Omeprazole, sodium bicarbonate (Zegerid)

SELF ADMINISTRATION

FDA Approved Indications:
  • Short-term treatment of active duodenal ulcer
  • Short-term treatment of active benign gastric ulcer
  • Treatment of gastroesophageal reflux disease (GERD)
  • Maintenance of healing of erosive esophagitis
  • Reduction of risk of upper GI bleeding in critically ill patients
Prior authorization criteria:
  • Diagnosis of FDA approved indication (see above), AND
  • Patient is 18 years of age or older, AND
  • Patient has tried and failed PPI alternatives (e.g., omeprazole capsules) with concomitant sodium bicarbonate (available OTC), and Zegerid OTC, OR
  • For packets: patient has a G-tube in place and has tried and failed PPI alternatives that are compatible with G-tube administration
Dosing:
  • Short-term treatment of active duodenal ulcer: 20 mg once daily for 4 weeks (some patients may require an additional 4 weeks of therapy)
  • Gastric ulcer: 40 mg once daily for 4-8 weeks
  • Gastroesophageal reflux disease (GERD):
    • Symptomatic GERD (with no esophageal erosions): 20 mg once daily for up to 4 weeks
    • Erosive Esophagitis: 20 mg once daily for 4-8 weeks
  • Maintenance of healing of erosive esophagitis: 20 mg once daily
  • Reduction of risk of upper GI bleeding in critically ill patients: (40 mg oral suspension only) 40 mg initially followed by 40 mg 6-8 hours later and 40 mg daily therafter for 14 days
Approval:
  • Dependent on diagnosis