esomeprazole

ESOMEPRAZOLE

Complete information including dosage, side effects, interations and pregnancy & breast feeding warnings for Patients and Healthcare professionals

Overview & uses

Esomeprazole is a drug used to reduce the amount of acid secreted in stomach.

Indication (uses) of Esomeprazole:

  • Used for short term (4-8 weeks) for the treatment of Gastroesophageal reflux disease (GERD).
  • For the reduction in the occurrence of gastric ulcers associated with NSAID therapy.
  • For the treatment of Helicobacter pylori infection and duodenal ulcer in combination with amoxicillin and clarithromycin.
  • For the treatment of Pathological Hypersecretory Conditions including Zollinger-Ellison syndrome.
  • For the healing of Erosive esophagitis.

Pharmacological classification: Proton pump inhibitor for the reduction of gastric acid secretion

Brand names: Nexium

Dosage form:

  • Delayed release capsules in strengths of 20 mg and 40 mg for oral use.
  • Delayed release oral suspension for oral use in strengths of 10 mg, 20 mg and 40 mg as unit dose packet.

Mechanism of action:

All proton pump inhibitors are inactive at neutral pH. But, as soon as pH drops below 5, the drug rearranges into two positively charged ions and binds with H+K+ATPase enzyme by forming a covalent bond and inactivates the enzyme. It also inhibits the mucosal carbonic anhydrase enzyme.

Dosage

How to take Esomeprazole oral suspension or capsules?

  • Esomeprazole should be taken on empty stomach, atleast 1 hour before meals.
  • Capsules of Rabeprazole should be swallowed whole and should not be chewed, crushed or spit.
  • For oral suspension, follow the instructions mentioned on the packet.

Dosage:

  • For Gastroesophageal reflux disease (GERD):
    • 20 mg or 40 mg once a day for 4 – 8 weeks.
  • For the maintenance of Healing of Erosive esophagitis:
    • 20 mg once a day.
  • For the reduction in the occurrence of gastric ulcers associated with NSAID therapy:
    • 20 mg or 40 mg once a day for up to 6 months.
  • For the treatment of symptoms of Gastroesophageal Reflux Disease (GERD):
    • Esomeprazole 20 mg once a day for 4 weeks.
  • For the treatment of Helicobacter pylori infection to reduce the risk for re-occurrence of duodenal ulcers:
    • Esomeprazole 40 mg once a day with amoxicillin 1000 mg twice a day and clarithromycin 500 mg twice a day for 10 days.
  • Pathological Hypersecretory Conditions including Zollinger-Ellison syndrome:
    • Esomeprazole 40 mg twice a day.

PEDIATRIC DOSE (for 1 year or more and less than 12 years of age):

  • Short term treatment of symptoms of Gastroesophageal Reflux Disease (GERD):
    • 10 mg once a day for up to 8 weeks.
  • For the healing of Erosive esophagitis:
    • Body weight less than 20 kg: 10 mg once a day for up to 8 weeks.
    • Body weight equal to or more than 20 kg: 10 mg or 20 mg once a day for up to 8 weeks.

PEDIATRIC DOSE (for more than 12 years and less than or equal to 17 years of age):

  • Short term treatment of symptoms of Gastroesophageal Reflux Disease (GERD):
    • 20 mg or 40 mg once a day for up to 8 weeks.

GERIATRIC DOSE ADJUSTMENT:

  • No adjustments needed.

RENAL DOSE ADJUSTMENTS:

  • No adjustments needed.

HEPATIC DOSE ADHUSTMENT:

  • No adjustments needed in mild to moderate hepatic impairment (Child – Pugh score A and B).
  • For Child – Pugh score C, dose should not exceed 20 mg.

