Omeprazole
From £12.99
If omeprazole does not seem to be controlling your symptoms, there are several possible reasons. This guide explains how to tell whether omeprazole is working, what to do if your symptoms continue, why breakthrough symptoms can happen, including with alternate day dosing, and when it is time to speak to your prescriber.
Treatment suitability depends on your individual circumstances. Your prescriber can decide whether your current dose and treatment plan are right for you.
How Do I Know If Omeprazole Is Working?
Omeprazole does not work like an antacid, which can provide relatively quick relief by neutralising stomach acid. It is a proton pump inhibitor (PPI) that reduces the amount of acid your stomach produces.
Some people notice their symptoms starting to improve within a few days, although the full effect can take longer. If you take omeprazole once a day, taking it at the same time each morning can help you take it consistently. Omeprazole can generally be taken with or without food.
You may still have some symptoms while treatment is getting established. That does not necessarily mean the medicine is not working.
A more useful sign is whether your heartburn, acid reflux or other symptoms gradually become less frequent or less severe. Everyone responds differently, and factors such as how your body processes the medicine can affect the response.
Omeprazole Not Working After 1, 2 or 3 Weeks: What to Do
If you still have symptoms after 1, 2 or 3 weeks, do not automatically increase your dose. How quickly you should have your treatment reviewed depends on why you are taking omeprazole and how severe or persistent your symptoms are.
It is worth checking a few simple things first:
- Have you been taking omeprazole regularly as prescribed rather than missing doses?
- Are there particular triggers, such as large or fatty meals, alcohol, caffeine or lying down soon after eating, that make your symptoms worse?
- Have you missed any doses that could be contributing to your symptoms?
- Are you taking any other medicines that could affect your symptoms or interact with omeprazole?
Lifestyle changes, such as eating smaller meals and identifying foods or drinks that trigger your symptoms, may also help some people manage GORD symptoms.
If your symptoms continue despite taking omeprazole as prescribed, your prescriber may review your diagnosis, how you are taking the medicine, your dose and whether another treatment or further investigation is appropriate. For symptomatic GORD, UK product information recommends further investigation if symptom control has not been achieved after 4 weeks of omeprazole 20mg daily.
If you are using omeprazole bought without a prescription, NHS guidance says not to take it for longer than 2 weeks without speaking to a doctor.
Omeprazole Every Other Day: Why Breakthrough Symptoms Happen
Taking omeprazole every other day is not the usual dosing schedule for treating active reflux symptoms. If you take it on alternate days, acid suppression may be less consistent and symptoms can return on the days you do not take it.
Omeprazole works by blocking active proton pumps in the stomach. The body continues to produce new proton pumps, so acid production can increase again between doses. This is one reason consistent dosing is important when omeprazole has been prescribed for regular symptom control.
Stopping a PPI after longer term use can also cause rebound acid related symptoms in some people. This can make heartburn or reflux feel worse after reducing or stopping treatment.
This applies whether you are taking 20mg or 40mg every other day. Alternate day dosing should not be assumed to provide the same symptom control as a prescribed daily regimen.
If you are considering alternate day dosing because of side effects, cost or the number of medicines you take, speak to your prescriber first. They may consider an appropriate lower daily dose, a different PPI or another treatment option depending on your circumstances.
Do not change from daily to alternate day treatment or stop omeprazole suddenly without discussing it with your prescriber, particularly if you have been taking it for a long time.
Breakthrough Symptoms While on a Consistent Daily Dose
Occasional breakthrough symptoms do not automatically mean that your omeprazole dose is wrong.
PPIs reduce the amount of acid your stomach produces, but they do not provide the same type of rapid relief as some antacids or alginates. An antacid or alginate may therefore be used for occasional symptoms when appropriate, while your regular PPI continues as prescribed.
If breakthrough symptoms are happening often, it is worth looking at possible triggers such as large meals, certain foods or drinks, alcohol and lying down soon after eating. If symptoms continue despite regular treatment, speak to your prescriber rather than increasing the dose yourself.
Can I Take Omeprazole Twice a Day?
Omeprazole can be prescribed twice a day for some conditions. The dose and frequency depend on the condition being treated and your individual treatment plan. Twice daily dosing is also used in some H. pylori eradication regimens.
If once daily treatment is not controlling your symptoms, your prescriber may decide that a different dose or dosing schedule is appropriate. Do not split or increase your daily dose yourself.
