Omeprazole
From £12.99
Omeprazole 40mg is a higher licensed dose used for certain conditions and situations where a lower dose may not be enough. It is not simply a stronger version of 20mg that you can request for faster relief. The right dose depends on why you are taking omeprazole, how severe the condition is, and how you respond to treatment.
For many adults with gastro oesophageal reflux disease (GORD), 20mg once daily is the standard treatment dose. A 40mg dose may be used for conditions such as severe reflux oesophagitis, or when a higher dose is specifically needed for another condition. (medicines.org.uk)
Whether 40mg is appropriate for you is a clinical decision made by your prescriber. If 20mg does not seem to be helping, it is better to have your treatment reviewed than to increase the dose yourself.
Key things to know
- 20mg once daily is the standard treatment dose commonly used for GORD
- 40mg is a higher dose used for specific conditions, such as severe reflux oesophagitis, or when a higher dose has been prescribed for another medical reason
- Two 20mg capsules or tablets contain the same total amount of omeprazole as one 40mg dose, but you should only combine doses if your prescriber has told you to do so
- Omeprazole can generally be taken with or without food, so there is no universal 30 to 60 minute pre meal rule
- Zollinger Ellison syndrome is treated with individually adjusted doses that can be considerably higher than 40mg, usually under specialist supervision
Standard 20mg: The First Line Dose to Treat Gastro Oesophageal Reflux Disease
Omeprazole 20mg once daily is commonly used as the standard treatment dose for GORD. It is also used for several other acid related conditions, including some stomach and duodenal ulcers. The exact dose depends on the condition being treated. (medicines.org.uk)
For reflux oesophagitis, the standard dose is generally 20mg once daily. If the oesophagitis is severe, 40mg once daily may be prescribed. This does not mean that everyone with more noticeable heartburn needs 40mg. The higher dose is used when there is a specific clinical reason for it.
When 40mg Is Genuinely Needed
40mg can be prescribed for conditions where a higher dose is appropriate. For example, the UK product information lists 40mg once daily for severe reflux oesophagitis. It may also be used when treatment needs to be adjusted because the standard dose has not provided enough control, depending on the condition and clinical assessment. (medicines.org.uk)
The reason for using 40mg matters. A higher dose is not automatically better for ordinary heartburn, and there is no need to move to 40mg simply because 20mg has not given immediate relief.
Zollinger Ellison syndrome is different. This rare condition causes the stomach to produce too much acid and may require much higher doses. The dose is adjusted individually, with the UK product information giving an initial dose of 60mg daily and higher doses used when necessary. (medicines.org.uk)
If you are currently taking 20mg and your symptoms are not improving, your prescriber may review your diagnosis, how you are taking the medicine, how long you have been taking it and whether a different dose or treatment is appropriate.
Side Effects: What Changes at the Higher Dose
The common side effects of omeprazole can occur with either 20mg or 40mg. They include headache, stomach pain, nausea, diarrhoea, constipation, vomiting and increased wind. Not everyone experiences them. (nhs.uk)
Long term treatment with omeprazole can be associated with problems such as low magnesium, vitamin B12 deficiency and an increased risk of fractures. Some of these risks are more relevant with prolonged treatment or in people who already have other risk factors. This does not mean that taking 40mg will cause these problems, but it is one reason long term treatment should be reviewed. (nhs.uk)
The UK product information also notes that prolonged treatment with omeprazole can be associated with certain gastrointestinal infections and, in some people, benign fundic gland polyps. (medicines.org.uk)
This is why long term PPI treatment should be reviewed from time to time. The aim is generally to use the lowest dose that continues to control the condition when ongoing treatment is needed.
Is Two 20mg Doses the Same as One 40mg Dose?
Two 20mg doses contain 40mg of omeprazole in total, but that does not mean you should automatically take two 20mg doses instead of a prescribed 40mg product.
In some situations, omeprazole may be prescribed as two doses during the day. The timing and total dose depend on the condition being treated and the prescriber's instructions. (medicines.org.uk)
If you think you need 40mg because your symptoms are not controlled, speak to your prescriber or pharmacist. Do not combine two lower strength doses without checking first.
