or oral suspension.

• Delayed-release capsules: 10 milligrams (mg), 20 mg, 40 mg

• Delayed-release powder packets for oral suspension: 2.5 mg, 10 mg

Prilosec OTC is used to treat frequent heartburn. It exists as a delayed-release tablet containing 20.6 mg of omeprazole magnesium (equivalent to 20 mg omeprazole).

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Prilosec dosage for adults

Prilosec dosing will depend on the condition being treated. Most conditions can be treated with 20 to 40 mg of prescription-strength Prilosec once a day, but hypersecretory conditions (like GERD) may require a higher dose.

• Standard Prilosec dosage for adults: 20-40 mg once a day for up to eight weeks 

• Maximum Prilosec dosage for adults: 120 mg three times a day for some patients with hypersecretory conditions

Prilosec dosage for children

Prescription Prilosec is approved to treat children 1 month or older with GERD or to maintain healing from erosive esophagitis. A doctor will prescribe a dose based on both age and weight. Note: Prilosec OTC is only approved for adults 18 years of age and older.

Symptomatic GERD

To treat heartburn and other symptoms caused by GERD, Prilosec is typically prescribed as a daily dose for four weeks. Treatment could be extended to as long as eight weeks. Although the manufacturer recommends a limit of eight weeks, it is not unusual for doctors to prescribe Prilosec long-term to patients with GERD.

• Standard Prilosec dosage for adults: 20 mg taken once a day for four weeks

• Maximum Prilosec dosage for adults: 20 mg taken once a day for eight weeks

• Standard Prilosec dosage for children 1-16: 5-20 mg (depending on weight) taken once a day for four weeks

• Maximum Prilosec dosage for children 1-16: 5-20 mg (depending on weight) taken once a day for eight weeks

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

Maintenance of healing of erosive esophagitis

Erosive esophagitis is damage to the lining of the esophagus often due to stomach acid backing up into the esophagus. Reducing stomach acid helps maintain the healing of the esophagus. There is no time limit on Prilosec therapy for erosive esophagitis, but the use of Prilosec for longer than 12 months has not been studied. 

• Standard Prilosec dosage for adults: 20 mg taken once a day for four to 12 weeks

• Maximum Prilosec dosage for adults: Not specified

• Standard Prilosec dosage for children 1 mo-16 yrs: 2.5-20 mg (depending on weight) taken once a day for four weeks

• Maximum Prilosec dosage for children 1 mo-16 yrs: 2.5-20 mg (depending on weight) taken once a day for eight weeks

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Dosage reduction to 10 mg once daily is recommended for patients with hepatic impairment (Child-Pugh Class A, B, or C).

• Asian population: Dosage reduction to 10 mg once daily is recommended for Asian patients. They have approximately a four-fold higher exposure than caucasians. 

Gastric ulcers

Prilosec is approved as a short-term treatment for active benign gastric ulcers. Treatment usually takes about four weeks but may be extended to eight weeks if necessary.

• Standard Prilosec dosage for adults: 40 mg taken once a day for four weeks

• Maximum Prilosec dosage for adults: 40 mg taken once a day for eight weeks

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

Gastric ulcer prevention

Prilosec may be used off-label to prevent gastric ulcers in patients taking NSAIDs.

• Standard Prilosec dosage for adults: 20-40 mg taken once per day

• Maximum Prilosec dosage for adults: Not specified

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

Duodenal ulcers

Prilosec is approved as a short-term (four to eight weeks) treatment for active duodenal ulcers.

• Standard Prilosec dosage for adults: 20 mg taken once a day for four to eight weeks

• Maximum Prilosec dosage for adults: 20 mg taken once a day for eight weeks

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

H. pylori eradication

Helicobacter pylori is a bacterial infection of the stomach lining that commonly causes gastritis and stomach ulcers. Prilosec is approved as part of a H. pylori eradication therapy in patients with duodenal ulcer disease. Combined with the antibiotic clarithromycin (14-day dual therapy) or a combination of clarithromycin and amoxicillin (10-day triple therapy), Prilosec helps to prevent duodenal ulcers as the antibiotics clear the H. pylori infection.

• Standard Prilosec dosage for adults: 20 mg twice a day for 10 days (triple therapy) or 40 mg once a day for 14 days (dual therapy) or 20-40 mg twice a day (sequential 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

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

Pathological hypersecretory conditions

Hypersecretory conditions such as Zollinger-Ellison syndrome cause the stomach to secrete excess amounts of stomach acid. For hypersecretory conditions, there is no maximum Prilosec dose or time limit. Some patients with Zollinger-Ellison syndrome have taken Prilosec continuously for more than five years.

