Omeprazole + Domperidone Pharmacology
Omeprazole + Domperidone
Omeprazole
(H+ K+ATPase) and inhibits the exchange of extracellular K+ for intracellular H+ ion. Omeprazole irreversibly inhibits proton pumps activity and decreases gastric acid secretion.
Distribution: It is widely distributed in the body in protein bound form.
Metabolism: Omeprazole is extensively metabolised in the liver.
Excretion: It is excreted mainly in the faeces and small amount in urine.
2. Nausea
3. Vomiting
4. Abdominal pain
5. Constipation
6. Flatulence
7. Headache
8. Dry mouth
9. Dizziness
10. Myalgia
11. Rash
.
2. Monitor gastric malignancy
3. Avoid prolonged use
NEONATES: Contraindicated
2. Gastric ulcer
3. Zollinger- Ellison syndrome
4. Gastroesophageal reflux disease
5. Oesophagitis
6. Acid related dyspepsia
7. NSAID associated ulceration
8. Prophylaxis of acid aspiration during anesthesia
Phenytoin: Increased plasma concentration of phenytoin.
Oral Anticoagulants: May prolong the elimination of warfarin.
Cyclosporine, Disulfiram: Omeprazole interferes with the metabolism of these drugs.
Ketaconazole, Ampicillin esters, Iron Salts: Omeprazole may interfere with the absorption of these drugs where gastric pH is a determinant of their bio-availability.
Adult: 10 - 20 mg / day to be taken before meals.
Duodenal ulcer: 20 mg / day to be taken 30 minutes before meals for 1-2 months.
Gastric ulcer: 20 mg / day for 1-2 months.In severe cases dose can be increased to 40 mg / day. Maintenance dose: 10 - 20 mg / day.
Zollinger- Ellison syndrome: 60 mg / day increase the dose maximum up to 360 mg/ day in 3 divided doses if needed.
Gastroesophageal reflux disease, oesophagitis: 20 mg / day for 1-2 months.
Acid related dyspepsia: 10 - 20 mg / day for 1 month.
NSAID associated ulceration: 20mg / day for 1 month.
Prophylaxis of acid aspiration during anesthesia: 40 mg in the evening before the surgery and the same dose 2 - 6 hours before the procedure.
Children: Not recommended
Domperidone
Domperidone acts peripherally in the gastrointestinal system and increases oesophageal peristalsis, oesophageal sphincter pressure and gastric motility. These all facilitates gastric emptying. Domperidone is used in migraine to relieve nausea and vomiting.
Anaesthetic adjuncts: It is used preoperatively in order to reduce the post operative vomiting.
2.Dry mouth
3.Galactorrhoea
4.Gynaecomastia
5.Skin rash
6.Abdominal discomfort
7.Dystonic reactions
2.Prolactin releasing pituitary tumour(prolactinoma)
3.Gastrointestinal obstruction
2.Renal impairment
NEONATES: contraindicated
2.Delayed gastric emptying of functional origin
3.As an Antiemetic in patient receiving cytotoxic drugs
4.Preanaesthetic medication
Aspirin, Paracetamol & Oral Diazepam: Increases absorption of these agents.
Anticholinergic agents: Antagonize the effects of domperidone.
Phenothiazines: CNS depression enhanced by domperidone.
Antimuscarinic agents and opioids: Antagonize GI effects of domperidone.
Suxamethonium: Neuromuscular blockade enhanced by domperidone.
Migraine: 20 mg by mouth may be taken up to every 4 hours with Paracetamol, as required up to a maximum of 4 doses in 24 hours.
Children: 300 mcg / kg body weight 3 - 4 times daily 30 minutes before meals and at bed time if required
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