Do You Need to Take Omeprazole Before Food?
No, there is no strict 30 to 60 minute pre meal rule for omeprazole.
NHS guidance says omeprazole can generally be taken with or without food. The important thing is to follow the instructions for your specific product and prescription and take it consistently. (nhs.uk)
Some product information gives specific advice about when to take the medicine, so if your pharmacist or prescriber has given you different instructions, follow those instructions.
How the Doses Compare
| 20mg | 40mg | |
|---|---|---|
| Typical use | Standard treatment dose for GORD and several other acid related conditions | Used for severe reflux oesophagitis and specific conditions where a higher dose is needed |
| Started by | Commonly used as the standard treatment dose | Prescribed when there is a specific clinical reason |
| Available at EverydayMeds | Yes, from £12.99 | Not currently stocked as standard, confirm with your prescriber |
| Suitable for self selection? | No, the appropriate dose depends on the condition being treated | No, requires clinical assessment |
Stepping Back Down Once Symptoms Settle
If you have been prescribed 40mg and your condition has improved, your prescriber may consider whether a lower dose is appropriate for ongoing treatment.
This is not automatic. Some conditions need continued higher dose treatment, while others can be managed with a lower dose once the initial problem has settled.
For long term treatment, NICE recommends reviewing the need for continued PPI treatment and using the lowest dose needed to control symptoms where appropriate. (nice.org.uk)
Do not reduce or stop your dose without checking first, particularly if 40mg has been prescribed for a specific condition.
Generic vs Branded, at Either Strength
Generic omeprazole contains the same active medicine as branded products containing omeprazole and must meet the requirements of its UK marketing authorisation.
At EverydayMeds, generic omeprazole 20mg is listed from £12.99, while Losec MUPS 20mg is listed from £29.99. Based on those prices, the generic option is about 57% cheaper.
Prices can change, so this percentage should be treated as a comparison of the listed prices rather than a permanent saving.
Alternative Proton Pump Inhibitor (PPI) Options
Other proton pump inhibitors include lansoprazole, pantoprazole, esomeprazole and rabeprazole. They work in a similar way by reducing stomach acid, but they are not identical medicines.
The choice can depend on the condition being treated, other medicines you take, previous treatment and how you respond.
One important example is clopidogrel. Omeprazole can reduce the antiplatelet effect of clopidogrel because of an interaction between the medicines. NHS guidance advises people taking clopidogrel to tell their doctor or pharmacist before taking omeprazole. (nhs.uk)
Some other PPIs, including pantoprazole, may be considered instead when a PPI is needed with clopidogrel. The appropriate option should be decided by a healthcare professional.
Treatment Duration
Treatment length depends on the condition being treated.
For reflux oesophagitis, the usual treatment dose is 20mg once daily, with 40mg once daily used for severe cases. Treatment is commonly given for 4 to 8 weeks, depending on the condition and response. (medicines.org.uk)
Omeprazole may also be used as part of treatment for stomach or duodenal ulcers. When an ulcer is linked to Helicobacter pylori, omeprazole is used alongside antibiotics as part of eradication treatment. (nhs.uk)
Some people need longer term treatment. If that applies to you, your prescriber can review whether you still need the medicine and whether your current dose remains appropriate.
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 | From £12.99 |
| Rabeprazole | From £19.99 |
| Losec MUPS 20mg Tablets | From £29.99 |
Medical Disclaimer
This page provides general information about omeprazole 20mg and 40mg. It is not a substitute for personalised medical advice.
Do not increase your omeprazole dose, combine two doses, or switch strengths without discussing it with your prescriber or pharmacist.
If your symptoms are not improving, keep coming back, or are getting worse, speak to a healthcare professional. Persistent reflux symptoms may need further assessment rather than simply a higher dose.
Seek medical advice if you have warning symptoms such as difficulty swallowing, repeated vomiting, vomiting blood, black stools or unexplained weight loss.