• Standard Prilosec dosage for adults: 60 mg once a day to 120 mg taken three times per day

• Maximum Prilosec dosage for adults: Not specified

• Renally impaired patients (kidney disease): No adjustment

• Hepatically impaired patients (liver disease): Not specified

Prilosec dosage for pets

Omeprazole, the active ingredient in Prilosec and Prilosec OTC, is approved for use in animals. As with human patients, dogs are prescribed omeprazole to treat ulcers, erosive esophagitis, H. pylori infection, or to prevent ulcers when taking erosive medications such as NSAIDs. Cats, horses, and pigs are often prescribed omeprazole for ulcers, but veterinarians may use omeprazole for other conditions as well. A veterinarian will prescribe generic omeprazole either as a capsule (10 mg, 20 mg, 40 mg) or oral paste (2 mg/mL). The dose prescribed will either be fixed or determined by the animal’s weight. 

How to take Prilosec

Prescription Prilosec is taken as a capsule or as an oral suspension mixed from a powder packet. Refer to your medication guide or consult a healthcare professional for instructions on how to take Prilosec. To get the most benefit from Prilosec, remember a few tips when taking this medication:

• Always take Prilosec before a meal, often breakfast.

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

• Take the medicine for the number of days prescribed even if you begin to feel better. 

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

• Don’t let Prilosec oral suspension packets get too cold or too warm; the packets should be stored at more narrow room temperatures of 68-77 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.

Prilosec capsules

• Swallow the capsule whole with a glass of water. 

• Do not crush or chew the capsule.

• If you cannot swallow the capsule:

  • Carefully open the capsule and sprinkle the pellets onto a tablespoon of applesauce or yogurt. 

  • Mix the pellets with the applesauce and immediately swallow the mixture without chewing. 

  • Then drink a full glass of water to make sure the whole dose is swallowed.

  • Do not store the applesauce/yogurt mixture for later use.

Prilosec oral suspension powder packet

• Prilosec suspension comes in packets of 2.5 mg and 10 mg.

• Use only water to mix the medicine. Do not use other liquids or food. 

• Use an oral syringe to measure the water. A pharmacist can supply a metered medicine syringe free of charge.

• To prepare and take Prilosec oral suspension:

  • For a 2.5 mg packet, draw up 5 mL of water with the oral syringe and put it in a clean container. 

  • For a 10 mg packet, draw up 15 mL of water with the oral syringe and put it in a clean container.

  • If using more than one packet per dose, the pharmacist will provide instructions on how much water to use.

  • Empty the contents of the packet into the water.

  • Stir gently.

  • Let the mixture thicken for two to three minutes.

  • Stir again.

  • Drink the medicine within 30 minutes. If not used within 30 minutes, dispose of the medicine safely and mix another packet.

  • If any medicine remains, add more water, stir, and drink immediately.

Feeding tube administration

• Use only a catheter-tipped syringe to administer Prilosec suspension through a nasogastric or gastric tube.

• To prepare and administer Prilosec oral suspension through a gastric or nasogastric tube:

  • For a 2.5 mg packet, add 5 mL of water to the catheter-tipped syringe.

  • For a 10 mg packet, add 15 mL of water to the catheter-tipped syringe.

  • Add the contents of the packet to the syringe.

  • Immediately shake the syringe.

  • Let the mixture thicken for two to three minutes.

  • Shake the syringe again.

  • Inject the mixture into the gastric tube or nasogastric tube within 30 minutes of mixing the packet with the water.

  • Refill the syringe with the same amount of water (5 mL or 15 mL) used to prepare the dose.

  • Immediately shake the syringe.

  • Inject the contents of the syringe into the gastric tube or nasogastric tube within 30 minutes from the time the syringe was refilled. 

Prilosec dosage FAQs

How long does it take Prilosec to work?

After swallowing, Prilosec starts working within one hour, with the maximum effect occurring within two hours. Depending on the medical condition being treated, omeprazole therapy may last anywhere from 10 days to eight weeks although some people take Prilosec long-term for several years.

How long does Prilosec stay in your system?

Omeprazole is rapidly cleared from the body. With a short half-life of 30 minutes to one hour depending on the patient’s age, omeprazole falls to undetectable levels in the bloodstream in about three to four hours. However, delayed-release formulations such as Prilosec take longer to clear from the body, so Prilosec achieves peak concentrations in about one to three hours. 

Although the body clears omeprazole rapidly, its effects on stomach acidity last considerably longer. Stomach acid is significantly lowered for about three days after a dose, and it can take three to five days for stomach acid to fully return to normal.

