Omeprazole
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Proton pump inhibitors (PPIs) such as omeprazole and esomeprazole are commonly used to treat acid reflux, heartburn and other conditions linked to stomach acid. Some medicines, foods and lifestyle factors can affect your symptoms or how your treatment works. This guide explains what PPIs are, when to take them, whether they should be taken with food, what to know about alcohol and coffee, and which medicines may interact with them. This is general guidance, so always follow the instructions for your specific medicine and any advice from your prescriber.
What Is a PPI Medication and How Does It Affect Stomach Acid Production?
A proton pump inhibitor, or PPI, is a medicine that reduces the amount of acid your stomach produces. It does this by blocking an enzyme called the hydrogen potassium ATPase, also known as the proton pump, in the cells lining your stomach.
PPIs used in the UK include omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole. By reducing the activity of the proton pumps, these medicines reduce stomach acid production.
For adults with acid reflux, GORD or other acid related conditions, PPIs can help control symptoms and allow irritation caused by stomach acid to heal. They are also used to treat stomach ulcers and, alongside antibiotics, as part of treatment for Helicobacter pylori, also known as H. pylori.
PPIs do not usually provide the same quick relief as an antacid or alginate. NICE recommends a full dose PPI for adults with GORD for 4 or 8 weeks, depending on the clinical situation.
When Is the Best Time to Take a PPI?
The best time to take a PPI depends on the medicine and formulation you have been prescribed or bought.
It is important not to assume that every PPI needs to be taken in exactly the same way. For example, NHS guidance says that omeprazole can be taken with or without food and, when taken once a day, is usually taken at the same time each morning. NHS guidance also says that esomeprazole can be taken with or without food and is usually taken once a day, often in the morning.
Some other PPIs and formulations have different instructions. Always check the leaflet supplied with your medicine or follow your prescriber's instructions.
If you have been prescribed a PPI twice a day, take the doses according to the instructions you were given. Do not automatically change the timing of your second dose without checking first.
Should You Take a PPI With or Without Food?
There is no single food rule that applies to every PPI.
For example, NHS guidance states that omeprazole can be taken with or without food. Esomeprazole can also be taken with or without food according to NHS guidance.
Some other PPIs or formulations may have specific instructions about when to take them. This is why it is better to follow the instructions for your particular medicine rather than using a general rule such as always taking a PPI 30 to 60 minutes before food.
If you accidentally take a PPI with food when your instructions say to take it before food, do not take an extra dose. Check the leaflet or ask a pharmacist what to do.
Esomeprazole and Food
Esomeprazole can be taken with or without food. NHS guidance recommends taking it once a day, usually in the morning, unless your prescriber has given you different instructions. If you take it twice a day, the doses are usually taken in the morning and evening.
Follow the instructions for your particular product, especially if you are using granules or a formulation designed to be mixed with water.
PPIs and Alcohol
Alcohol does not usually stop a PPI from working directly, but it can make reflux and indigestion symptoms worse for some people. NHS guidance for omeprazole and esomeprazole notes that alcohol can increase stomach acid and may make symptoms worse.
You do not necessarily need to avoid alcohol completely because you take a PPI. However, if you notice that alcohol makes your heartburn, reflux or stomach discomfort worse, cutting down or avoiding it may help.
If you regularly need a PPI but still have symptoms despite treatment, speak to your GP or pharmacist rather than simply increasing your dose.
PPIs and Coffee
Coffee does not have a known clinically significant interaction with PPIs, but it can trigger or worsen reflux symptoms in some people.
You do not automatically need to stop drinking coffee. If you notice that coffee brings on heartburn or makes your symptoms worse, try reducing the amount you drink and see whether your symptoms improve. Caffeinated drinks, including tea and cola, can also be a trigger for some people.
Trigger Foods to Watch
PPIs can reduce stomach acid, but they do not mean that every food will suit you. Some foods and drinks can still trigger reflux symptoms.
Common triggers include chocolate, tomatoes, citrus fruits, spicy foods, rich or fatty foods and fizzy drinks. Coffee and other caffeinated drinks can also cause problems for some people.
You do not need to avoid every food on this list. Instead, pay attention to your own symptoms. If a particular food regularly causes heartburn or reflux, reducing it may help.
If you are living with overweight or obesity, losing weight may also help reduce GORD symptoms. Your GP or pharmacist can give you advice if you are unsure which lifestyle changes may be useful for you.
Can You Take Peptac or Gaviscon With Omeprazole?
Yes, Gaviscon or Peptac may be used alongside a PPI such as omeprazole, provided the medicines are suitable for you. NHS guidance confirms that Gaviscon can be taken with a PPI.
They work in different ways. PPIs reduce the amount of acid your stomach produces, while alginate products such as Gaviscon form a protective layer over the stomach contents. Some products also contain an antacid, which helps neutralise stomach acid.
