Omeprazole
From £12.99
The British National Formulary (BNF) provides UK prescribing information for omeprazole and other medicines used to treat conditions such as gastro oesophageal reflux disease (GORD), stomach and duodenal ulcers, H. pylori infection and Zollinger Ellison syndrome.
For GORD, NICE lists omeprazole 20mg once daily as the standard dose, with 10mg once daily as a lower or on demand dose. For severe oesophagitis, NICE uses a higher dosing range, with 40mg once daily as the standard dose and 40mg twice daily as a high dose in some circumstances.
Your prescriber will decide which dose and treatment length are appropriate for you. This guide explains the general UK dosing framework, but it is not a substitute for personalised medical advice.
Key things to know
- For general GORD, the standard omeprazole dose is 20mg once daily. A lower 10mg once daily dose may be used as an on demand or maintenance dose in appropriate situations.
- For severe oesophagitis, 40mg once daily is the standard dose in NICE's specific dosing table. A higher 40mg twice daily dose may be used in some cases under medical supervision.
- Omeprazole can be taken with or without food, so there is no strict requirement to take it 30 to 60 minutes before breakfast.
- Hiatal hernia related reflux may need longer term treatment in some people, but having a hiatal hernia does not automatically mean you need omeprazole indefinitely.
- H. pylori treatment uses a different dosing pattern, commonly omeprazole 20mg twice daily alongside antibiotics for 7 days in some licensed regimens. Other regimens can be used depending on the antibiotics selected.
- Long term PPI treatment should be reviewed periodically to check whether treatment is still needed and whether the dose remains appropriate.
Standard BNF Dosing for GORD (Gastro oesophageal Reflux Disease) and Acid Reflux
| Condition | Typical dose |
|---|---|
| GORD, standard dose | 20mg once daily |
| GORD, lower or on demand dose | 10mg once daily |
| Severe oesophagitis, standard dose | 40mg once daily |
| Severe oesophagitis, high dose | 40mg twice daily in appropriate cases |
| Peptic ulcer healing | Usually 20mg once daily, with duration depending on the ulcer and response |
| H. pylori eradication | Commonly 20mg twice daily plus antibiotics for 7 days in licensed regimens |
| Zollinger Ellison syndrome | Individually adjusted, usually starting at 60mg daily under specialist care |
NICE lists 20mg once daily as the full or standard omeprazole dose for GORD, 10mg once daily as a low or on demand dose and 40mg once daily as a double dose in its general PPI dosing table. For severe oesophagitis, NICE lists 40mg once daily as the standard dose and 40mg twice daily as a high dose.
The product information for omeprazole also gives different doses for individual conditions. For example, active duodenal ulcers are generally treated with 20mg once daily, while poorly responsive duodenal ulcers may require 40mg once daily.
Your specific dose depends on your diagnosis and treatment response. The table is there to explain the usual dosing framework, not to help you choose a dose yourself.
How Long Should You Take Omeprazole for a Hiatal Hernia?
A hiatal hernia happens when part of the stomach moves up through the opening in the diaphragm. It can contribute to GORD and reflux symptoms, but omeprazole does not repair the hernia itself. Instead, it reduces stomach acid, which can help control acid related symptoms and give an irritated oesophagus time to heal.
There is no single omeprazole treatment length specifically for a hiatal hernia. The duration depends on whether you have reflux symptoms, whether the oesophagus has become damaged and whether symptoms return when treatment is reduced or stopped.
Some people with ongoing reflux may need longer term PPI treatment. NICE recommends reviewing long term PPI treatment regularly and considering whether the lowest effective dose is still appropriate.
Having a hiatal hernia on its own does not necessarily mean that you need long term omeprazole. If the hernia was found during an investigation for another reason and you do not have troublesome reflux symptoms, your doctor may decide that regular acid suppression is not needed.
If your reflux remains troublesome despite treatment, speak to your prescriber. They may consider adjusting your treatment or investigating the symptoms further.
Common and Serious Side Effects
Common side effects of omeprazole can include headache, nausea, diarrhoea, stomach pain, constipation and wind. Not everyone experiences them, and they may improve as your body gets used to the medicine.
More serious side effects are uncommon. Long term PPI treatment can sometimes be associated with low magnesium levels. Symptoms can include muscle cramps, muscle twitches, weakness or an irregular heartbeat. If you develop these symptoms, speak to your doctor or pharmacist.
A serious allergic reaction is rare but requires urgent medical attention. If you develop swelling of the lips, mouth or throat, difficulty breathing or another severe reaction, seek urgent medical help.
Long Term Use and Monitoring
Long term PPI treatment can be appropriate for some people, but it should be reviewed from time to time. Prolonged treatment has been associated with problems such as low magnesium and vitamin B12 deficiency in some people, and there is also evidence of an increased risk of fractures with long term PPI use.
These associations do not mean that everyone taking omeprazole will develop these problems. The reason for regular review is to check that the benefits of continuing treatment still outweigh the possible risks and that you are taking the lowest dose that is suitable for your condition.
