GENERIC NAME: Esomeprazole

COMMON BRANDS: Nexium

Esomeprazole is an oral prescription drug that belongs to a class of medication known as proton pump inhibitors (PPI’s). It acts by inhibiting (blocking) the excess release of acid in your stomach. It is available as an oral capsule form, which is a delayed-release drug (releases slowly in the stomach), with brand-name “Nexium”, liquid suspension, intravenous (IV) form, which is only given by a healthcare provider, and as a generic drug.

What is Esomeprazole (Nexium) used for?

Esomeprazole is used for the treatment of specific stomach and esophagus problems (such as acid reflux, ulcers). It acts by reducing the excess amount of acid production in your stomach. It helps in relieving symptoms such as heartburn, difficulty swallowing, and a persistent cough. This medication helps heal stomach and esophageal damage caused by excessive stomach acid, thereby preventing ulcers, and also prevent the development of esophageal cancer.

Esomeprazole is used for the treatment of certain conditions such as:

    • Gastroesophageal reflux disease (GERD) – Acid reflux occurs when stomach contents move babackward toward the esophagus.
    • Erosive esophagitis -Esophagus damage caused by excess acid.
    • Gastric ulcers (stomach ulcers) or duodenal ulcers (ulcers on the upper part of small intestine).
    • Zollinger-Ellison syndrome (ZES) – A rare condition characterised by the formation of tumours on digestive tract (especially duodenum).
    • Helicobacter pylori – Stomach infections caused by bacteria.
    • This drug also prevents stomach ulcers caused by excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs).

This drug is used alone or in combination with other medications.

How to use Esomeprazole (Nexium)?

Before you start your treatment with esomeprazole, and each time you get a refill, read the patient information guideline if available from your pharmacist.

Take this medication once a day orally, on an empty stomach, at least an hour before meals. Follow the product package information. The treatment depends on your medical condition and treatment response. Avoid increasing your dose or taking it frequently unless your doctor’s recommendation. Ask your doctor/pharmacist for further information.

If you are taking sucralfate or any antacids, take esomeprazole at least 30 minutes before taking sucralfate or antacid. Swallow the capsules whole without breaking, crushing or chewing.

Take this drug regularly to get the full benefit from it. Preferably take this medicine at the same time each day to avoid missing any dose. Continue this medication even if you feel better until the course of the treatment is completed.

Ask your doctor, if your condition does not improve or if it gets worse. The risk of side effects increases by time. Ask your doctor about how long you should use this medication.

What are the side effects of taking Esomeprazole (Nexium)?

The side effects of esomeprazole are slightly different for children and adults.

The common side effects observed in an adult such as a headache, diarrhoea, nausea, flatulence (passing gas), constipation, stomach pain and dry mouth. Whereas, in children side effects consist the above, plus regurgitation (burping up food) in babies, increased breathing rate in babies. Take your doctor’s advice if any of these side effects continue or worsen.

Using this drug for a prolonged duration more than three years can make vitamin B-12 absorption difficult, resulting in vitamin B-12 deficiency. Symptoms of vitamin B-12 deficiency such as neuritis (inflammation of a nerve), poor muscular coordination, nervousness, tingling or numbness in hands and feet and changes in menstruation may occur.

Get medical assistance promptly if you notice any severe side effects, such as signs of lupus (like a rash on nose and cheeks, new or worsening joint pain), symptoms of a low magnesium blood level (like an unusually fast/slow/irregular heartbeat, persistent muscle spasms, seizures).

This drug rarely causes a severe intestinal infection caused by Clostridium difficile (a type of bacteria). Avoid using any anti-diarrhoea or opioid medications as these products may make them worse. Tell your doctor right away if you observe symptoms such as stomach pain/cramping, persistent diarrhoea, fever, blood/mucus in your stool.

Allergic reaction to this medicine is very rare. However, get medical help promptly if you notice any symptoms of a severe allergic reaction, itching/swelling (face/tongue/throat), such as rash, breathlessness.

This is not a full record of all possible side effects. If you mark other effects not listed above, contact your doctor or pharmacist.

