Understanding Prilosec and Its Usage

What is Prilosec?

Prilosec is the brand name for the generic drug omeprazole. It belongs to a group of medications called proton pump inhibitors (PPIs).

Prilosec is available as a prescription drug as well as an over-the-counter medication. Prilosec OTC and prescription Prilosec contain the same active ingredient, omeprazole. The main differences between prescription and OTC Prilosec are the available strengths, dosage forms, and approved indications (what they’re used for). Notably, the OTC products are only available as 20 milligrams (mg) products.

Omeprazole (Prilosec) is commonly used to treat frequent heartburn and symptoms of gastroesophageal reflux disease (GERD).

Heartburn is a symptom (burning pain in the chest) that occurs due to acid reflux (backflow of stomach acid into the esophagus). GERD is a condition in which there is chronic (long-lasting) acid reflux. Find out how to tell the difference between heartburn and GERD.

Keep in mind that dyspepsia (indigestion) is different from heartburn and refers to fullness and stomach discomfort after eating.

OTC omeprazole is used to alleviate heartburn, while the prescription formulation is approved to treat other stomach conditions caused by excess stomach acid, such as GERD, erosive esophagitis, stomach ulcers or bleeding, and Barrett’s esophagus. It can also be used as part of the treatment regimen for Helicobacter pylori (H. Pylori) infection.

Prilosec Dosage Forms and Strengths

Dosage forms and strengths are the main differences between OTC and prescription omeprazole.

OTC Prilosec (omeprazole and other OTC brands) is available as:
- Oral tablets, capsules, and orally disintegrating tablets (ODT): 20 m.
Prescription omeprazole is available as:
- Delayed-release capsules 10 mg, 20 mg, 40 mg
- Delayed-release oral suspension (granule packets): 2.5 mg and 10 mg

How Does Prilosec (Omeprazole) Work?

Prilosec is a proton pump inhibitor (PPI). It works by reducing the amount of acid made by the parietal cells in the stomach lining. Backflow of stomach acid into the esophagus (the tube that connects the throat and stomach) causes heartburn and can lead to esophagitis (inflammation and damage of the esophagus).

Common Uses of Prilosec

Prescription-strength Prilosec is used to:

Treat symptoms of gastroesophageal reflux disease (GERD).
Treat erosive esophagitis (damage to the esophagus caused by GERD).
Prevent further damage to the esophagus and allow it to heal.
Treat duodenal and gastric ulcers (stomach ulcers).
Treat and prevent ulcers caused by Helicobacter pylori bacteria.
Reduce stomach acid in people with Zollinger-Ellison syndrome (a condition in which there is too much stomach acid).

Over-the-counter Prilosec is used to treat frequent heartburn (heartburn that occurs at least two days a week). It works by reducing the amount of acid the stomach makes.

Prilosec OTC starts working in 1 to 4 days and does not provide immediate relief from heartburn. Therefore, if you need immediate heartburn relief, Tums, Pepto-Bismol, and Maalox are some commonly used products. Your doctor can help you determine the best treatment option.

Find Discounts On Heartburn & GERD Medications

The 14-Day Rule for OTC Prilosec

FDA Guidelines on Prilosec OTC Usage

Prilosec OTC (omeprazole magnesium delayed-release tablet 20 mg) is available without a doctor’s prescription for use by adults 18 years of age and older to treat frequent heartburn (heartburn that occurs on more than 2 days a week).

The U.S. Food and Drug Administration (FDA) has issued the following guidelines for taking Prilosec OTC safely:

Take omeprazole (Prilosec OTC) by swallowing the tablet with a glass of water first thing in the morning on an empty stomach. Make sure you swallow the tablet whole. Do not cut, crush, or chew the delayed-release tablet.
You can take Prilosec OTC once a day for 14 days to treat frequent heartburn.
It can take 1-4 days for the medicine to have its full effect and give you complete relief from heartburn. You should take Prilosec OTC daily for the full 14-day course of treatment.
Do not take Prilosec OTC for more than 14 days without talking to your healthcare provider. Long-term treatment with omeprazole has specific indications, for example, if you are diagnosed with GERD.
If you miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take more than one tablet in 24 hours.
You can repeat a 14-day course of Prilosec OTC every 4 months. Do not take the medicine more frequently than every 4 months (3 times a year) without talking to your healthcare provider.

