- What is esomeprazole, and how does it work (mechanism of action)?
- What brand names are available for esomeprazole?
- Do I need a prescription for esomeprazole?
- What are the side effects of esomeprazole?
- What is the dosage for esomeprazole?
- Which drugs or supplements interact with esomeprazole?
- Is esomeprazole safe to take if I'm pregnant or breastfeeding?
- What else should I know about esomeprazole?
What is esomeprazole, and how does it work (mechanism of action)?
Esomeprazole is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach. Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). 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 the Zollinger-Ellison syndrome which all are caused by stomach acid. Esomeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February 2001.
What are the side effects of esomeprazole?
Esomeprazole, like other PPIs, is well-tolerated. The most common side effects are
Proton pump inhibitors may increase the risk of Clostridium difficile infection. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).
Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.
Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.
What is the dosage for esomeprazole?
- For GERD, 20 or 40 mg of esomeprazole is given once daily for 4-8 weeks. In children ages 1-11, the dose is 10 or 20 mg daily.
- For the treatment of H. pylori, 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days.
- Frequent heartburn is treated with 20 mg daily for 14 days.
- The dose for preventing 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, swallowed whole and should not be crushed or chewed. Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce. The applesauce should not be hot and the pellets should not be chewed or crushed.
Which drugs or supplements interact with esomeprazole?
Esomeprazole potentially can increase the concentration in blood of diazepam (Valium, Diastat) by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.
The absorption of certain drugs may be affected by stomach acidity. Therefore, esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.
Through unknown mechanisms, esomeprazole may 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 in order to avoid side effects from saquinavir.
Clopidogrel (Plavix) is converted to its active form by enzymes in the liver. Esomeprazole reduces the activity of these enzymes and potentially can 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 given with esomeprazole.
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Is esomeprazole safe to take if I'm pregnant or breastfeeding?
Use of esomeprazole in pregnant women has not been adequately evaluated.
Esomeprazole has not been adequately studied in nursing women.
What else should I know about esomeprazole?
What preparations of esomeprazole are available?
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.
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, dosing, warnings and precautions, and pregnancy safety should be reviewed prior to taking any medication.
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Related Disease Conditions
GERD (Acid Reflux, Heartburn)
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are: heartburn, regurgitation, and nausea. Effective treatment is available for most patients with GERD.
H. pylori (Helicobacter Pylori) Infection
Helicobacter pylori (H. pylori) is a bacteria that causes chronic inflammation (gastritis) of the inner lining of the stomach, and also is the most common cause of ulcers worldwide. About 50% of people in the world carries or is infected with H. pylori. Common symptoms of H. pylori infection are occasional abdominal discomfort, bloating, belching or burping, and nausea and vomiting. H. pylori infection is difficult to eradicate, and treatment is with two or more antibiotics.
Peptic Ulcer (Stomach Ulcer)
Peptic or stomach ulcers are ulcers are an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to H. pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking. Symptoms of peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause.
Reflux Laryngitis (Diet, Home Remedies, Medicine)
Reflux laryngitis is caused by acid refluxing back up through the esophagus and voice box. Reflux laryngitis causes irritation and inflammation of the lining of the esophagus, larynx, and throat; and can lead to symptoms, signs, and other problems like esophagitis, sinusitis, strictures, throat clearing, swallowing problems, asthma, chronic cough, and growths on the vocal cords. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with diet chanes, OTC medication, prescription medication, and lifestyle changes.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn. Learn the symptoms, causes, and treatments for Barrett's esophagus.
Indigestion (Dyspepsia, Upset Stomach Pain)
Indigestion (dyspepsia) can be caused by diseases or conditions that involve the gastrointestinal (GI) tract, and also by some diseases and conditions that do not involve the GI tract. Indigestion can be a chronic condition in which the symptoms fluctuate in frequency and intensity. Signs and symptoms that accompany indigestion include pain in the chest, upper abdominal pain, belching, nausea, bloating, abdominal distention, feeling full after eating only a small portion of food, and rarely, vomiting.
