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*Dermatologic: rash (2%)
Other concerns related to adverse effects are:
*Recurrence of ''[[Clostridium difficile colitis|Clostridium difficile]]'' associated diarrhea<ref>{{cite journal | vauthors = Abou Chakra CN, Pepin J, Sirard S, Valiquette L | title = Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review | journal =
*[[osteoporosis#Fractures|Osteoporosis-related fractures]]<ref>{{cite journal | vauthors = Yang YX, Lewis JD, Epstein S, Metz DC | title = Long-term proton pump inhibitor therapy and risk of hip fracture | journal =
*[[Hypomagnesemia]]<ref>{{cite journal | vauthors = Hess MW, Hoenderop JG, Bindels RJ, Drenth JP | title = Systematic review: hypomagnesaemia induced by proton pump inhibition | journal = Alimentary Pharmacology & Therapeutics | volume = 36 | issue = 5 | pages = 405–413 | date = September 2012 | pmid = 22762246 | doi = 10.1111/j.1365-2036.2012.05201.x | s2cid = 9073390 | doi-access = free }}</ref>
Concern has been expressed regarding [[vitamin B12|vitamin B<sub>12</sub>]]<ref>{{cite journal | vauthors = Neal K, Logan R | title = Potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors | journal = Alimentary Pharmacology & Therapeutics | volume = 15 | issue = 7 | pages = 1085–1086 | date = July 2001 | pmid = 11421886 | doi = 10.1046/j.1365-2036.2001.0994a.x | s2cid = 39455836 | doi-access = free }}</ref> and [[iron]] [[malabsorption]],<ref>{{cite journal | vauthors = Sarzynski E, Puttarajappa C, Xie Y, Grover M, Laird-Fick H | title = Association between proton pump inhibitor use and anemia: a retrospective cohort study | journal = Digestive Diseases and Sciences | volume = 56 | issue = 8 | pages = 2349–2353 | date = August 2011 | pmid = 21318590 | doi = 10.1007/s10620-011-1589-y | s2cid = 33574008 }}</ref> but effects seem to be insignificant, especially when supplement therapy is provided.<ref>{{cite journal | vauthors = McColl KE | title = Effect of proton pump inhibitors on vitamins and iron | journal = The American Journal of Gastroenterology | volume = 104 | issue = Suppl 2 | pages =
Since their introduction, proton-pump inhibitors (PPIs, especially omeprazole) have also been associated with several cases of [[acute interstitial nephritis]],<ref>{{cite journal | vauthors = Härmark L, van der Wiel HE, de Groot MC, van Grootheest AC | title = Proton pump inhibitor-induced acute interstitial nephritis | journal = British Journal of Clinical Pharmacology | volume = 64 | issue = 6 | pages = 819–823 | date = December 2007 | pmid = 17635502 | pmc = 2198775 | doi = 10.1111/j.1365-2125.2007.02927.x }}</ref> an inflammation of the [[kidneys]] that often occurs as an adverse drug reaction.
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There is a possible association between long term use and dementia which requires further study to confirm.<ref>{{cite journal | vauthors = Eusebi LH, Rabitti S, Artesiani ML, Gelli D, Montagnani M, Zagari RM, Bazzoli F | title = Proton pump inhibitors: Risks of long-term use | journal = Journal of Gastroenterology and Hepatology | volume = 32 | issue = 7 | pages = 1295–1302 | date = July 2017 | pmid = 28092694 | doi = 10.1111/jgh.13737 | doi-access = free }}</ref>
A review article in ''[[U.S. Pharmacist]]'' in 2013 states that long-term use of PPIs is associated with [[Hypocalcaemia|decreased calcium absorption]] (causing increased risk of [[osteoporosis]] and [[Bone fracture|fractures]]), [[Magnesium deficiency|decreased magnesium absorption]] (causing [[Electrolyte imbalance|electrolyte disturbances]]), and increased risk of certain infections such as ''[[C. difficile]]'' and [[community-acquired pneumonia]]. They hypothesize that this is due to decreased stomach acid production.<ref>{{Cite
===Pregnancy and breastfeeding===
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Important drug interactions are rare.<ref>{{cite web | vauthors = Fitzakerley J |url= http://www.d.umn.edu/~jfitzake/Lectures/DMED/Antiulcer/Treatment/ReducePain/PPIs/PPIsSE.html |title=2014 Treatments for Acid-Peptic Diseases. |access-date=21 October 2018|url-status=dead | archive-url=https://web.archive.org/web/20140419014436/http://www.d.umn.edu/~jfitzake/Lectures/DMED/Antiulcer/Treatment/ReducePain/PPIs/PPIsSE.html |archive-date=19 April 2014 |publisher=University of Minnesota Medical School Duluth}}</ref><ref>{{cite web |url=http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-factsheet.pdf |title=Proton Pump Inhibitor: Use in Adults |archive-url=https://web.archive.org/web/20131212143828/http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-factsheet.pdf |archive-date=12 December 2013 |access-date=21 October 2018 |work=CMS Medicaid Integrity Program}}</ref> However, the most significant major drug interaction concern is the decreased activation of [[clopidogrel]] when taken together with omeprazole.<ref>{{cite journal | vauthors = Douglas IJ, Evans SJ, Hingorani AD, Grosso AM, Timmis A, Hemingway H, Smeeth L | title = Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs | journal = BMJ | volume = 345 | pages = e4388 | date = July 2012 | pmid = 22782731 | pmc = 3392956 | doi = 10.1136/bmj.e4388 }}</ref> Although still controversial,<ref>{{cite journal | vauthors = Focks JJ, Brouwer MA, van Oijen MG, Lanas A, Bhatt DL, Verheugt FW | title = Concomitant use of clopidogrel and proton pump inhibitors: impact on platelet function and clinical outcome- a systematic review | journal = Heart | volume = 99 | issue = 8 | pages = 520–527 | date = April 2013 | pmid = 22851683 | doi = 10.1136/heartjnl-2012-302371 | s2cid = 23689175 }}</ref> this may increase the risk of stroke or heart attack in people taking clopidogrel to prevent these events.