Note: Prescription Prilosec may be used for a longer period of time to treat certain conditions under the supervision of a healthcare professional.

The Reason Behind the 14-Day Limitation: What Can’t You Take Prilosec For More Than 14 Days?

You can’t take Prilosec OTC for more than 14 days due to a risk of serious side effects, including hypomagnesemia (low blood magnesium levels).

Potential Risks of Extended Use: What Happens If You Take Prilosec Long-Term?

Extended use of omeprazole (Prilosec) for more than 3 months is associated with a risk of hypomagnesemia (low magnesium levels in your blood). Low magnesium can lead to signs and symptoms such as fatigue, dizziness, confusion, muscle twitches, irregular heartbeats, and seizures. In addition, hypomagnesemia (low magnesium) can lead to other electrolyte imbalances such as hypocalcemia (low calcium) and hypokalemia (low potassium).

Taking omeprazole long-term (for more than a year) can increase the risk of:

Osteoporosis and bone fractures
Serious infections such as Clostridium difficile-associated diarrhea
Vitamin B12 deficiency
Fundic gland polyps (a type of gastric polyp)

Other risks of taking omeprazole (Prilosec) include:

Severe allergic reactions, including skin reactions such as Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP)
Acute tubulointerstitial nephritis (kidney injury)
New or worsening lupus: cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE)
Drug interactions with medications such as clopidogrel, methotrexate, and rifampin and herbal products like St. John’s wort

Risks of Taking Prilosec for More Than 14 Days

Short-Term versus Long-Term Use

Common side effects of short-term omeprazole use include gas, constipation, nausea, vomiting, diarrhea, headache, and erection problems in men. These side effects are usually temporary and go away once your body adjusts to the drug. However, long-term use of omeprazole can increase the risk of more serious health problems.

Why Can’t You Take Prilosec Long-Term?

Long-term use of omeprazole can increase the risk of low serum magnesium levels, bone fractures, serious gut infections, vitamin B12 deficiency, and fundic gland polyps (small growths in the fundus or upper part of the stomach).

Serious Side Effects of Prilosec

Stop taking omeprazole (Prilosec) and seek emergency medical care if you develop the following serious side effects after taking Prilosec:

Skin rash, hives, itching, blistering, peeling
Mouth sores
Fever and flu-like symptoms
Swelling of the face, eyes, lips, tongue, or throat
Difficulty breathing
Difficulty swallowing
Hoarseness
Fast, pounding, or irregular heartbeat
Muscle spasms or muscle twitching
Uncontrolled shaking
Unusual tiredness
Dizziness or lightheadedness
Seizures
Severe watery diarrhea and stomach pain with or without fever
Skin rash on the cheeks
New or worsening joint pain
Problems with urination

Medical Complications from Overuse

Long-term use of proton pump inhibitors (PPIs) can increase the risk of several medical complications, including:

