Pediatrics: Orders for omeprazole suspension may be interchanged to an appropriate alternative PPI product. (e.g., lansoprazole suspension or esomeprazole granules)

PriLOSEC DR capsules and DR oral suspension medication guide

Zegerid Capsules should be converted to oral pantoprazole according to existing omeprazole to pantoprazole conversion nomogram.

Per P&T approval, pharmacists are now able to discontinue inappropriately prescribed Proton Pump Inhibitors (all dosage forms of pantoprazole and omeprazole) as COSIGN REQUIRED in adult patients without proper indication for stress ulcer prophylaxis or other appropriate indication as indicated below.

**Exclusions: PPIs prescribed by GI physicians, home medications, and the criteria listed below.**

Criteria for use as stress ulcer prophylaxis:
   •Mechanical ventilation > 48 hours
   •Coagulopathy (in absence of an anticoagulant)
        •  Platelet count < 50, INR > 1.5, or PTT 2x baseline        
   •Use of 2 antiplatelet agents (Clopidogrel, aspirin, ticagrelor, etc.) 
   •Ulcer or GI bleed in the past year
   •Major trauma
   •Traumatic head injury or spinal cord injury
   •Partial hepatectomy/ hepatic failure 
   •Patients with TWO or more of the following risk factors:
        •Sepsis
        •ICU length of stay > 7 days
        •Occult bleeding > 6 days
        •High dose steroids
             Dexamethasone: 10 mg/day
             Methylprednisolone: 50 mg/day
             Prednisone: 60 mg/day
             Hydrocortisone: 250 mg/day    

      
PPI indications for treatment or maintenance prophylaxis:
   •Gastroesophageal Reflux Disease (GERD)
   •Gastric or duodenal ulcer
   •GI bleed
   •Erosive esophagitis
   •Helicobacter pylori treatment
   •Chronic NSAID therapy
   •Zollinger-Ellison Syndrome
   •Other appropriate maintenance therapy

Reviewed: September 28, 2005 (Zegerid Capsules), May 2023 (Konvomep)

Updated: October 2022 (Pediatric PPIs), October 2023 (Konvomep)

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