This can be particularly useful when reflux is linked to a hiatal hernia, because some people may need ongoing symptom control while others may be able to reduce treatment over time.
Missed and Extra Doses
If you miss a dose, take it when you remember unless it is nearly time for your next dose. If it is nearly time, skip the missed dose and take your next dose at the usual time. Do not take two doses together to make up for a missed dose.
If you accidentally take an extra dose, it is unlikely to cause problems in many cases, but you should get medical advice if you have taken more than the amount stated on your packet, leaflet or prescription. You can contact NHS 111 or speak to a pharmacist.
Do You Need to Take Omeprazole Before Food?
No, not strictly. Current NHS guidance confirms that omeprazole can be taken with or without food.
A "30 to 60 minutes before food" rule is often repeated online, but it is not a universal requirement for standard omeprazole capsules and tablets.
If you take omeprazole once a day, the NHS advises taking it at the same time each morning. If it has been prescribed twice daily, take it at the same time each morning and evening.
If your prescriber or the instructions supplied with your particular medicine give you different directions, follow those instructions.
Diet and Lifestyle Alongside Omeprazole
Some people find that certain foods and drinks make their reflux symptoms worse. Common triggers can include coffee, alcohol, chocolate, tomatoes and fatty or spicy foods. However, triggers vary from person to person, so there is no need to avoid every food on this list if it does not affect your symptoms.
Alcohol does not appear to directly stop omeprazole from working, but it can make reflux symptoms worse for some people. Reducing alcohol may therefore help with symptom control even while you continue taking omeprazole as prescribed.
If you have night time reflux, avoiding large meals close to bedtime may help. Raising the head of your bed can also be useful for some people with reflux. Using blocks to raise the head of the bed is generally more useful than simply adding extra pillows.
Lifestyle changes can support treatment, but they do not replace medical treatment when you have diagnosed reflux disease or oesophageal damage.
How Omeprazole Works
Omeprazole is a proton pump inhibitor (PPI). It reduces stomach acid by blocking the proton pumps in the cells that produce acid in the stomach.
This can reduce acid exposure in the oesophagus and help acid related irritation heal. The amount of acid suppression varies between people, so there is no single percentage that applies to everyone.
Omeprazole is not an instant antacid. Some people notice their symptoms improving within the first few days, while healing of conditions such as reflux oesophagitis can take several weeks.
Treatment Duration by Condition (Including Duodenal Ulcer)
Treatment length depends on the condition being treated.
For GORD, NICE recommends a full dose PPI for 4 or 8 weeks, depending on the clinical situation.
For active duodenal ulcers, omeprazole 20mg once daily is generally used for 2 weeks. If the ulcer has not fully healed, another 2 weeks may be needed. Poorly responsive duodenal ulcers may be treated with 40mg once daily for around 4 weeks.
For reflux oesophagitis, treatment commonly lasts 4 to 8 weeks depending on severity and response. Severe oesophagitis may require 40mg once daily.
H. pylori eradication treatment follows a different pattern and combines omeprazole with antibiotics, commonly for 7 days in licensed regimens.
Hiatal hernia related reflux does not have one fixed treatment length. Some people need longer term maintenance treatment if symptoms return when treatment is reduced.
Alternative PPI Options
If omeprazole is not suitable or does not suit you, your prescriber may consider another PPI such as lansoprazole, pantoprazole, esomeprazole or rabeprazole. These medicines work in a similar way, but they are not identical and can differ in how they interact with other medicines.
This can matter if you take clopidogrel. Omeprazole can reduce the antiplatelet effect of clopidogrel, so anyone taking both should discuss the combination with their prescriber or pharmacist. An alternative PPI may be considered when appropriate. Do not switch medicines yourself.
Famotidine is different because it is an H2 receptor antagonist rather than a PPI. A prescriber may consider an H2 receptor antagonist in some people who do not tolerate PPIs or who need a different approach to symptom control.
Available Treatments
| Treatment | Price |
|---|---|
| Lansoprazole 15mg Capsules | From £5.99 |
| Pantoprazole | From £5.99 |
| Famotidine Tablets | From £8.49 |
| Lansoprazole 15mg Orodispersible Tablets | From £8.49 |
| Esomeprazole | From £16.99 |
| Omeprazole 20mg gastro resistant capsules, tablets or liquid | From £12.99 |
| Rabeprazole | From £19.99 |
| Losec MUPS 20mg Tablets | From £29.99 |
Follow the instructions supplied with your particular product. Gastro resistant capsules and tablets should not be crushed or chewed. If you have difficulty swallowing them, ask a pharmacist whether your particular product can be opened or dispersed in another way.
If you are buying omeprazole without a prescription, do not take it for longer than 2 weeks without speaking to a doctor. See a GP if your symptoms get worse or do not improve.
Medical Disclaimer
This page provides general information about omeprazole dosing based on UK clinical guidance. It is not a substitute for personalised medical advice.
Do not change your dose or treatment duration without discussing it with your prescriber or pharmacist first. Tell your healthcare professional about any other medicines, vitamins, supplements or herbal remedies you take, as omeprazole can interact with some medicines.