This interaction is possible because omeprazole is an [[enzyme inhibitor|inhibitor]] of the enzymes [[CYP2C19]] and [[CYP3A4]].<ref>{{cite journal | vauthors = Shirasaka Y, Sager JE, Lutz JD, Davis C, Isoherranen N | title = Inhibition of CYP2C19 and CYP3A4 by omeprazole metabolites and their contribution to drug-drug interactions | journal = Drug Metabolism and Disposition | volume = 41 | issue = 7 | pages = 1414–1424 | date = July 2013 | pmid = 23620487 | pmc = 3684819 | doi = 10.1124/dmd.113.051722 }}</ref> [[Clopidogrel]] is an inactive [[prodrug]] that partially depends on CYP2C19 for conversion to its active form. Inhibition of CYP2C19 may block the activation of clopidogrel, which could reduce its effects.<ref>{{cite journal | vauthors = Lau WC, Gurbel PA | title = The drug-drug interaction between proton pump inhibitors and clopidogrel | journal =
Almost all [[benzodiazepines]] are metabolised by the CYP3A4 and [[CYP2D6]] pathways, and inhibition of these enzymes results in a higher [[Area under the curve (pharmacokinetics)|area under the curve]] (''i.e.'', the total effect over time of a given dose). Other examples of drugs dependent on CYP3A4 for their metabolism are [[escitalopram]],<ref>{{EMedicine|article|1879354|Selective Serotonin Reuptake Inhibitors and CYP2D6}}</ref> [[warfarin]],<ref name="pmid12724615">{{cite journal | vauthors = Daly AK, King BP | title = Pharmacogenetics of oral anticoagulants | journal = Pharmacogenetics | volume = 13 | issue = 5 | pages = 247–252 | date = May 2003 | pmid = 12724615 | doi = 10.1097/00008571-200305000-00002 }}</ref> [[oxycodone]], [[tramadol]], and [[oxymorphone]]. The concentrations of these drugs may increase if they are used concomitantly with omeprazole.<ref name=Stedman>{{cite journal | vauthors = Stedman CA, Barclay ML | title = Review article: comparison of the pharmacokinetics, acid suppression and efficacy of proton pump inhibitors | journal = Alimentary Pharmacology & Therapeutics | volume = 14 | issue = 8 | pages = 963–978 | date = August 2000 | pmid = 10930890 | doi = 10.1046/j.1365-2036.2000.00788.x | s2cid = 45337685 }}</ref>
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It can be taken by mouth, as a capsule, tablet, or suspension, or by [[intravenous|injection into a vein]].<ref name=AHFS2015/><ref name=UK2016/>
Omeprazole is available in strengths of 10, 20, 40, and in some markets 80 mg; and as a powder (omeprazole sodium) for [[intravenous]] injection. Most oral omeprazole preparations are [[enteric coating|enteric-coated]], due to the rapid degradation of the drug in the acidic conditions of the stomach. This is most commonly achieved by formulating enteric-coated granules within capsules, enteric-coated tablets, and the multiple-unit pellet system (MUPS).<ref>{{cite journal | vauthors = Aubert J, Mulder CJ, Schrör K, Vavricka SR | title = Omeprazole MUPS®: An advanced formulation offering flexibility and predictability for self medication. | journal = SelfCare | date = May 2011 | volume = 2 | pages =
It is also available for use in injectable form (IV) in Europe, but not in the U.S. The injection pack is a combination pack consisting of a vial and a separate ampule of reconstituting solution. Each 10 mL clear glass vial contains a white to off-white [[Freeze-drying|lyophilised]] powder consisting of omeprazole sodium 42.6 mg, equivalent to 40 mg of omeprazole.
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