What are the precautions while using Esomeprazole (Nexium)?

Before using this drug, inform your doctor or pharmacist if you are allergic to it or if you have any other allergies.

Discuss with your doctor about medical history, mainly of liver disease, kidney problems, or lupus (an autoimmune disease).

Get medical assistance promptly if you have heartburn with lightheadedness/dizziness/sweating, chest pain radiating to jaw/arm/shoulder (especially with shortness of breath, unusual sweating), sudden unexplained weight loss.

If you are using this medication as over-the-counter, get medical help right away if you notice any of these signs of a severe condition like bloody vomit, vomit that looks like coffee grounds, pain/trouble swallowing food, bloody/black stools, recurrent wheezing (especially with heartburn), heartburn for over 3 months, frequent chest pain, nausea/vomiting, abdominal pain.

Esomeprazole (proton pump inhibitors) may increase your risk for bone fractures, mainly when used for a more extended period, higher doses, and in older adults. Talk with your doctor or pharmacist about how to prevent bone loss/fracture, such as by taking calcium and vitamin D supplements.

In pregnancy, use this drug only when benefits outweigh the risk. Discuss with your doctor for further details about the risks and benefits.

This medication may cross into breast milk. The effects of this drug are unknown on a nursing infant. Consult your doctor before breastfeeding.

What are the drug interactions of Esomeprazole (Nexium)?

Esomeprazole may interact with other medications, herbs, or vitamins you may be using. A drug interaction is when a substance changes the way a drug works which can be harmful or hinder the drug from working well.

Do not start, stop, or alter the dose of the drug without discussing your doctor because your doctor may be monitoring you for possible drug interactions.

Hypomagnesemia (low blood magnesium levels) may occur with prolonged use (more than 1 year). Report any incidence of hypomagnesemia symptoms such as tetany, arrhythmias, and seizures to the doctor. Magnesium supplementation alone did not help to maintain serum magnesium levels, and the PPI need to be discontinued. Regular monitoring is advised for patients taking esomeprazole in such cases.

Esomeprazole may interact with some medications like clopidogrel, cilostazol, methotrexate (at high-dose treatment), rifampin, St John’s wort.

Some medications need stomach acid to absorb them properly in the body. Esomeprazole decreases stomach acid so it may hinder work of these products. Some of the affected medicines like nelfinavir, pazopanib, atazanavir, erlotinib, rilpivirine, certain azole antifungals (itraconazole, ketoconazole, posaconazole), among others.

Esomeprazole is very similar to omeprazole. Do not use any medications containing esomeprazole with this drug.

This medication may intervene with specific lab tests, resulting in a false test. Assure that all your doctors and lab personnel know you use this drug.

WARNINGS:

Allergy: Esomeprazole can cause a severe allergic reaction in some people Such as rashes, face swelling, throat tightness or trouble breathing. Call an emergency if notice any of these effects.

Pregnant women: No established evidence proves this drug is safe in pregnancy. Notify to your doctor before using this drug if you are pregnant.

Breastfeeding women: Esomeprazole passes into breast milk. Inform your doctor if you breastfeed. You may need to choose whether to stop taking this medication or stop breastfeeding.

Carcinogenic: Prolonged use of proton pump inhibitors are known to cause stomach cancer in animal studies. However, there are no established studies on humans that prove this drug does not cause cancer. Avoid prolonged use of this drug.

For children: Avoid using this drug in children below 16 years as the studies are not established yet in this age group.

For seniors: The dose of the drug depends on your kidney function as with the ageing kidney function decrease, and your body may metabolise this drug more slowly. At the start of therapy, your doctor may prescribe you a low dose to avoid too much of esomeprazole in your body which can be dangerous.

What are the forms and strengths of Esomeprazole?

Form: Capsule, delayed-release
Strengths: 20mg, 40mg

Form: Tablet delayed-release
Strengths: 20 mg

Form: Injection, powder for reconstitution
Strengths: 20mg/vial, 40mg/vial

Form: Packets for oral suspension
Strengths: 10mg, 20mg, 40mg

What is the dosage of Esomeprazole?