Gaviscon is usually taken after meals and at bedtime, while the timing of your PPI depends on the specific medicine. Always follow the instructions for both products.
Some antacid and alginate products can affect how other medicines are absorbed. For example, NHS guidance says Gaviscon should not be taken within 2 hours before or after certain medicines, including some antibiotics, iron tablets, beta blockers and levothyroxine. If you take several medicines, ask a pharmacist about the correct spacing.
Can You Take Omeprazole and Esomeprazole Together?
Omeprazole and esomeprazole should not normally be taken together unless a prescriber specifically tells you to do so.
Both medicines are PPIs and reduce stomach acid. Taking two PPIs together is not standard treatment and is not something you should try yourself if one medicine is not controlling your symptoms.
If your PPI is not helping, speak to your prescriber. They may review your diagnosis, dose, timing or medicine and decide whether a different approach is needed.
Pantoprazole and Other Interactions to Be Aware Of
PPIs can interact with some medicines. The exact interactions depend on the PPI you take and the other medicines involved.
Some important examples include:
- Clopidogrel: omeprazole and esomeprazole can reduce the effect of clopidogrel. If you need a PPI while taking clopidogrel, your prescriber may choose another PPI, such as lansoprazole, pantoprazole or rabeprazole. Do not change either medicine without medical advice.
- Certain HIV medicines: PPIs can reduce stomach acid and may affect the absorption of some HIV medicines. Some combinations should not be used together.
- Some antifungal medicines: medicines such as ketoconazole and itraconazole need an acidic environment for absorption, so PPIs can affect how well they are absorbed.
- Warfarin: PPIs can interact with warfarin in some people, so your doctor may need to monitor you when treatment is started or changed.
- Other medicines and supplements: omeprazole and esomeprazole can also interact with medicines such as digoxin, diazepam, phenytoin and St John's wort. This is not a complete list.
Pantoprazole is considered to have a lower potential for a clinically significant interaction with clopidogrel than omeprazole or esomeprazole. However, the choice of PPI depends on your individual medicines and health needs.
The safest approach is to tell your prescriber or pharmacist about everything you take, including prescription medicines, pharmacy medicines, vitamins, supplements and herbal remedies.
Incorrect Usage and Side Effects to Avoid
A few common mistakes can cause problems when taking a PPI:
- Stopping a PPI after long term use without checking first. Your symptoms may return, and some people can experience increased acid production after stopping. If you have been taking a PPI for a long time, ask your prescriber or pharmacist whether you should reduce the treatment gradually or change the dose. NICE recommends reviewing long term treatment and considering the lowest dose needed to control symptoms, unless there is a reason to continue treatment.
- Continuing an over the counter PPI beyond the recommended course without speaking to a doctor. For example, NHS guidance says not to take omeprazole bought without a prescription for longer than 2 weeks without medical advice.
- Chewing or crushing gastro-resistant or enteric coated tablets or capsules unless the product information specifically says that this is allowed. Some medicines have alternative ways of being taken if you have difficulty swallowing, so check the leaflet or ask a pharmacist.
- Taking a double dose after missing a dose. In general, take the missed dose when you remember unless it is nearly time for your next dose. Follow the instructions for your particular medicine and do not take two doses to make up for a missed one.
- Taking two PPIs together without medical advice. Omeprazole and esomeprazole, for example, are both PPIs and should not normally be combined.
- Changing the timing or dose yourself because you think the medicine is not working. If symptoms continue, ask your prescriber or pharmacist to review your treatment instead.
When to See a Doctor
Speak to your GP if your reflux is frequent, keeps coming back or does not improve with treatment. You should also seek medical advice before continuing an over the counter PPI beyond the recommended course.
If you need a PPI for a long time, your treatment should be reviewed regularly. NICE recommends an annual review for people who need long term treatment for dyspepsia, with a step down or stopping considered where appropriate. Some people need longer term treatment because of an underlying condition or another medicine they take.
PPIs are generally well tolerated, but side effects can happen. Depending on the medicine, these can include headache, stomach pain, nausea, diarrhoea or constipation.
Long term use can also be linked with problems such as low magnesium, vitamin B12 deficiency, bone fractures and gut infections. The level of risk varies between people and does not mean that everyone taking a PPI will develop these problems. Some PPIs, including esomeprazole and pantoprazole, have specific NHS guidance about monitoring during longer term treatment.
If you are taking a PPI long term, your doctor or pharmacist can review whether you still need it and whether the dose is appropriate.
Seek prompt medical advice if you have difficulty or pain when swallowing, unexplained weight loss, persistent vomiting, or signs of gastrointestinal bleeding such as black, tarry stools or vomiting blood. These symptoms need medical assessment rather than continued self treatment.
