Omeprazole

In My Humble Opinion
1

Not looking for medical advice, just anecdotes.

I have taken Omeprazole for a while. Started on the prescription stuff, then switched to Prilosec OTC. Finally tried the CVS brand and it worked as well, so i saved the couple bucks a month. Last time however I wasn’t paying much attention. And got a different box of the CVS stuff. This is in capsules. About a two weeks ago I started getting heartburn again, and was popping a couple Tums a day again. Then last night I woke up with the miserable acid in the lungs things.

So I just went and got the normal CVS tablets again. The thing that has me wondering though is that the capsules are called “Omeprazole magnesium” The tablets which I have used for a couple years now are just Omeprazole. But the Prilosec OTC I used without problem before that are also omeprazole Magnesium.

Do the two compound work different(or are they even different at all) or do youiknow of anyone else who had problems with the capsules? I’m just kind of nervous that maybe the whole Omeprazole thing is wearing off, and that would really suck. This stuff has made my life so much better. I guess I’ll know in a week or so if it’s all back to normal.

2

Are you taking the capsules at bedtime? Because those things can get stuck in your esophagus and create ulcers if you lie down too soon after swallowing them. This doesn’t usually happen with tablets, but capsules get sticky on the outside when they get wet.

3

no, I take them in the morning

4

When my patients have breakthrough symptoms on omeprazole and similar medications, I make sure they’re taking the med on an empty stomach, a good 30 minutes before eating. If taken with food, the medication is not nearly as effective.

If that’s not it, I worry that the problem is more than just heartburn, and consider testing for H. Pylori infections, along with other GI pathology.

5

I am fortunate (?) to have a mutation in my 2C9 gene, the gene whose protein metabolizes omeprazole. This makes me a slow metabolizer of omeprazole, so one OTC tablet lasts about 30 hours or so. I was taking omeprazole OTC for a while, but then switched to OTC famotadine, which is cheaper. I haven’t had breakthrough problems with either one, which I take about an hour before bedtime.

6

Omeprazole magnesium is (as I understand it) a salt of two molecules of omeprazole “bound” together by a magnesium ion. I believe that these two omeprazole ions are the S- enantiomer;the pharmaceutically active form of the drug.

Products marketed as “Omeprazole” are not magnesium (or sodium, or any other kind of) salts; it is just the molecule itself. I believe these are all racemic mixtures, containing both the R and the S enantiomers of the drug and the R form is converted into the S form by the body’s metabolic process.

There is a small but chemically real differene between drugs called "omeprazole’ and ones called “omeprazole magnesium” - one is a salt and may not be racemic, both of which could, theoretically, affect the rate of uptake and effectiveness of the drug in individual patients. I’m not actually familiar with these drugs, nor a good enough chemist or pharmacokineticist, to actually say that this is the case, but it’s certainly plausible.

Also, gelcaps, tablets and capsules are all different types of dosage forms (obviously) and very well could have different behaviour in a patient, most likely in the form of changing the rate of dissolution of the drug and in how well/whether the drug molecule is being protected from stomach acid etc.

Keep in mind that while various generics/competitive brands are designed to be the same as “brand name” ones, that determination is made on a statistically representative population: individuals can, and do, vary.

So, in short, it’s quite possible to get different results when you switch dosage forms and switch drugs, even if the difference is a very trivial chemical one. Stick to one form of one drug product and you should get more consistent results.

Otherwise, talk to your doctor (or do so in addition to my post, as I am most assuredly not a doctor, and, honestly, not even a chemist any more!).

7

My husband sometimes has breakthrough symptoms on omeprazole because he eats late in the day or eats the wrong things. You might want to examine what you are eating and when to see if that’s what is exacerbating the reflux. In his case, he works the graveyard shift and eats when he gets home, then goes to bed within a couple of hours and wakes up choking and coughing, or he eats chocolate or peanuts within a few hours of going to bed with the same results. If he is more careful about eating in relation to his bedtime he has much better results.

8

I know everyone was in unbearable suspense.
Well after 3 days back on the pills things seem back to normal/good. So i guess my acid reflux don’t do list now has omeprazole capsules, added to the previous with habaneros and more than three pieces of Churches chicken.

9

I just wanted to add something that might help those who have insurance. We can buy 60 pills for $12 under our insurance. We pay $11 over the counter for the Prilosec, for 14 tablets. Same 20mg. I’ll let you do the math.

Of course you keep having to go back to the doctor for the refills.