For Gastroesophageal Reflux Disease (GERD):

Adult dosage (18 years and above):

Gastroesophageal reflux disease (GERD): Take 20mg once per day, up to 4 weeks.
Esophagitis with GERD symptoms: Take 20mg taken once per day, up to 4 weeks.

Pediatric:

Children (2 to 11 years):

Gastroesophageal reflux disease (GERD): Take 10mg orally once a day, up to 8 weeks.

Children (12 to 17 years):
Take 20mg orally once a day, up to 4 weeks.

Children (0–2 year):
Esomeprazole has not been studied in children younger than 2 years. It should not be used in this age group.

For Erosive Esophagitis (EE):

Adult dosage:

Esomeprazole magnesium:

Dosage: 20 to 40mg orally once a day, up to 4 to 8 weeks.
Maintenance dose: 20mg orally once a day.

Esomeprazole strontium:

Dose: 24.65 to 49.3mg orally once a day, up to 4 to 8 weeks.
Maintenance dose: 24.65mg orally once a daily.

Pediatric:

Children:

Erosive Esophagitis due to Acid-Mediated GERD:

Esomeprazole Magnesium:

Children 1 month to 1 year old: Dosage is based on weight in this age group.

Children 3kg to 5kg: 2.5mg orally once a day.
Children above 5 kg to 7.5 kg: 5mg orally once a day.
Children above 7.5 kg to 12 kg: 10mg orally once a day, up to 6 weeks.

Children 1 to 11 years:

Less than 20 kg: 10mg orally once a day.
20 kg or more: 10 to 20mg orally once a day, up to 8 weeks.

Children 12 to 17 years:
20 or 40mg orally once a day, up to 4 to 8 weeks.

For Helicobacter pylori Infection:

Adult dosage:

Esomeprazole Magnesium:

Triple therapy: 40mg orally once a day, taken concomitantly with amoxicillin and clarithromycin, up to 10 days.

Esomeprazole Strontium:

Triple therapy: 49.3mg orally once a day, taken concomitantly with amoxicillin and clarithromycin, up to 10 days.

For NSAID-Induced Gastric Ulcer:

Adult dosage:

Esomeprazole Magnesium: 20mg to 40mg orally once a day, up to 6 months

Esomeprazole Strontium: 24.65mg to 49.3mg orally once a day, up to 6 months

For Zollinger-Ellison Syndrome:

Adult dosage:

Esomeprazole Magnesium: 40mg orally 2 times a day.

Esomeprazole Strontium: 49.3mg orally 2 times a day.

For Pathological Hypersecretory Conditions:

Adult dosage:

Esomeprazole Magnesium: 40mg orally 2 times a day.

Esomeprazole Strontium: 49.3mg orally 2 times a day.

For Duodenal Ulcer Prophylaxis:

Adult dosage:

Esomeprazole Sodium:

Initial dose: 80mg via IV infusion over 30 minutes.
Maintenance dose: 8 mg/hr given via IV continuous infusion over 71.5 hours (for a total of 72 hours, or 3 days).

For Gastric Ulcer Prophylaxis:

Adult dosage:

Esomeprazole Sodium:

Initial dose: 80mg via IV infusion over 30 minutes.
Maintenance dose: 8mg/hr given via IV continuous infusion over 71.5 hours (for a total of 72 hours, or 3 days).

Most common questions asked about Esomeprazole / Q&A’s:

Can you take Esomeprazole (Nexium) while pregnant?

There are no established studies in pregnant women that prove this drug is safe in pregnancy. However, the animal studies show that this drug passes to the fetus and can cause harm to the fetus because animal reproduction is not always predictive of human response. “Food and Drug Administration” has categorised esomeprazole (Nexium) in the pregnancy category B, and this drug should be used during pregnancy only if clearly needed. The drug of choice for gastric reflux during pregnancy is to use antacids, which neutralises excess of acid present in the stomach.

Disclaimer

TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.