Ultop^® (Capsules, Lyophilisate) Instructions for Use

ATC Code

A02BC01 (Omeprazole)

Active Substance

Omeprazole (Rec.INN registered by WHO)

Clinical-Pharmacological Group

H⁺-K⁺-ATPase inhibitor. Antiulcer drug

Pharmacotherapeutic Group

Acid-related disorder treatment agents; antiulcer agents and agents for the treatment of gastroesophageal reflux disease (GERD); proton pump inhibitors

Pharmacological Action

An H⁺-K⁺-ATPase inhibitor, it is a weak base. It inhibits the activity of H⁺-K⁺-ATPase in the gastric parietal cells and thereby blocks the final stage of hydrochloric acid secretion. This leads to a decrease in the level of basal and stimulated secretion, regardless of the nature of the stimulus. Due to the reduction in acid secretion, it reduces or normalizes the effect of acid on the esophagus in patients with reflux esophagitis.

Omeprazole has a bactericidal effect on Helicobacter pylori. Eradication of H. pylori with the simultaneous use of omeprazole and antibiotics allows for rapid relief of disease symptoms, achievement of a high degree of healing of the damaged mucosa and sustained long-term remission, and reduces the likelihood of gastrointestinal bleeding.

Pharmacokinetics

When taken orally, it is rapidly absorbed from the gastrointestinal tract. It penetrates into the parietal cells of the gastric mucosa. Plasma protein binding is about 95%, mainly with albumin. It is biotransformed in the liver. Excreted by the kidneys – 72-80%, with feces – about 20%. T_1/2 is 0.5-1 hour. T_1/2 after intravenous administration is 40 minutes and does not change with long-term treatment.

In patients with chronic liver diseases, T_1/2 increases to 3 hours. In patients with impaired liver function, an increase in the bioavailability of omeprazole and a significant decrease in plasma clearance are noted.

Indications

For oral administration

Gastric and duodenal ulcer in the acute phase (including associated with Helicobacter pylori), reflux esophagitis, Zollinger-Ellison syndrome, erosive and ulcerative lesions of the stomach and duodenum associated with the use of NSAIDs.

Gastroesophageal reflux disease in children over 2 years of age, duodenal ulcer associated with Helicobacter pylori (as part of combination therapy), in children over 4 years of age.

For intravenous administration

Omeprazole for intravenous administration is indicated as an alternative to oral administration.

Gastric and duodenal ulcer; erosive and ulcerative lesions of the stomach associated with the use of NSAIDs; erosive and ulcerative lesions of the duodenum associated with the use of NSAIDs; stress ulcers; symptomatic gastroesophageal reflux disease; reflux esophagitis; Zollinger-Ellison syndrome; prevention of aspiration of gastric contents into the airways during general anesthesia (Mendelson’s syndrome).

ICD codes

Dosage Regimen

Capsules, Lyophilisate

Individual.

For oral administration, a single dose is 20-40 mg. The daily dose is 20-80 mg; frequency of application is 1-2 times/day. The duration of treatment is 2-8 weeks.

Omeprazole can be administered intragastrically through a nasogastric tube in an appropriate dosage form according to the method described in the instructions for the drug used.

Intravenous drip at a dose of 40-120 mg/day. The frequency of administration depends on the indications and the treatment regimen used.

Adverse Reactions

From the digestive system often – diarrhea, constipation, abdominal pain, nausea, vomiting, flatulence; rarely – dry mouth, stomatitis, gastrointestinal candidiasis, microscopic colitis. Cases of glandular cyst formation in the stomach have been reported in patients taking drugs that reduce gastric gland secretion over a long period of time; they resolve spontaneously with continued therapy.

From the liver and biliary tract: infrequently – increased activity of “liver” enzymes; rarely – hepatitis (with or without jaundice), liver failure, encephalopathy in patients with liver disease.

From the hematopoietic system rarely – leukopenia, thrombocytopenia, agranulocytosis, pancytopenia, hypochromic microcytic anemia in children.

From the nervous system often – headache; infrequently – vertigo, paresthesia, drowsiness; rarely – taste disturbance.

From the musculoskeletal system: infrequently – fractures of the hip, wrist bones and vertebrae; rarely – arthralgia, myalgia, muscle weakness.

From the skin and subcutaneous tissues infrequently – dermatitis, rash, itching, urticaria; rarely – alopecia, photosensitivity, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.

