Omeprazole liquid, also known as omeprazole oral suspension is a liquid form of omeprazole drug, a prescription-only medication (POM). Omeprazole liquid can only be prescribed by a GP or other qualified prescriber. A liquid formulation of Omeprazole is designed for the administration of the drug in the young population, including babies, toddlers, children and patients with swallowing difficulties.
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What is Omeprazole?
Omeprazole belongs to a group of drugs called Proton Pump Inhibitors (PPIs). PPIs stop the production of stomach acid, and generally, this group of drugs is the most effective in controlling the symptoms of dyspepsia and GORD.
Omeprazole liquid availability as a powder for oral suspension
A while ago, omeprazole liquid became available as a powder for oral suspension (Rosemont Pharmaceuticals Limited). Omeprazole powder for oral suspension is the only licensed form of liquid PPI. Omeprazole powder for oral suspension is licensed for babies from 1 month.
Omeprazole powder for oral suspension comes in two different strengths:
- 2mg/ml
- 4mg/ml
What is a powder for oral suspension?
As the name suggests omeprazole comes in form of powder in the above medication. Omeprazole powder needs reconstitution with water before administration. Once mixed with water omeprazole liquid (suspension) is formed. When mixed with water, omeprazole suspension needs to be kept in the fridge (2°C – 8°C).
One advantage of omeprazole powder for oral suspension over other forms of omeprazole liquid (see the next paragraph) from the patient’s point of view is prompt availability. Omeprazole powder for oral suspension is available from leading wholesalers, which means it can be ordered to fulfil prescriptions the same or the next day.
Since powder for oral suspension is the only licensed PPI, it should be prescribed in preference to ‘special’ omeprazole discussed in the next section.
Omeprazole liquid as a ‘special’ medication
Some forms of omeprazole liquid are classified as a ‘special’ product. Special products are unlicensed medicines produced on an individual basis when there is no licensed medication that could be prescribed to meet the patient’s treatment needs.
Because Omeprazole liquid is a ‘special’, pharmacies do not stock it as part of their regular stock as other drugs but order each product when a prescription is brought to the pharmacy. Each Omeprazole suspension is made on an individual basis. It may take a few days to process the prescription for Omeprazole liquid, although it is not uncommon to see the next-day delivery. The processing time of ‘special’ items will vary between pharmacies.
Patients may request a specific flavour of omeprazole liquid. In my practice as a pharmacist, I saw a request for raspberry omeprazole liquid, which was fulfilled at no extra cost to the pharmacy.
Other factors that need attention when a ‘special’ is collected from the pharmacy:
- Storage: some Omeprazole preparations may need to be stored in the fridge, however, check with the pharmacy team on the collection and/or read the information label on the bottle
- Expiry date: special products may have shorter expiry dates. Check the label for the expiry date.
Omeprazole liquid indications
The indications of Omeprazole liquid are in line with the Omeprazole drug, which is the treatment of (NICE, 2019):
- Acid-related dyspepsia
- Gastro-oesophageal reflux disease (GORD)
- Treatment of ulcers
- Eradication of Helicobacter pylori in combination with antibiotics
- Zollinger–Ellison syndrome
- In cystic fibrosis for fat malabsorption
Omeprazole liquid: strength of formulations
Omeprazole liquid (specials) is usually prescribed in the following strengths:
- Omeprazole 5mg/5ml oral suspension
- Omeprazole 10mg/5ml oral suspension
- Omeprazole 20mg/5ml oral suspension
- Omeprazole 40mg/5ml oral suspension
Omeprazole powder for oral suspension (Rosmond) comes in two strengths:
- 2mg/ml
- 4mg/ml
Omeprazole liquid has common side effects
Common side effects experienced by patients taking Omeprazole include:
- Headaches
- Gastrointestinal side effects:
- Constipation
- Diarrhoea
- Abdominal pain
- Nausea/vomiting
- Fluctuance
Omeprazole liquid cost
The price of Omeprazole liquid will only apply to private patients (of any age). When prescribed on NHS prescription, patients either pay the standard prescription charge or get the item for free, if exempt from paying, for example, based on the patient’s age (16 or under, 16-18 and in full-time education or over 60 years of age).
