AlternativeLosec / Zoton
Omeprazole / Lansoprazole
Proton pump inhibitor
Third-line pregnancy GORD; first-line for severe symptoms or ulcer.
OralIV (omeprazole)
First-line for
- Severe/complicated pregnancy GORD
- Peptic ulcer disease
- Prophylaxis before general anaesthesia in obstetrics
Mechanism
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells → profound acid suppression.
"PPI = pregnancy proven, potent, prokinetic-friendly"
- Omeprazole = most data in pregnancy
- Take 30–60 min before breakfast
- Long-term ↓ Mg, B12, ↑ fracture risk
Dosing
- Omeprazole GORD
- 20 mg OD × 4–8 weeks
- Lansoprazole
- 30 mg OD
- Rapid seq. GA prep
- Omeprazole 40 mg PO evening + morning of surgery
Contraindications
- CautionConcurrent clopidogrel (choose pantoprazole)
Side effects
- Headache, diarrhoea
- Long-term: hypomagnesaemia, B12 deficiency, ↑ C. difficile, ↑ hip fracture
- Interstitial nephritis (rare)
Fetal & maternal notes
- • Most reassuring pregnancy data of any PPI (omeprazole)
- • Compatible with breastfeeding
Key interactions
Clopidogrel
Avoid↓ activation via CYP2C19
Methotrexate
Caution↑ MTX levels
Warfarin
Caution↑ INR
Clinical pearls
- 💡 Give omeprazole 40 mg PO the night before and morning of elective LSCS in high-risk aspiration cases (BMI, difficult airway)
- 💡 Try step-down after 8 weeks
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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