From the immune system rarely – hypersensitivity reactions (e.g., angioedema, fever, anaphylactic reaction/anaphylactic shock).

From metabolism rarely – hyponatremia; very rarely – hypocalcemia due to severe hypomagnesemia, hypokalemia due to hypomagnesemia; unspecified frequency – hypomagnesemia.

From the psyche infrequently – insomnia; rarely – agitation, aggression, confusion, hallucinations, depression.

From the organ of vision rarely – blurred vision.

From the respiratory system rarely – bronchospasm.

From the kidneys and urinary tract rarely – interstitial nephritis.

From the genital organs and mammary gland: rarely – gynecomastia.

General reactions infrequently – malaise; rarely – sweating, peripheral edema.

Contraindications

For oral administration

Hypersensitivity to omeprazole, substituted benzimidazoles; concomitant use with erlotinib, posaconazole, clarithromycin in patients with hepatic insufficiency, preparations of St. John’s wort; breastfeeding period.

Children under 18 years of age, except for: gastroesophageal reflux disease in children over 2 years of age and weighing more than 20 kg; duodenal ulcer associated with Helicobacter pylori – in children over 4 years of age and weighing more than 31 kg.

With caution: osteoporosis, significant spontaneous weight loss, frequent vomiting, dysphagia, vomiting blood or melena, as well as in the presence of a gastric ulcer (or suspicion of a gastric ulcer), pregnancy.

For intravenous administration

Hypersensitivity to omeprazole, other substituted benzimidazoles; children and adolescents under 18 years of age; simultaneous use with erlotinib, posaconazole, nelfinavir, atazanavir and preparations of St. John’s wort; simultaneous use with clarithromycin in patients with hepatic insufficiency.

With caution osteoporosis, hepatic insufficiency, vitamin B₁₂ deficiency, pregnancy, breastfeeding period. Simultaneous use with clopidogrel, itraconazole, warfarin, cilostazol, diazepam, phenytoin, saquinavir, tacrolimus, clarithromycin, voriconazole, rifampicin. Presence of the following “alarm” symptoms; significant weight loss, recurrent vomiting, vomiting blood (hematemesis), swallowing disorder, change in stool color (tarry stool – melena

Use in Pregnancy and Lactation

Use during pregnancy and breastfeeding is possible depending on the dosage form used.

Use in Hepatic Impairment

In patients with impaired liver function, an increase in the bioavailability of omeprazole and a significant decrease in plasma clearance are noted.

Concomitant use with clarithromycin is contraindicated in patients with hepatic insufficiency.

Pediatric Use

Contraindicated in children and adolescents under 18 years of age, except for: gastroesophageal reflux disease in children over 2 years of age and weighing more than 20 kg; duodenal ulcer associated with Helicobacter pylori – in children over 4 years of age and weighing more than 31 kg.

Geriatric Use

The rate of metabolism of omeprazole in elderly patients is somewhat reduced, but dose adjustment is not required.

Special Precautions

Before starting therapy, it is necessary to exclude the possibility of a malignant process (especially with gastric ulcer), because treatment with omeprazole may mask symptoms and delay correct diagnosis.

During the use of omeprazole, distortion of the results of laboratory tests of liver function and plasma gastrin concentration indicators is possible.

Although a causal relationship between the use of omeprazole/esomeprazole and fractures against the background of osteoporosis has not been established, patients at risk of developing osteoporosis or fracture against its background should be under appropriate clinical supervision.

The possibility of measuring magnesium content before starting therapy with proton pump inhibitors and periodic monitoring during treatment should be considered.

Effect on ability to drive vehicles and work with machinery

Since dizziness, blurred vision and drowsiness may be observed during therapy, patients should be cautious when driving vehicles or when working with machinery requiring increased concentration and speed of psychomotor reactions.

Drug Interactions

Cases of symptoms of toxic effects of benzodiazepines have been described with simultaneous use, which is associated with inhibition of the activity of CYP3A isoenzymes and, apparently, CYP2C9.

With simultaneous use with atracurium besilate, the effects of atracurium besilate are prolonged.

With simultaneous use with bismuth tripotassium dicitrate, an undesirable increase in bismuth absorption is possible.

With simultaneous use with digoxin, a slight increase in the plasma concentration of omeprazole is possible. At an omeprazole dose of 20 mg/day, the bioavailability of digoxin increases by 10%.