NHS guidance says that when omeprazole is prescribed twice a day, it is generally taken at the same time each morning and evening.
What Happens If I Take a Double Dose of Omeprazole?
If you accidentally take an extra dose of omeprazole, it is unlikely to cause problems in many cases. However, NHS guidance recommends getting medical advice if you take more than the amount stated on your prescription, packet or leaflet.
Do not intentionally take an extra dose to try to make your symptoms improve faster. Taking more than prescribed does not necessarily provide quicker relief.
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 2 doses together to make up for a missed dose.
How Long Should You Take Omeprazole?
How long you need omeprazole depends on the condition being treated and how you respond to treatment.
For symptomatic GORD, the usual recommended adult dose is 20mg daily. If symptoms have not been controlled after 4 weeks, further investigation is recommended.
Some reflux conditions need a course lasting several weeks. For example, reflux oesophagitis is commonly treated with 20mg once daily for 4 weeks, with a further 4 weeks if needed. Severe oesophagitis may require 40mg once daily for up to 8 weeks.
Stomach ulcers can also take several weeks to heal. H. pylori treatment uses omeprazole alongside appropriate antibiotics, with the exact regimen depending on the treatment prescribed.
For a hiatus hernia, omeprazole does not repair the hernia itself. It can reduce the acid reflux and heartburn associated with it. Some people with ongoing symptoms may need longer term treatment, with the dose reviewed periodically.
If you take omeprazole for a long time, your treatment should be reviewed regularly. Long term PPI treatment has been associated with effects such as low magnesium levels, vitamin B12 deficiency and weakened bones, although these effects do not happen to everyone. NHS guidance notes that the chance of some serious side effects can be higher with long term use, particularly after a year or more.
Omeprazole Dosing Troubleshooting Summary
| Situation | What it usually means | What to do |
|---|---|---|
| Symptoms persist in week 1 to 2 | Treatment may not have reached its full effect yet, or another factor may be contributing | Continue taking it as prescribed and speak to a pharmacist or prescriber if symptoms are not improving |
| No improvement after 3 to 4 weeks | The treatment or diagnosis may need review | Speak to your prescriber |
| Breakthrough symptoms on alternate day dosing | Acid suppression may be less consistent between doses | Discuss your dosing schedule with your prescriber rather than changing it yourself |
| Occasional breakthrough on daily dosing | Food, drink or lifestyle triggers may be contributing | Review your triggers and ask a pharmacist about suitable short term relief |
| Symptoms return after missing a dose | Missing doses can affect consistent treatment | Take the missed dose when remembered unless it is nearly time for the next one. Do not double up |
This table is a general guide only. Persistent, worsening or severe symptoms should be discussed with a healthcare professional.
When to Seek Medical Advice
Seek prompt medical advice if you have difficulty swallowing, persistent vomiting, unexplained weight loss, blood in your vomit or stools, or severe abdominal pain. These symptoms can need assessment beyond routine reflux treatment.
If you are using over the counter omeprazole and your symptoms are not better after 2 weeks, speak to a GP rather than continuing to self treat. NHS guidance specifically advises against taking non prescription omeprazole for longer than 2 weeks without medical advice.
Omeprazole can cause side effects. Common side effects include headache, stomach pain, nausea, vomiting, constipation and diarrhoea. Dizziness and vision problems can also occur, although they are not among the most common effects. Speak to a pharmacist or doctor if side effects bother you or do not go away.
Follow the product information for the specific omeprazole product you are using and seek medical advice if you are unsure about your symptoms or treatment.
Available Treatment Options and Side Effects
EverydayMeds stocks omeprazole 20mg capsules and Losec MUPS 20mg tablets, alongside lansoprazole 15mg capsules and orodispersible tablets, pantoprazole, esomeprazole and rabeprazole. These medicines are used for different acid related conditions, including acid reflux, GORD and some ulcer related conditions.
Famotidine is an H2 receptor antagonist. It works differently from a PPI and may be considered as an alternative in some circumstances.
As with any medicine, the most suitable treatment depends on your symptoms, medical history, other medicines and the reason treatment is needed.
How to Get Your Omeprazole Dose Reviewed Through EverydayMeds
If your current dose does not seem to be working, you can request a treatment review through EverydayMeds. You will be asked about your symptoms, current treatment and other medicines. A UK registered prescriber can then assess whether a dose change, a different PPI or further medical assessment may be appropriate.
The outcome depends on your individual clinical assessment, so a particular medicine or dose cannot be guaranteed.
