Omeprazole: NHS prescribing information and patient guidance

Omeprazole is a common medication in NHS primary care. As a prescribing doctor, I can explain how it works and what patients can expect.

Prescription strengths available on the NHS:

• Omeprazole 10 mg capsules
• Omeprazole 20 mg capsules (most common)
• Omeprazole 40 mg capsules
• Omeprazole 10 mg dispersible (MUPS) tablets
• Omeprazole 20 mg dispersible (MUPS) tablets
• Omeprazole 40 mg dispersible (MUPS) tablets

Most NHS prescriptions are for generic omeprazole capsules. These are very cost-effective. Branded versions, like Losec, are available. However, they are rarely prescribed due to their higher cost.

How to get a prescription:

1. Book a GP appointment if you have ongoing acid reflux, heartburn, or dyspepsia.
2. Your GP will check your symptoms. They may prescribe a 4-to-8-week course.
3. For ongoing prescriptions, many practices offer repeat prescribing. You will have an annual review.
4. Some pharmacists can now provide PPIs. This is part of the Pharmacy First service for minor conditions.

The NHS prescription charge in England is a standard fee per item. Prescriptions are free in Scotland, Wales, and Northern Ireland.

A prepayment certificate can save money if you take multiple medications.

Omeprazole is available both on prescription and over the counter (OTC). Patients should understand the key differences.

Over-the-counter (pharmacy sale):

• Available as omeprazole 10 mg or 20 mg.
• Sold under brand names like Pyrocalm Control and Zanprol.
• For short-term reflux treatment only (maximum 2 weeks).
• Suitable for adults aged 18 and over.
• No prescription is needed. You can buy it from pharmacies with pharmacist advice.
• Cost: typically around three to five pounds for a 14-day supply.

Prescription only:

• Higher doses (40 mg) need a prescription.
• Longer treatment (over 2 weeks) needs doctor supervision.
• Specific conditions need a prescription. These include ulcer healing, H. pylori eradication, and Zollinger-Ellison syndrome.
• Paediatric use requires a prescription.

When to switch from OTC to prescription:

I advise patients to see their GP if:

• OTC omeprazole does not help after 2 weeks.
• Symptoms return often after stopping.
• They have 'alarm symptoms'. These include difficulty swallowing, unexpected weight loss, vomiting blood, or black stools.
• They are over 55 with new indigestion.

NICE recommends testing for H. pylori if symptoms persist. If appropriate, patients should be referred for an upper GI endoscopy.

NICE Clinical Guideline CG184 gives full advice for using PPIs. This includes omeprazole, for GORD and dyspepsia.

Key NICE recommendations:

• First-line PPI: Omeprazole is a first-line PPI for most conditions. This is due to its proven effectiveness, safety, and cost.
• Lowest effective dose: Prescribe the lowest dose that controls symptoms. Review it regularly.
• Step-down therapy: After initial healing, try to lower the dose. Or, switch to 'as-needed' use.
• Annual review: All patients on long-term PPIs must have their prescription reviewed yearly.
• H. pylori testing: Test for H. pylori before starting long-term PPIs. Eradication may resolve symptoms.

NICE recommendations for specific conditions:

• Uninvestigated dyspepsia: A 4-week PPI trial with H. pylori testing.
• GORD without oesophagitis: Step down to the lowest dose after symptom control.
• Erosive oesophagitis: Treat for 4 to 8 weeks. Then, maintain at the lowest effective dose.
• Barrett's oesophagus: Ongoing full-dose PPI therapy is recommended.

These guidelines stress that PPIs should not continue indefinitely without review. In my practice, I follow NICE guidance.

I schedule medication reviews and aim to reduce doses when clinically suitable.

The NHS focuses more on structured medication reviews. PPIs are a key target for reducing unnecessary use.

Structured Medication Reviews (SMRs):

Since the Network Contract DES, PCN clinical pharmacists do SMRs. These are for patients on long-term medications. PPIs are specifically flagged for review. During an SMR, the pharmacist will:

• Confirm why the PPI was first prescribed.
• Check if the reason for taking it still applies.
• Look for possible side effects and drug interactions.
• Discuss dose reduction or trying to stop the medication if suitable.

What to expect at your review:

If you are called for a medication review, your pharmacist or GP will discuss:

1. Why you were first prescribed omeprazole.
2. If your symptoms are currently controlled.
3. If a lower dose might work.
4. If you could try stopping, using antacids as needed.
5. Any necessary blood tests (magnesium, B12, kidney function).

I encourage patients to take part in these reviews. Many patients are happy to learn they can safely reduce or stop a long-term medication.

NHS savings:

Reducing PPI use also saves the NHS money. Cutting unnecessary long-term PPI prescribing could save millions of pounds each year. It also improves patient health.

Omeprazole is safe and effective for most patients. However, you should seek medical advice in certain situations. Do not self-manage in these cases.

See your GP if:

• You have bought omeprazole OTC for over 2 weeks without improvement.
• Your symptoms have changed or worsened.
• You have new difficulty swallowing (dysphagia).
• You have unintentional weight loss.
• You are over 55 with new indigestion.
• You are vomiting blood or passing black, tarry stools.
• You take medicines that may interact with omeprazole, such as clopidogrel.
• You are pregnant or planning pregnancy and need advice on acid reflux.

Urgent referral criteria:

NICE advises urgent (2-week wait) referral for upper GI endoscopy if you have:

• Dysphagia at any age.
• An upper abdominal mass.
• Are aged 55 or over with unexplained weight loss. This is true if you also have upper abdominal pain, reflux, or dyspepsia.

Your GP is always the best contact for concerns about omeprazole or any medication. You can also ask your community pharmacist for advice on minor side effects and OTC use.