To :  Mary Nebert:


Prilosec
Generic  = OMEPRAZOLE
Category = Reduces gastric acid secretion
Secretion of omeprazole into human milk is unreported but is likely to be
minimal.   In rodent studies, high doses (35 X) produced decreased weight
gain in pups,  however  comparison to humans is unknown.  Physician must
weigh dangers of this drug with need in mother.  Not generally recommended
in nursing mothers, but the drug is very safe and has few side effects.  See
famotidine or nizatidine as better choices.  Capsules are delayed release.
Observe for headaches and diarrhea.

AHL= 1 hr.       M/P=    PB= 95%
PHL=                     PK = 0.5-3.5 hrs.


        Omeprazole is a powerful proton pump inhibitor,  acting somewhat
differently than the typical Histamine-2 blockers such as Pepcid, Tagamet,
Axid, etc,  although they all inhibit acid production in the stomach.  In
general,  most gastroenterologists use Prilosec as  second line therapy,
opting instead to used Pepcid,  or the others(H-2 blockers) first.
Prilosec is very expensive,  inhibits acid production for long periods(24
hours),  and is used in only the most severe of cases.   We do not have any
data as to the concentration of Prilosec in breast milk.  Even if it were
transferred,  the only likely consequence would be to raise the pH of the
stomach in the infant,  since all of these compounds are relatively safe,
side-effect-free compounds.   However,   long term exposure,  > 6 months is
not a good idea,  as the stomach in humans expects an acid milieu and
changes in gastric function and integrity could ensue,  although this is
only speculative.

        One suggestion,  it would probably be safer for mom to use Pepcid,
or Axid,  since we know that only minimal levels of these two compounds are
transferred into milk,  and they are very safe.  But that is a judgement
that the physician will have to make considering the seriousness of the
ulceration.


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T.W. Hale, Ph.D.
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