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Esomeprazole

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Esomeprazole, Nexium

  • See Also
  1. Proton Pump Inhibitor
  2. Omeprazole
  3. Lansoprazole
  4. Pantoprazole
  5. Rabeprazole
  6. Dexlansoprazole
  • Indications
  1. Peptic Ulcer Disease
  2. Gastroesophageal Reflux
  3. Erosive Esophagitis
  4. Zollinger-Ellison Syndrome
  • Contraindications
  1. Hypersensitivity to Proton Pump Inhibitors
  2. Use with caution in severe liver disease
    1. Limit to maximum dose of 20 mg/day (except in Zollinger Ellison Syndrome)
  • Medications
  1. Esomeprazole Magnesium (Nexium)
    1. Standard, original Esomeprazole and generic in 2014
    2. Esomeprazole Delayed Release OTC 20 mg
    3. Esmeprazole Delayed Release 40 mg and oral suspension are trade name and prescription only
  2. Esomeprazole Strontium
    1. Dose 49.3 mg orally daily is equivalent to Esomeprazole Magnesium (Nexium) 40 mg
    2. Created as a patent extender in 2014 by changing the Esomeprazole salt from Magnesium to strontium
    3. Do not use in children due to possible bone adverse effects with Strontium
    4. Very expensive ($150/month in 2014) and no advantage over soon to be generic Esomeprazole Magnesium (Nexium)
    5. (2014) Presc Lett 21(2): 8
  • Dosing
  • Adults
  1. See Helicobacter Pylori Treatment
  2. Background
    1. Take at least one hour before meals
    2. Capsule contents may be sprinkle on apple sauce (and may be given via NG tube)
  3. Erosive Esophagitis
    1. Take 40 mg orally daily for 4 to 8 weeks, and then 20 mg orally daily for up to 6 months
  4. Gastroesophageal Reflux
    1. Take 20 mg orally daily for up to 4 weeks
  5. Zollinger-Ellison Syndrome
    1. Take 40 mg orally twice daily
  6. Gastrointestinal Prophylaxis of Peptic Ulcer Disease
    1. Take 20 to 40 mg orally daily for up to 6 months
  • Dosing
  • Children
  1. Indicated in Pediatric Gastroesophageal Reflux
  2. Weight 3 to 5 kg
    1. Give 2.5 mg orally daily for up to 6 weeks
  3. Weight 5 to 7.5 kg
    1. Give 5 mg orally daily for up to 6 weeks
  4. Weight 7.5 to 20 kg
    1. Give 10 mg orally daily for up to 6 weeks
  5. Weight >20 kg and age <11 years
    1. Give 20 mg orally daily for up to 8 weeks
  6. Age <12 to 17 years
    1. Take 20 to 40 mg orally daily for up to 8 weeks
  • Pharmacokinetics
  1. All PPIs have short plasma half life of 1-2 hours
  2. Effect is delayed 5-7 days until proton pumps are fully blocked
  3. Metabolized by CYP2C19 and CYP3A4
  4. Inhibits CYP2C19
  • Mechanism
  1. See Proton Pump Inhibitor
  • Adverse Effects
  1. See Proton Pump Inhibitor
  • Precautions
  1. See Proton Pump Inhibitor
  • Safety
  1. Pregnancy Category B
  2. Unknown safety in Lactation
  • Efficacy
  1. See Proton Pump Inhibitor
  • Drug Interactions
  1. See Proton Pump Inhibitor
  2. Methotrexate (high dose)
  3. Voriconazole
    1. Doubles the serum levels of Esomeprazole
  • Resources
  1. Esmeprazole Magnesium delayed release (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f4853677-1622-4037-688b-fdf533a11d96
  • References
  1. (2022) Comparison of Proton Pump Inhibitors, Presc Lett, #380327
  2. (2012) Prescr Lett 19(3): 14 [PubMed]
  3. (2013) Prescr Lett 20(5): 30 [PubMed]
  4. (2001) Med Lett Drugs Ther 43(1103):36-7 [PubMed]
  5. Ament (2012) Am Fam Physician 86(1): 66-70 [PubMed]
  6. Vanderhoff (2002) Am Fam Physician 66(2):273-80 [PubMed]