Wonder Drug? I Wonder: Prilosec (Omeprazole)

Approved by the FDA in 1989, Prilosec (generic name: omeprazole) is one of several protein pump inhibitors, which are medications that decrease the amount of acid in the stomach. (Other protein pump inhibtors are Prevacid, Aciptex (rabeprazole,) Protonix (pantoprazole), and Nexium (esomeprazole.) PPI's are used to treat a multitude of gastrointestinal ills, including GERD (gastroesophageal reflux disease), inflammation caused by acids, erosive esophagitis, ulcers, and heartburn. They also can be used in conjunction with antibiotics to treat ulcers that were caused by hpylori infection.

My introduction to Prilosec (omeprazole) came about six years ago, when I visted our local hospital’s emergency room with chest pains that turned out to be symptoms of the gastritis/GERD/heartburn with which I’d suffered for years. (I treated my gastritis with Tagamet (cimetidine) for about about twenty years but had stopped taking it when I learned that it could cause depression.... but that’s another story. Since then, I hadn’t used anything other than antacids until I ended up in that emergency room and found myself with a prescription for omeprazole.) Because of my experience with Tagamet, I researched the possible side effects of Prilosec immediately and learned that the most common, non-life-threatening side effects are headache, dizziness, gas, stomach pain, nausea, vomiting, and diarrhea. (No mention of depression, though I wasn’t thrilled at the prospect of the impact that the gas, dizziness, and stomach pain might have on the IBS with which I’d suffered since childhood. At that point, though, my GERD had become more than “a nuisance” and needed to be treated more aggressively.) I also learned the signs of a serious allergic reaction to Prilosec: swellig of the face, lips, throat or tongue; hives; difficulty breathing; excitedness; hoarseness; muscle spasms; shaking; dizziness, irregular , pounding or fast heartbeat, water retention, leg cramps, weakness, feeling extremely tired, sore throat with fever, blood i the urine, mouth sores, urinary infection, and unexplained bruising or bleeding. (Scary, to be sure, but these are the signs of an allergic reaction to many medications and call for an immediate contact with your doctor and/or reporting to the nearest emergency room.) It’s also important to inform your doctor of any history you might have of heart or liver disease or low levels of magnesium. You must not take Prilosec if you are allergic to any benzimidazole drug, such as Vermox (mebenzadole) or Albenza (alberdazola). It’s also important to know that omeprazole can increase the concentration in the blood of Warfarin (coumadin), Valium (diazepan) and Dilantin (phenytonin) because it makes it more difficult for the liver to eliminate these medications.

Prilosec is not a “quick fix” for heartburn. If taken regularly over a period of time, however, the heartburn should be alleviated. (Also, I was surprised to read that over-the-counter Prilosec should be taken once a day for fourteen days, and that, if another 14-day treatment option is needed, at least four months should pass before another fourteen-day regimen is begun. I’ve never taken OTC Prilosec, however, so I can’t vouch for that advice.) The prescription capsules that I take, come in 10, 20, and 40 mg doses. 20-40 mg daily is the recommended dosage for treating GERD. I have not heard or read about any “fourteen days on, four months off” warnings for the prescription-strength Prilosec, although I have read that taken in large doses for a long period of time, Prilosec could increase the risk of osteoporosis-related fractures of the spine, wrist, and/or hip and could weaken the lining of the stomach. A few more things to consider before you take Prilosec(omeprazole:)

. IPrilosec reduces the absorption and concentration in the blood of Nizoral (ketoconazole).

. It increases the absorption and concentration of Lanoxin (digoxin).

. It might increase blood levels of sequinavis and reduce levels of the HIV drugs nelfinavi and atazanavir.

. If you take Pletal (cilostazol), the dose probably will have to be reduced if you need

to take Prilosec.

. Prilosec is excreted in breast milk.

.If you take Plavix (clopidogrel) DO NOT USE PRILOSEC.

. When taken for Zollinger- Ellison syndrome, Prilosec usually is prescribed in doses hgher than the standard 10,20, or 40 mg. The dosage is then adjusted as the effects of the omeprazole are noted.

A couple of years ago I was asked as a colon cancer survivor to participate in a study on colorectal cancer. During the course of my interview, I was surprised that the only one of the drugs I had been taking prior to the cancer (fosinopril, metoprolol, nortriptylene, etc.) in which the people conducting the study seemed to be interested was Prilosec (omeprazole. ) This disburbed me to the point that I decided to try to wean myself off the Prilosec. I had weaned myself to one 20 mg capsule every third day (it is unwise to do this without consulting a physician), when I read an article which mentioned that some studies have shown that Prilosec might inhibit colorectal cancer. Needless to say, I felt quite relieved. (My GERD was relieved, too, when I resumed the 20 mg daily dose.)

A few months ago, however, my surgeon discovered during the course of an endoscopy that a I had two gastric polyps, which he attributed to Prilosec. He hastened to add that it was nothing be be concerned about; he had found six or seven such polyps in other patients.However, I was concerned, and proceeded to do more research on the medication. Sure enough.... it has been shown that long-term use of 20-40mg Prilosec daily can cause gastric polyps which, allegedly, are not malignant. When I mentioned the polyps to my family doctor, she seemed surprised and suggested that I use the Prilosec “as needed.” For me, “as needed” has meant 20 mg daily. Rest assured that I plan to keep a close eye on the Prilosec- polyp situation. This certainly validates the need to stay abreast of all current information on every medication you take.

If you take Prilosec, I’m sure you know that the capsules should not be chewed or crushed, although they can be opened and the contents sprinkled on applesauce. (I don’t know why anyone would need to do that, though. The capsules are tasteless and easy to swallow with water.) Also, despite the fact that a few web sites claim that Prilosec may be taken with or without food, my doctor told me that they should be taken at least a half hour before eating. You may take antacids while you're taking this medication, as long as they are not taken at the same time and the dosages are spaced accordingly.

The most important thing to remember when you’re on any medication, of course, is to stay current on research involving the drug and to be aware of side effects, particularly those that must be reported to a doctor. Also, it is exremely important to know how your medications interact with one another. I have found a pharmacist to be extremely helpful with this. In fact, as soon as I’m prescribed a new medication, I immediately research the medication and question my pharmacist as to drug interactions and/ or side effects. Don’t just assume that Doctor Knows Best, and don't think that because a medication has "been around for a long time," all the glitches have been worked out. In other words, your best advocate is you.