Fact Checked

Is Omeprazole an Antacid?

If you’ve ever been woken up at night by a burning, uncomfortable feeling behind your chest or experienced a sour stomach, you’re likely familiar with heartburn and indigestion. Although many people experience heartburn or indigestion occasionally, approximately 15 to 30 percent of Americans suffer from a chronic form of the condition called gastroesophageal reflux disease, or GERD. People who are diagnosed with GERD experience heartburn or indigestion at least twice per week. The prevalence of GERD has been increasing in the United States, and the International Foundation for Gastrointestinal Disorders notes that this is likely due to a number of factors, including the rising obesity rates, as people who are overweight or obese are more likely to suffer from GERD. Depending on the severity of your symptoms, there are several different ways to treat GERD. Many people start with lifestyle changes like dietary adjustments and weight loss, but some patients also benefit from medications like proton pump inhibitors, antacids, and H2 blockers. With the number of GERD medications available these days, it can be hard to keep them all straight. One of the most popular medications for the treatment of GERD is omeprazole, and people often wonder, “Is Omeprazole an antacid?”

What Is Omeprazole?

Omeprazole is a generic drug that is also sold under the brand name Prilosec. The medication belongs to a class of drugs called proton pump inhibitors (PPIs), which are the most widely prescribed class of medications in the world. Omeprazole and Prilosec were originally sold by prescription only until the U.S. Food and Drug Administration (FDA) approved Prilosec OTC (over the counter) as the first over the counter treatment for GERD in June 2003.  Omeprazole is available over the counter at lower strengths and is also available by prescription at higher strengths. More than 59 million prescriptions were written for the drug in the United States in 2017 alone, making it the seventh most commonly prescribed drug in the country. There are other PPIs like lansoprazole (Prevacid), esomeprazole (Nexium), and famotidine (Pepcid).

What Conditions Is Omeprazole Used to Treat?

Omeprazole is used to treat a number of digestive conditions, including GERD, Zollinger-Ellison Syndrome, stomach ulcers, duodenal ulcers, and erosive esophagitis. 

Gastroesophageal Reflux Disease 

Gastroesophageal reflux disease, also known as GERD or heartburn, is a condition that is often attributed to a weak or dysfunctional esophageal sphincter. The esophageal sphincter is responsible for allowing food and liquids into the stomach and then sealing back up to prevent erosive gastric acid and digestive enzymes from flowing backward from the stomach into the esophagus. Although most people experience heartburn or acid reflux every once in a while, people with gastroesophageal reflux disease experience these symptoms at least twice per week over an extended period of time. GERD is problematic because in addition to being uncomfortable, it can also cause long term damage to the esophagus. When exposed to stomach acid repeatedly over an extended period of time, the esophagus can experience inflammation, narrowing, development of open sores, or a condition called Barrett’s esophagus, which is associated with an increased risk of esophageal cancer. People with GERD often experience some or all of the following symptoms:

  • Sharp or burning pain behind the breast bone
  • Sore throat
  • Coughing, wheezing or needing to clear your throat
  • Nausea
  • A repeated sour or bitter taste in the mouth
  • Tightness in the chest or upper abdomen
  • Regurgitation
  • Difficulty swallowing
  • Hoarseness

Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome is a condition that causes tumors to form in the pancreas or upper small intestines. These tumors secrete large amounts of a hormone called gastrin, which causes the stomach to overproduce acid. As a result of the extra acid, people with Zollinger-Ellison syndrome often have peptic ulcers, diarrhea, and other symptoms.  Most people are diagnosed with Zollinger-Ellison syndrome between the ages of 20 and 50, but the condition may be present at any time in life. Symptoms associated with Zollinger-Ellison syndrome include:

  • Burning, aching, or discomfort in the upper abdomen
  • Nausea and vomiting
  • Bleeding in the digestive tract
  • Abdominal pain
  • Decreased appetite
  • Diarrhea
  • Acid reflux and heartburn

Is Omeprazole an Antacid?