OVER DOSAGE:

  • Symptoms of overdose include reduced motor activity, tremor, ataxia, reduced respiratory frequency and intermittent clonic convulsions.
  • Confusion, drowsiness, dry mouth, blurred vision, nausea, tachycardia, headache, flushing and diaphoresis were also reported.
  • No specific antidote is known.
  • Dialysis does not aid in excess drug removal as Rabeprazole is extensively protein bound.
  • Supportive treatment should be given as and when required.
  • Contact the emergency department of your local hospital in cases of over dose or suspected over dose.

Side effects or unwanted effects:

  • Increased total bilirubin, Creatinine, uric acid and alkaline phosphatase was reported in laboratory findings of the patients taking Esomeprazole.
  • Decreased hemoglobin, WBC, platelets, sodium, potassium and thyroxine was reported in laboratory findings of the patients taking Esomeprazole.
  • Treatment with proton pump inhibitor may be associated with an increased risk of Clostridium difficile associated diarrhea, particularly in hospitalized patients.
  • Change of taste or a bad taste, acne, back pain and drowsiness was reported by patients taking Esomeprazole for a long period of time.
    • Ask your pharmacist to recommend a suitable medicine and consult your doctor.
  • Hypomagnesemia in patients taking proton pump inhibitors for over a year, characterized by arrhythmias, seizures and tetany.
    • Consult your doctor as soon as possible. This may require magnesium supplement and discontinuation of the proton pump inhibitor.

WARNINGS:

  • Treatment with proton pump inhibitor may be associated with an increased risk of Clostridium difficile associated diarrhea, particularly in hospitalized patients.

Pregnancy:

Category B, which means that Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Nursing:

  • Data not available.
  • Caution should be exercised while administering Esomeprazole to a nursing mother as many drugs are secreted in milk.

Interactions

Drug interactions of Esomeprazole:

  • Esomeprazole decreases gastric pH. Any drug, whose absorption is dependent on gastric pH, affects the absorption of that drug when co-administered with Esomeprazole.
    • Absorption of Ketoconazole, Atazanavir, Erlotinib, iron salts and mycophenolate mofetil is decreased while absorption of digoxin in increased.
  • Esomeprazole increases the concentration of Saquinavir.
  • Esomeprazole decreases the concentrations of Atazanavir and Nelfinavir.
  • Elimination of diazepam, warfarin and phenytoin was prolonged by Esomeprazole.
  • Concomitant use of Esomeprazole and warfarin should be done under strict monitoring, particularly for the increases in INR and prothrombin time.
  • Voriconazole increases the concentration of Esomeprazole by more than double.
  • Concomitant administration of esomeprazole, clarithromycin and amoxicillin increases the plasma levels of esomeprazole.

Drug – food interactions:

  • Esomeprazole should be taken on empty stomach, atleast 1 hour before meals.

Click here to go to Esomeprazole forums

Note: The sole purpose of every information shared on this article is to bring awareness. Do not use this information as a medical advice or prescription advice or as a tool for the treatment, diagnosis or prevention of the disease.

By | 2017-05-02T13:19:02+00:00 May 2nd, 2017|medicines|2 Comments

About the Author:

B. Pharm (K.L.E. society’s S.V.V. Patil College of Pharmacy, Bengaluru)
M. Pharm (Maharishi Arvind Institute of Pharmacy, Jaipur)

2 Comments

  1. Edward Thorpe June 11, 2017 at 5:36 pm - Reply

    Hi Dhruv,

    Not having digestion problems I’ve not run into the drug, or medicine, esomeprazole. This is good information about its uses.

    Even though you couldn’t link problems with using esomeprazole during pregnancy, I’d be really hesitant to do so.

    That there’s no antidote is a pretty big deal. Thanks,
    Edward

    • Dhruv Mangukia June 11, 2017 at 5:57 pm - Reply

      Hi Edward,
      Thanks for stopping by.
      When a drug falls under pregnancy category B, it can be taken during pregnancy with minimal or no side effects if other alternatives are not available.
      Data not available refers to insufficient studies conducted regarding its usage on nursing mothers.
      hope this clarifies.
      Thanks.

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