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?

If used following the manufacturer’s recommendations, Prilosec can be safely stopped at any time without causing problems or withdrawal symptoms. Most people take Prilosec on a strict, short-term timeline. Take Prilosec daily throughout that period and talk to a healthcare provider if problems persist beyond that treatment period.

People who take proton-pump inhibitors over the long-term, however, may experience rebound heartburn when they stop taking the drug. Talk to a healthcare professional about lifestyle changes coupled with a steadily tapering dose of Prilosec to discontinue chronic use of Prilosec. 

Prilosec may not be the right medicine to take if stomach acid problems have lasted for more than three months or are accompanied by:

• Chest pain

• Shoulder pain

• Stomach pain

• Lightheadedness

• Unexplained weight loss

• Nausea or vomiting

If Prilosec is started, discontinue the drug and seek medical help if:

• Heartburn or stomach acid problems worsen

• Diarrhea occurs while taking the drug

• Prilosec does not improve symptoms or the medical condition

• Signs of an allergic or hypersensitivity reaction appear

RELATED: Omeprazole side effects

What can be used instead of Prilosec?

If you can’t take Prilosec, other proton-pump inhibitors (PPIs) that reduce stomach acid include Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Aciphex (rabeprazole). PPIs work in ways very similar to Prilosec, so if there are problems with Prilosec, chances are these other PPIs will also cause problems.

Other alternatives to reducing stomach acid are prescription or over-the-counter histamine-2 blockers. These drugs—Pepcid AC (famotidine), Tagamet (cimetidine), and Axid AR (nizatidine)—also reduce stomach acidity but through a different chemical mechanism.

Finally, antacids and dietary and lifestyle changes may be a sustainable treatment for stomach acid problems or GERD. Some foods, such as coffee and sodas, will need to be discontinued. Other dietary changes may vary from person to person.

RELATED: How to treat heartburn and GERD

What is the maximum dosage for Prilosec?

The manufacturer has not specified a maximum dosage for Prilosec but recommends that the drug not be taken for longer than the prescribed period to avoid chronic or long-term use. 

Long-term use of proton-pump inhibitors can change the pH in the gut. This leads to the growth of microorganisms and increases the risk of GI infections including Clostridium difficile infection and possibly pneumonia. Chronic use also produces low levels of calcium in the blood, ultimately leading to osteoporosis and related bone fractures. Chronic users should ensure adequate calcium and vitamin D intake. Other problems associated with chronic use of Prilosec include vitamin B-12 or magnesium deficiency, fundic gland polyps, and kidney problems. A doctor should be consulted if the drug needs to be continued for longer than eight weeks. There may be other alternatives.

What interacts with Prilosec?

Take Prilosec before meals. The manufacturer does not specify how long before a meal Prilosec should be taken, but standard practice is to take omeprazole 30 to 60 minutes before a meal. Specific foods will not delay the body’s absorption of omeprazole.

Omeprazole does have significant drug interactions. A healthcare provider may hold off combining Prilosec with prescription drugs such as

• Blood-thinning drugs (anticoagulants): Warfarin, Plavix (clopidogrel), or Pletal (cilostazol)—there is an increased risk of bleeding or clotting problems when these drugs are taken with omeprazole.

• Anticancer drugs: Methotrexate, tacrolimus, or mycophenolate mofetil— omeprazole increases the toxicity and side effects of these drugs.

• Diazepam or digoxin—omeprazole increases the toxicity of these drugs.

• ADHD medications: Methylphenidate, dextroamphetamine, or dexmethylphenidate—taking omeprazole with these medications increases their absorption and side effects.

• Antifungal drugs: Ketoconazole, itraconazole, or voriconazole—taking omeprazole with these drugs decreases their effectiveness.

• HIV drugs: Rilpivirine, atazanavir, or nelfinavir are less effective when taken with omeprazole. Omeprazole significantly decreases the amount that gets into the system which can result in treatment failure.

• Antibiotics: Rifampin, rifaximin, rifamycin, or rifapentine decrease the effectiveness of omeprazole.

• Antiepileptic drugs: Phenytoin and fosphenytoin—omeprazole increases the toxicity of these drugs.

• St. John's wort

Resources:

• Prilosec

• Prilosec OTC

• Gastric hypersecretory states: Investigation and management

• Prilosec instructions for use

• Prilosec medication guide

• Prilosec prescribing information

• Are you stuck on heartburn medications?

• Omeprazole

• Omeprazole pharmacokinetics and metabolism in man

• Proton pump inhibitors and fracture risk

• ACG Clinical Guideline: Treatment of Helicobacter pylori Infection