The cost of Omeprazole liquid depends on:
- Strength prescribed: for ‘specials’ the price for Omeprazole 40mg/5ml will be higher than for all lower strengths, for example, Omeprazole 20mg/5ml and Omeprazole 10mg/5ml
- Volume prescribed: for each preparation of Omeprazole oral suspension, there is a minimum volume that is chargeable, for example:
- Omeprazole 5mg/5ml oral suspension minimum 70ml
- Omeprazole 10mg/5ml oral suspension minimum 75ml
- Omeprazole 20mg/5ml oral suspension minimum 150ml
- Omeprazole 40mg/5ml oral suspension minimum 100ml
- Mark-up cost: can vary between pharmacies; for example, for private prescriptions, you would expect to pay an additional 20%-40% on top of the cost of the medication.
The cost for Omeprazole liquid (specials):
- Omeprazole 5mg/5ml oral suspension: £27.94 + 20% VAT (70ml)
- Omeprazole 10mg/5ml oral suspension: £25.72 + 20% VAT (75ml)
- Omeprazole 20mg/5ml oral suspension: £44.37 + 20% VAT (150ml)
- Omeprazole 40mg/5ml oral suspension: £46.97 + 20% VAT (100ml)
The above prices are based on NHS reimbursements (payments) for the cost of medication dispensed by a pharmacy. In some cases, the reimbursement price drives the cost of medication and vice versa.
Cost of omeprazole powder for suspension:
- Omeprazole powder for suspension 2MG/ML: £112.00 + 20% VAT (75ml)
- Omeprazole powder for suspension 4MG/ML: £216.00 + 20% VAT (75ml)
Omeprazole liquid alternatives: Can you make Omeprazole liquid?
In the context of this post, the only alternative forms for Omeprazole liquid, are the dispersible and orodispersible tablets.
In practice, dispersible formulations of omeprazole tablets are sometimes prescribed. When placed in water, dispersible tablets dissolve to give a solution, which can be given to babies or toddlers according to the prescribed dose (unlicensed use).
The following dispersible preparation of Omeprazole tablets are available:
- Mezzopram 10mg, 20mg and 40mg dispersible gastro-resistant tablets
- Losec MUPS Tablets 10mg, 20mg and 40mg, all dispersible gastro-resistant tablets
The above products should not be crushed; however, a patient can break the tablet and disperse it in water or non-carbonated fruit juice. Milk or carbonated drinks should not be used to disperse Omeprazole gastro-resistant dispersible tablets (eMC, 2019). When dispersing the tablet, please follow the prescriber’s directions for preparation and dosage. You may need to disperse the tablet in a specific volume of liquid, and not all the liquid may have to be used to meet the dose requirements. A dispersed tablet (solution) should be taken immediately or within 15 minutes of preparation.
Lansoprazole as Omeprazole liquid alternative
Lansoprazole is another PPI, indicated for the same conditions as Omeprazole. Lansoprazole is most commonly prescribed as gastro-resistant capsules; however, an orodispersible form of lansoprazole drug also exists:
- Lansoprazole 15mg and 30mg orodispersible tablets
- Zoton FasTab 15mg and 30mg (a branded version of orodispersible tablets)
Orodispersible tablets disperse quickly when placed on the tongue. The above orodispersible tablets can be placed in water and administered with an oral syringe. Follow prescriber directions on preparation and dose (unlicensed use).
Can you use gastro-resistant capsules to prepare Omeprazole liquid?
Omeprazole is most commonly prescribed in form of gastro-resistant capsules. Gastro-resistant capsules should not be crushed or chewed. Some manufacturers allow the content of the capsule to be mixed with fruit juice or non-carbonated water.
References:
EMC (2019). Losec MUPS Tablets 40mg. Available at: https://www.medicines.org.uk/emc/product/1374/smpc Accessed on 14/11/2022
Ecm (2019). Mezzopram 20 mg Dispersible Gastro-resistant Tablets. Available at: https://www.medicines.org.uk/emc/product/4584/smpc Accessed on 14/11/2022
NICE (2019). Drugs: Omeprazole. Available at: https://bnfc.nice.org.uk/drug/omeprazole.html Accessed on 14/11/2022
