Omeprazole liquid, formally known as Omeprazole oral suspension, is a liquid form on 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, and children or patients with swallowing difficulties.
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: A ‘Special’ Medication
Currently, in the UK, Omeprazole liquid is 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 a patient’s treatment needs.
Because Omeprazole liquid is a ‘special’ , most 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 flavor of Omeprazole liquid. I recently saw a request for raspberry Omeprazole oral suspension, 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 Powder For Oral Suspension
Since I wrote this post originally, a newly licensed liquid of Omeprazole was introduced to the market. Rosemont launched two versions of Omeprazole liquid, which comes in the form of two different products:
- Omeprazole 2mg/ml powder for oral suspension (= 10mg/5ml)
- Omeprazole 4mg/ml powder for oral suspension (= 20mg/5ml)
Both of the above formulations are the only products licensed for the management of gastro-oesophageal reflux disease in children, including infants from 1 month of age.
Omeprazole powder for oral suspension requires reconstitution with water. Please refer to the product information leaflet on how to mix the powder with water and how much water is needed for reconstitution. A pharmacy team can mix Omeprazole powder when medication is collected from the pharmacy.
How Does The Availability Of Licensed Omeprazole Liquid Affect The Supply To Patients?
Since the launch of licensed versions of Omeprazole liquid, some patients may no longer get Omeprazole which has been previously made as ‘special.’ This may not be a problem for most patients, however, it is possible, for example, that a child does not accept a new formulation.
Since a licensed formulation of liquid Omeprazole exists, doctors are required to prescribe this form of medicine in the first instance before an unlicensed formulation is prescribed.
Companies that make Omeprazole ‘special’ liquid ask pharmacies to provide a letter from GP explaining the reasoning for the need for unlicensed preparation (Omeprazole liquid as ‘special’) rather than licensed preparation (Omeprazole powder for oral suspension).
The need cannot be simply a clinical need, for example, patients require medication as he/she suffers from gastro-oesophageal reflux disease. An example of the need could be non-compliance (patient not taking medication) when a licensed product was prescribed.
Omeprazole Liquid: Indicated Use
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: The Strength Of Formulations
Omeprazole liquid 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 Liquid: Common Side Effects
Common side effects experienced by patients taking Omeprazole include:
- Gastrointestinal side effects:
- Abdominal pain
Omeprazole Liquid Cost
The price of Omeprazole liquid will only apply to private patients. 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 patient’s age (16 or under, 16-18 and in full-time education or over 60 years of age).
Factors affecting the cost
- Strength prescribed: 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, which can vary between pharmacies; for example, for private prescriptions, you would expect to pay an additional 10%-20% on top of the cost of the product + VAT.
The cost of Omeprazole liquid
- 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 final price would carry additional 20% charge for private prescription, for example for Omeprazole 20mg/5ml the final price would be £44.37 + £8.87 (VAT) + 20% private mark-up = £63.89 for 150ml.
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 production cost of specials.
Omeprazole Solution: What Are The Alternatives?
In the context of this post, the only alternative forms for Omeprazole liquid are the dispersible and orodispersible tablet formulations.
Dispersible and orodispersible tablets
In practice, dispersible formulation of Omeprazole tablets is sometimes prescribed instead of Omeprazole liquid. When placed in water, dispersible tablets dissolve to give a solution, which can be given to babies or toddlers according to the prescribed dose.
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, the 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. Not all the liquid may 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 most commonly is 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.
Can you use gastro-resistant capsules to prepare a liquid?
Omeprazole is most commonly prescribed as 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; however, in practice, I have never seen this type of Omeprazole formulation prescribed to babies or toddlers since dispersible and orodispersible formulations exist.
- McGowan, B., Bennett, K., Tilson, L. and Barry, M., 2005. Cost effective prescribing of proton pump inhibitors (PPI’s) in the GMS Scheme. Irish medical journal, 98(3), pp.78-79. Available at:https://www.researchgate.net/profile/Lesley-Tilson/publication/7869483_Cost_effective_prescribing_of_proton_pump_inhibitors_PPIs_in_the_GMS_Scheme/links/0046351d1318f490c8000000/Cost-effective-prescribing-of-proton-pump-inhibitors-PPIs-in-the-GMS-Scheme.pdf Accessed on 16/12/2019
- Liu, F. and Shokrollahi, H., 2015. In vitro dissolution of proton-pump inhibitor products intended for paediatric and geriatric use in physiological bicarbonate buffer. International journal of pharmaceutics, 485(1-2), pp.152-159. Available at: https://www.sciencedirect.com/science/article/pii/S0378517315002100 Accessed on 16/12/2019
- Langtry, H.D. and Wilde, M.I., 1998. Omeprazole. Drugs, 56(3), pp.447-486. Available at: https://link.springer.com/article/10.2165/00003495-199856030-00012 Accessed on 15/12/2019