GERD and GER (Acid Reflux) in Infants and Children
GERD (gastroesophageal reflux disease) is the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Common symptoms of GERD in children include colic, feeding problems, poor growth, frequent vomiting or coughing, heartburn, regurgitation, recurrent wheezing, pneumonia, choking, or gagging. Treatment may involve elevating the child's bed, keeping the child upright after eating, limiting foods that seem to make the reflux worse, encouraging your child to exercise, and serving several small meals a day.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Gastritis Symptoms, Causes, Diet, Home Remedies, Treatment, and Cure
Gastritis (acute and chronic) is an inflammation of the lining of the stomach Some people have no gastritis symptoms, but when they do occur they may include bloating, belching, loss of appetite, nausea, and vomiting. H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two main causes of gastritis. Alcohol, caffeine, and high-fat foods also can cause gastritis. Fried, fatty, and spicy foods, and alcohol aggravate gastritis symptoms. Other stomach lining irritants that aggravate symptoms include cigarette smoking, acidic juices, caffeine, tomato products, peppers, and chili powder. Foods that sooth gastritis symptoms, and that help reduce and stop H. pylori infection growth in the stomach include apples, onions, garlic, teas, green leafy vegetables, coconut water, and wheat bran. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Some people get relief from gastritis symptoms with prescription and non-prescription antacids, histamine blockers like famotidine (Pepcid AC) or ranitidine (Zantac 75), or proton pump inhibitors (PPIs) like omeprazole (Prilosec) and esomeprazole (Nexium). These drugs will not cure gastritis. Complications of gastritis include gastric cancers, MALT lymphoma, renal problems, and death.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication,prescription medication, and surgery.
Is H. pylori Contagious?
H. pylori (Helicobacter pylori) infection: Is it contagious? H. pylori infection is caused by fecal contamination in either food or water, and by poor hygiene practices such as not washing the hands often. Common symptoms of H. pylori are a discomfort or pain in the area of the stomach. Some individuals describe the pain as gnawing or burning. Treatment of H. pylori infection is antibiotic therapy.
Cough: 19 Tips on How to Stop a Cough
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke. Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs. Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
Heartburn vs. Acid Reflux (Differences and Similarities)
Heartburn and acid reflux are not the same thing. Heartburn is actually a symptom of acid reflux. Heartburn gets its name because it feels like a burning sensation around the heart. Another symptom that occurs with heartburn is a bitter or sour taste in the mouth, usually when you eat or lye down. Heartburn affects more than 60 million people in the US at least once a month. Acid reflux, or GERD, occurs when stomach acid backs up into the esophagus, which irritates it. Heartburn is just one symptom of acid reflux. Other symptoms of acid reflux include: Belching Nausea after eating A feeling of fullness during or after eating Abdominal bloating Upset stomach Belching Wheezing Reflux laryngitis A tightness in the throat Problems swallowing Indigestion In some people, vomiting Causes of acid reflux and heartburn include: Being obese Slouching (poor posture) Medications like calcium channel blockers, theophylline, nitrates, and antihistamines Foods and drinks like caffeine, citrus fruits and vegetables, alcohol, and chocolate Pregnancy Diabetes Increase in stomach acid Eating a heavy meal Eating before bed The treatment for heartburn and acid reflux is to treat the underlying cause, for example, GERD, with over-the-counter (OTC) medicine, prescription medicine, natural remedies, and lifestyle changes like a eating a healthy, less fatty, spicy diet, not eating big meals, not eating before bed, and getting regular exercise to improve your posture.Sometimes a heart attack can mimic heartburn and acid reflux because they feel very similar. If you have symptoms of chest pain, tightness in the chest, heartburn, acid reflux, jaw, tooth, or head pain; shortness of breath, nausea, vomiting, sweating, discomfort in the upper middle of the abdomen, arm or upper back pain, or the general feeling of being ill, go to the nearest Emergency Department immediately because these are the symptoms of a heart attack.REFERENCES:American College of Gastroenterology. "Acid Reflux." 2017.<http://patients.gi.org/topics/acid-reflux/> familydoctor.org. "Heartburn." Updated: Mar 2014.<https://familydoctor.org/condition/heartburn/> National Library of Medicine; PubMed Health. "Heartburn and GERD: Treatment options for GERD." Updated: Nov 18, 2015.<https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072436/>
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