With simultaneous use with disulfiram, a case of impaired consciousness and catatonia has been described; with indinavir – a decrease in the plasma concentration of indinavir is possible; with ketoconazole – a decrease in the absorption of ketoconazole.

With long-term simultaneous use with clarithromycin, an increase in the plasma concentrations of omeprazole and clarithromycin occurs.

Decreased absorption of erlotinib was observed.

With simultaneous use with theophylline, a slight increase in the clearance of theophylline is possible.

Cases of increased plasma concentration of cyclosporine have been described with simultaneous use with cyclosporine.

With simultaneous use with erythromycin, a case of increased plasma concentration of omeprazole has been described, while the effectiveness of omeprazole decreased.

Omeprazole has been shown to interact with some antiretroviral drugs. The mechanisms and clinical significance of these interactions are not always known. An increase in pH value during omeprazole therapy may affect the absorption of antiretroviral drugs. Interaction at the level of the CYP2C19 isoenzyme is also possible. With the combined use of omeprazole and some antiretroviral drugs, such as atazanavir and nelfinavir, a decrease in their serum concentration is noted during omeprazole therapy. In this regard, the combined use of omeprazole with antiretroviral drugs such as atazanavir and nelfinavir is not recommended.

With simultaneous use of omeprazole and saquinavir, an increase in the serum concentration of saquinavir was noted.

Concomitant use of omeprazole with other drugs metabolized by the CYP2C19 isoenzyme, such as diazepam, warfarin (R-warfarin) or other vitamin K antagonists, phenytoin and cilostazol, may lead to a slowdown in the metabolism of these drugs. Monitoring of patients taking phenytoin and Omeprazole is recommended; a reduction in the phenytoin dose may be required. However, concomitant treatment with omeprazole at a daily dose of 20 mg does not affect the plasma concentration of phenytoin in patients taking the drug long-term. When using omeprazole in patients receiving warfarin or other vitamin K antagonists, monitoring of INR is necessary; in some cases, a reduction in the dose of warfarin or another vitamin K antagonist may be required. At the same time, concomitant treatment with omeprazole at a daily dose of 20 mg does not lead to a change in coagulation time in patients taking warfarin long-term. The use of omeprazole at a dose of 40 mg once/day led to an increase in C_max and AUC of cilostazol by 18% and 26%, respectively; for one of the active metabolites of cilostazol, the increase was 29% and 69%, respectively.

According to study results, a pharmacokinetic/pharmacodynamic interaction between clopidogrel (loading dose 300 mg and maintenance dose 75 mg/day) and omeprazole (80 mg/day orally) was noted, which leads to a decrease in exposure to the active metabolite of clopidogrel by an average of 46% and a decrease in maximum inhibition of ADP-induced platelet aggregation by an average of 16%. The clinical significance of this interaction is unclear. An increased risk of cardiovascular complications with the combined use of clopidogrel and proton pump inhibitors, including omeprazole, has not been shown in randomized clinical trials. The results of a number of observational studies are contradictory and do not provide a clear answer about the presence or absence of an increased risk of thromboembolic cardiovascular complications with the combined use of clopidogrel and proton pump inhibitors.

With simultaneous use of omeprazole and tacrolimus, an increase in the serum concentration of tacrolimus was noted.

A slight increase in the plasma concentration of methotrexate has been reported in some patients with its simultaneous use with proton pump inhibitors. When using high doses of methotrexate, omeprazole should be temporarily discontinued.

Omeprazole is metabolized by the CYP2C19 and CYP3A4 isoenzymes. Concomitant use of omeprazole and inhibitors of the CYP2C19 and CYP3A4 isoenzymes, such as clarithromycin, erythromycin and voriconazole, may lead to an increase in the plasma concentration of omeprazole due to a slowdown in the metabolism of omeprazole. Concomitant use of omeprazole and voriconazole leads to a more than twofold increase in the AUC of omeprazole. Due to the good tolerability of high doses of omeprazole, no dose adjustment of omeprazole is required with short-term concomitant use of these drugs.

Drugs that induce the CYP2C19 and CYP3A4 isoenzymes, such as rifampicin and preparations of St. John’s wort, when used concomitantly with omeprazole, may lead to a decrease in its plasma concentration due to acceleration of its metabolism.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Over-the-Counter

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.