Proton Pump Inhibitors – Omeprazole
|
Generic Name |
omeprazole | |
|
Strength |
20 mg | |
| Form | tablet/capsule | |
|
Criteria |
Approval Period |
|
1. For gastroesophageal reflux disease (GERD), reflux esophagitis, duodenal ulcer, or gastric ulcer. |
Indefinite |
| OR | |
|
2. For Barrett's esophagus, Zollinger-Ellison syndrome, connective tissue disease, e.g., lupus, scleroderma, CREST. |
Indefinite |
| OR | |
|
3. For eradication of Helicobacter pylori, as part of triple therapy |
Maximum 14 days |
| PLUS | |
Failure of reasonable trials of, or intolerance to, rabeprazole AND pantoprazole magnesium. |
|
Practitioner Exemptions
- No practitioner exemptions.
Special Notes
- CREST is an acronym for the five main features of the limited form of scleroderma: Calcinosis, Raynaud’s disease, Esophageal dysmotility, Sclerodactyly, and Telangiectasia.
- Reasonable trials of rabeprazole and pantoprazole magnesium will be considered a trial at usual adult doses for at least 4 weeks for each of the two reference PPIs.