Omeprazole is not an antacid; it is a proton pump inhibitor. Antacids are fast-acting medications that are designed to begin reducing heartburn symptoms immediately. They work by weakening the acid affecting the stomach lining through the use of ingredients like calcium carbonate, magnesium hydroxide, aluminum hydroxide, and/or sodium bicarbonate. Antacids are an excellent tool for dealing with symptoms associated with occasional heartburn or indigestion, but they do not reduce the likelihood of heartburn occurring again; they simply lower the acidity of the stomach for a few hours until symptoms subside. Proton pump inhibitors like omeprazole are designed to prevent the recurrence of GERD and other digestive problems by reducing the overall amount of acid in the stomach. 

How Does Omeprazole Work?

Proton pump inhibitors like omeprazole work by blocking the action of the H+/K+ ATPase enzyme, which is found in parietal cells of the stomach. The proton pumps referred to in the name of the drug class actually refer to the enzymes, which are responsible for the final production of hydrochloric acid. Hydrochloric acid is the main component of stomach acid, so shutting down the pumps that produce hydrochloric acid helps reduce acidity. PPIs work by decreasing the amount of acid made by proton pumps, bringing acidity levels down and preventing the creation of excess acid. Proton pump inhibitors were first introduced in 1981 and are considered the most effective class of medications for reducing stomach acid.

What Dosage of Omeprazole Should I Take?

Most adults find that taking between 20 to 40 mg of omeprazole once or twice daily is sufficient to control their symptoms. Omeprazole is available over the counter in the form of 20 mg strength delayed-release capsules and is available by prescription in the form of delayed-release capsules and suspension at higher strengths. Over the counter omeprazole is sold in quantities of 14 because the medication is not supposed to be used for more than 14 days in a row without a doctor’s advice. While omeprazole is typically taken for anywhere from ten days to eight weeks, some patients with chronic GERD or other digestive conditions will need to take this medication for extended periods of time at the direction of their healthcare provider. Omeprazole works best when it is taken on an empty stomach, so it should be taken prior to eating a meal. Omeprazole capsules should be swallowed whole and should not be crushed, divided, or chewed. Omeprazole is not designed to start working immediately, so you’ll need to give it about two and a half hours to kick in. Patients needing immediate relief from their symptoms can take the medication with a fast-acting acid reducer, such as Tums or Maalox. If taking the oral suspension form of omeprazole, the medication must be prepared, mixed into apple juice or apple sauce, and taken 30 minutes before a meal.

How Much Does Omeprazole Cost?

There are several factors that influence the cost of omeprazole, which is an affordable medication for most people. There are many different PPIs on the market in terms of both brand name and generic drugs, and several PPIs are also available over the counter, including omeprazole. The cost of omeprazole is partially determined by whether it is purchased over the counter or by prescription, as over the counter medications are often more expensive because of the convenience associated with their purchase. Additionally, the strength of the medication will also affect the cost. The cash price for a one-month supply of 40 mg capsules is approximately 57 dollars when purchased by prescription, while 20 mg capsules would cost 26 dollars for a one month supply. The over the counter version of the medication is generally sold in bottles of 14 pills, as they are intended to be taken for no more than two weeks at a time.  Omeprazole is covered by most insurance plans, including Medicare and Medicaid, as well as most commercial insurance programs. However, insurance may not always offer the best prices on prescription drugs. Pharmacy discount card programs like USA Rx also offer savings on all FDA-approved brand name and generic medications, including omeprazole, and patients can sign up for free. 

What Benefits Are Associated With Omeprazole?

Unlike antacids, which provide heartburn relief by temporarily weakening the acid in your stomach, proton pump inhibitors like omeprazole work by reducing the production of excess stomach acid. There are several benefits associated with omeprazole’s ability to control acid production over an extended period of time:

  • Affordable medication that is accessible for most people
  • Available over the counter at a strength appropriate to control heartburn that occurs for up to two weeks every four months
  • Blocks the action of the majority of the stomach pumps that produce acid
  • Reduces the amount of stomach acid that causes heartburn
  • Relief from heartburn symptoms lasts up to 24 hours when taking one pill per day

What Risks Are Associated With Omeprazole?