10

Having tried various ppis without success including Dexilant, what’s the general consensus about the most effective prescription or OTC? It may be worth trying one again, especially now knowing to take them on an empty stomach (like rite after waking up).

11

We did that with my husband’s prescription until the insurance company got wise* and decided that anything available over the counter was not covered under our insurance.

  • realized that they were actually paying for something
12

Prescription Omeprazole is double the strength of the OTC stuff. And for me, the Rx variety works better.

Along with being nicer to my wallet.
~VOW

13

Mine was the same strength, I checked both the Prilosec box and the Rx bottle. Could be different strength levels being prescribed I guess.

Now I wonder if my insurance will wise up. Heh.

14

I’m surprised insurance will even pay for the prescription for the same dosage, given that it’s the same strength and now available OTC.

Note that the stuff isn’t really 12.00 from insurance, that’s just your copay. Your insurance is likely paying 48 or so for their share. So the net cost is the same, you’re just isolated from it.

FWIW, Amazon.com sells brand-name Prilosec tablets for something like 20-22 dollars for a 42-count package, if you do the “subscribe and save” thing. As my husband and I are both on it daily (he has Barrett’s and has a rather strong incentive to keep the reflux under control as much as possible), this is a great cost savings.

It can be more of a pain to get reimbursement from flex spending if you get the stuff OTC, of course. Which reminds me I need to get the doc to write a prescription for the OTC stuff, so I can get reimbursed.

Interesting about the omeprazole with / without magnesium.

I too would chalk it partly up to the fact that the troublesome dosage was via capsule vs. tablets, as that can indeed affect absorption. I have also found that when reducing one’s dosage (I was on 80 mg a day for a bit a couple years ago), you can get rebound acid, so your symptoms will actually be worse for a couple of days when you reduce the dosage. I wound up having to sloooowly titrate the stuff down (went from 80 to 60 by taking 80 / 60 on alternating days for a bit, then going down to 60 every day, etc.).

15

Yeah, I think for Rx there’s both the regular 20mg that’s also available OTC, and also a 40mg version.

Fake edit: Yeah, from wikipedia:

It’s weird that the only kind I ever see OTC is 20mg (though if you notice, the capsule version (omeprazole magnesium,) is 20.6 mg, IIRC.)

16

See that there has been a lot of discussion abt Omeprazole Magnesium. Want to add: I bought some six days ago because I was out of my regular OTC Sam’s Club version without magnesium. I realized today the brain fog and headaches have been occuring since I have been taking the CVS w/magnesium. I will know in a few days if this is the cause but I think so.

Also on FAMOTIDINE…I read in a Readers Digest book on health that as an H2 BLOCKER it is suspected of causing dementia…“WHAT WORKS” 2008, p. 203

17

For folks who don’t recall offhand (like me), H2 blockers are things like Tagamet / cimetidine and Zantac / ranitidine.

Prilosec OTC, per their web page, is omeprazole magnesium. I just went to walgreens.com and looked for omeprazole and they do carry versions with/without magnesium. It had never occurred to me to look. It looks like the capsules have magnesium and the tablets don’t (for the generic, anyway).

Since this thread came out, my husband accidentally found out that his insurance would cover prescribed omeprazole - the doctor was writing a lot of prescription updates for him and wrote one for that! He didn’t notice, and mailed 'em all in… and was surprised to get a 3 months supply (of the generic) for quite a bit less than the OTC (even factoring in the insurance’s portion).

So when I was in for my latest colonoscopy, I asked the doc for a scrip. Their office was able to transmit it electronically - so a week or so later I had a 90 day supply. Total cost (including insurance) less than 13 dollars. My mind is still boggling. I can’t tell whether it’s the magnesium version, doesn’t seem to be - and it’s capsules which I don’t like quite as much. But for 13 dollars (vs nearly 50 for the same amount of OTC) it’s worth it.

18

Interesting thread. I am not sure the formulation is the same in Canada. But my wife used to take prescription losec (what they called prilosec here). Then two things happened. The patent ran out and generic omeprazole came out and losec was changed to capsules (because they could patent it?). My wife was under the impression that the capsules didn’t work nearly as well. She was switched to omeprazole and is happy with that. She always takes it upon awakening, then waits at least a half hour before breakfast. In Canada, they are both prescription only.

19

Around here’s it’s cheaper than that at both Walmart and Target. I got some last week at Walmart that was $18 for a 42 count box, and they’d stuck a $2 off coupon on it to boot, which is nothing I’ve ever seen on any of their brand of products before.