Esomeprazole: Indications, Side Effects, Dosage, Interactions and Presentations

It belongs to a class of drugs called proton pump inhibitors (PPIs) that block the production of acid by the stomach.

Other medications in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix).

Indications

Chemically, esomeprazole is very similar to omeprazole.

Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome, all caused by stomach acid.

Esomeprazole, like other proton pump inhibitors, blocks the enzyme in the stomach wall that produces acid. By blocking the enzyme, the production of acid decreases, and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February 2001.

Available brands

  • Nexium, Nexium 24HR, Nexium IV.

Do I need a prescription?

  • Sí – Nexium, Nexium IV.
  • No – Nexium 24 hours.

Side effects

Like other proton pump inhibitors, it is well tolerated. The most common side effects are:

  • Diarrhea.
  • Nausea.
  • Vomiting
  • Headaches.
  • Eruption.
  • Dizziness.
  • Nervousness.

Proton pump inhibitors may increase the risk of Clostridium difficile infection.

High doses and long-term use (1 year or more) may increase the risk of fractures related to osteoporosis of the hip, wrist or spine. Prolonged use also reduces the absorption of vitamin B12 (cyanocobalamin).

The long-term use of proton pump inhibitors has also been associated with low levels of magnesium ( hypomagnesemia ). The analysis of patients taking proton pump inhibitors for long periods of time showed an increased risk of heart attacks .

Therefore, it is important to use the lowest doses and the shortest duration of treatment necessary for the condition being treated.

Dose

  • For gastroesophageal reflux disease, 20 or 40 mg esomeprazole is administered once a day for 4-8 weeks. In children from 1 to 11 years, the dose is 10 or 20 mg per day.
  • For the treatment of H. pylori, 40 mg are administered once a day in combination with amoxicillin and clarithromycin for 10 days.
  • Frequent heartburn is treated with 20 mg daily for 14 days.
  • The dose to prevent NSAID-induced ulcers is 20 to 40 mg daily for 6 months.
  • Zollinger-Ellison syndrome is treated with 40 mg twice daily.

Esomeprazole capsules should be administered one hour before meals, should be swallowed whole and should not be crushed or chewed.

Patients with difficulty swallowing can open the capsule and mix the granules with applesauce. The applesauce should not be hot and the granules should not be chewed or crushed.

Interactions

Esomeprazole can potentially increase the blood concentration of diazepam (Valium, Diastat) by decreasing the clearance of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.

The absorption of certain medications can be affected by heartburn. Therefore, esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and blood concentration of ketoconazole (Nizoral) and increase the absorption and blood concentration of digoxin (Lanoxin).

This can lead to reduced effectiveness of ketoconazole or increased toxicity of digoxin, respectively.

Through unknown mechanisms, esomeprazole can increase blood levels of saquinavir (Invirase, Fortovase) and reduce blood levels of nelfinavir (Viracept) and atazanavir (Reyataz).

Therefore, nelfinavir or atazanavir should not be administered with esomeprazole, and physicians should consider reducing the dose of saquinavir to avoid the side effects of saquinavir.

Clopidogrel (Plavix) is converted to its active form by enzymes in the liver. Esomeprazole reduces the activity of these enzymes and can potentially reduce the activity of clopidogrel. Esomeprazole should not be used with clopidogrel.

Esomeprazole increases the concentration of cilostazol (Pletal) and its metabolites. The dose of cilostazol should be reduced from 100 mg twice daily to 50 mg twice daily when administered with esomeprazole.

It can also increase blood levels of methotrexate (Rheumatrex, Trexall) and tacrolimus (Prograf).

Is it safe to take esomeprazole if I am pregnant or breast-feeding?

The use of esomeprazole in pregnant women has not been adequately evaluated. It has not been adequately studied in lactating women.

Presentations

  • Capsules: 20 and 40 mg.
  • Intravenous: 20 and 40 mg.
  • Powder for oral suspension: 10 mg, 20 mg, 40 mg.

How should I keep esomeprazole stored?

Store at room temperature, 15-30 C (59-86 F) in a tightly closed container.

Summary

Esomeprazole (Nexium, Nexium 24HR, Nexium IV) is a proton pump inhibitor prescribed for the treatment of gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome and for the treatment of H. pylori in combination with antibiotics.

Side effects, doses, warnings and precautions, and the safety of pregnancy should be reviewed before taking any medication.