In general, proton pump inhibitors are not intended for long term use. However, some people do take them for extended periods of time due to chronic GERD and other conditions, and there are some risks associated with long term use of the medication. Use of PPIs for a prolonged period of time (longer than the indicated dosing period) may increase the risk of the following conditions:

  • Bone weakening conditions, such as osteoporosis, leading to bone fractures in the spine and wrist in postmenopausal women, particularly when taken for a year or more at a high dose
  • Kidney disease and other problems
  • Bacterial inflammation of the colon (Clostridium difficile-associated diarrhea) due to disruption of the gut microbiome
  • Nutritional deficiencies, such as vitamin B-12 and magnesium deficiencies
  • Cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) 
  • Fundic gland polyps
  • Pneumonia
  • Heart-related conditions and cardiovascular issues

Some groups of people are considered more likely to experience negative effects associated with the long term use of PPIs. Risk factors include:

  • Being of Asian descent, as the body may require a different dosage due to a longer length of time needed to process PPIs
  • Medical conditions like liver disease
  • History of low magnesium levels
  • Being pregnant or planning to become pregnant
  • Breastfeeding

What Side Effects Are Associated With Omeprazole?

Side effects associated with omeprazole are fairly uncommon and most do not require medical attention. However, some can be serious. Side effects associated with omeprazole that do not normally require medical attention include:

  • Chest pain
  • Cough
  • Trouble breathing or shortness of breath
  • Ear congestion
  • Heartburn
  • Muscle pain
  • Runny nose
  • Unusual drowsiness
  • Body aches or pain
  • Constipation
  • Diarrhea or loose stools
  • Dizziness
  • Gas
  • Loss of voice
  • Nasal congestion
  • Sneezing

Serious side effects associated with omeprazole are rare, but they can occur. Patients should seek immediate medical advice if they experience any of the following serious side effects while taking omeprazole:

  • Bleeding or crusting sores on the lips
  • Bloody or cloudy urine
  • Continuing ulcers or sores in the mouth
  • Fever
  • The feeling of discomfort or illness
  • Joint pain
  • Muscle aches or cramps
  • Red or irritated eyes
  • Sore throat
  • Unusual bleeding or bruising
  • Back, leg, or stomach pain
  • Blisters
  • Chills
  • Difficult, burning, or painful urination
  • Frequent urge to urinate
  • Frequent heartburn
  • Itching, skin rash
  • Loss of appetite
  • Pain
  • Redness, tenderness, itching, burning or peeling of the skin
  • Sores, ulcers, or white spots on the lips, in the mouth, or on the genitals
  • Unusual tiredness or weakness

Are There Any Drug Interactions Associated With Omeprazole?

Certain drugs and supplements should not be taken with Omeprazole. These medications include:

  • Clopidogrel
  • St. John’s wort
  • Delavirdine
  • Rifampin
  • Risedronate
  • Nelfinavir
  • Rilpivirine

Other drugs may interact with Omeprazole but can be taken with them under certain conditions. Make sure to tell your medical professional if you are taking any of the following medications:

  • Aripiprazole
  • Bisphosphonates
  • Carvedilol
  • Citalopram
  • Cyclosporine
  • Escitalopram
  • Fosphenytoin
  • Hydrocodone
  • Methotrexate
  • Phenytoin
  • Saquinavir
  • Warfarin or other vitamin K antagonists
  • Amphetamine
  • Atazanavir
  • Bosentan
  • Cilostazol
  • Clozapine
  • Dextroamphetamine
  • Antifungal drugs
  • Iron
  • Mesalamine
  • Methylphenidate
  • Raltegravir
  • Tacrolimus
  • Voriconazole

Is Omeprazole Safe for Use in Pregnant and Breastfeeding Women?

Approximately 30 to 50 percent of women experience heartburn during their pregnancies, and many are interested in the safety of omeprazole and other proton pump inhibitors.  Omeprazole is an FDA Category C medication for pregnant women, meaning that the effects of the medication on developing fetuses has not been conclusively studied. However, all proton pump inhibitors besides omeprazole are categorized by the FDA as Category B medications, meaning they are safe for use during pregnancy, and there is ample data that suggest that omeprazole should be categorized similarly.   However, the manufacturer advises that each woman speak with their doctor to determine if the benefit of taking omeprazole during pregnancy may outweigh the risk. Omeprazole is generally considered safe to use while breastfeeding, as studies have shown that while PPIs do pass through breast milk to a nursing infant, no negative side effects have been demonstrated, and the amount that passes through the breast milk is less than the prescribed dose given to infants of the same age. Some infants suffer from acid reflux and receive a small dose of Zantac as a treatment for the condition; the dose given to infants is less than the amount that passes through breast milk.

Published July 14th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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