Kidney problems: PPIs have been linked to an increased risk of acute interstitial nephritis, acute kidney injury, chronic kidney disease, and end-stage renal disease.
Cardiovascular risks: Some studies have found a link between PPI use and major cardiovascular events like heart attack and stroke.
Bone health: Long-term use of PPIs can lead to weakening of the bones (osteoporosis) and an increased risk of hip, spine, and wrist fractures.
Infections: Research suggests that proton pump inhibitors, including omeprazole (Prilosec), can affect the gut microbiota (balance between good and bad gut bacteria). This can increase the risk of infections such as Clostridium difficile-associated diarrhea, community-acquired pneumonia, and coronavirus disease (COVID-19).
Micronutrient deficiencies: Reports of hypomagnesemia (low magnesium) in PPI treated patients has led the FDA to issue a warning against overuse of these drugs. Long-term PPI use can also lead to vitamin B12 deficiency, iron deficiency anemia, hypocalcemia (low calcium), and hypokalemia (low potassium).
Cancer: Meta-analysis of studies shows that long-term use of proton pump inhibitors may increase the risk of gastric cancer (stomach cancer), pancreatic cancer, colorectal cancer, and liver cancer.
Liver disease: PPIs can lead to unfavorable clinical outcomes in people with chronic liver disease.
Dementia: Studies have shown that long-term PPI users are at an increased risk of developing dementia.
Rebound acid hypersecretion (more acid in the stomach) after stopping omeprazole or other PPI therapy due to a compensatory increase in stomach acid production.

Recommendations for Safe Use of Prilosec and Other PPIs

The recommendation is to use the lowest dose of a proton pump inhibitor for the shortest time necessary to treat your condition or control your symptoms. If you have a chronic condition, your healthcare provider will reassess you periodically to see if you still need to take the PPI.

The recommended duration of PPI therapy is 2 to 12 weeks for managing acid-related conditions such as gastroesophageal reflux disease, peptic ulcer disease, and H. pylori infection. Long-term or indefinite PPI therapy may be considered for the management of severe erosive esophagitis (acid damage to the esophagus) and Barrett’s esophagus (precancerous changes in the lining of the esophagus).

Treatment Options for GERD

The American Gastroenterological Association (AGA) recommends managing GERD with PPIs and other acid reducers. Treatment options include:

Proton Pump Inhibitors

Nonprescription proton pump inhibitors include omeprazole (Prilosec OTC), esomeprazole (Nexium), and lansoprazole (Prevacid).

Prescription-strength proton pump inhibitors include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), and rabeprazole (Aciphex).

Other Medications for GERD

OTC Antacids such as calcium carbonate (Mylanta, Rolaids, Tums) to neutralize stomach acid and provide quick relief from heartburn.
OTC H2 blockers such as cimetidine (Tagamet HB), nizatidine (Axid), and famotidine (Pepcid AC) to reduce acid production.
Prescription medicines (H2 blockers) such as famotidine and nizatidine.

Surgical Procedures for GERD

Nissen fundoplication or Toupet fundoplication, a minimally invasive (laparoscopic) procedure in which the surgeon tightens the lower esophageal sphincter by wrapping the upper part of the stomach around it.
LINX device: Placement of a ring containing tiny magnetic beads at the junction of the esophagus and stomach to prevent reflux of stomach acid.
Transoral incisionless fundoplication (TIF), a new type of surgical procedure in which the lower esophageal sphincter is tightened with polypropylene fasteners.

Natural Remedies and Lifestyle Changes

The following lifestyle changes can help to control symptoms of acid reflux:

Avoid trigger foods like spicy foods, fatty foods, caffeine, alcohol, and chocolate.
Avoid meals within 2-3 hours of bedtime.
Eat slowly and chew your food thoroughly.
Don’t lie down immediately after eating.
Try sleeping on your left side.
Elevate the head of your bed by about 6 inches.
Lose weight if you are overweight or obese.
Quit smoking.
Avoid tight-fitting clothing that places pressure on your abdomen.

Frequently Asked Questions (FAQ)

What Is The Safest Acid Reflux Medicine For Long-Term Use?

All medications for acid reflux carry the risk of adverse effects with long-term use. If you need immediate relief from heartburn, try an antacid or H2 blocker first. If you have more chronic issues with stomach acid, you may need to take proton pump inhibitors. Read the package instructions and prescription label carefully and take the medicine exactly as prescribed to lower your risk of adverse effects and medical complications.

Find out how to get rid of acid reflux fast.

Why Can't You Take Prevacid For More Than 14 Days?

You can’t take Prevacid and other over-the-counter proton pump inhibitors like Prilosec OTC for more than 14 days due to a risk of serious side effects such as low magnesium.

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