Indications
Esomeprazole is indicated:
Treatment of Gastroesophageal Reflux Disease (GERD)
Healing of Erosive Esophagitis
Maintenance of Healing of Erosive Esophagitis
Symptomatic Gastroesophageal Reflux Disease
H. pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence
Zollinger-Ellison Syndrome
Acid Related Dyspepsia
Duodenal and Gastric Ulcer
Therapeutic Class
Proton Pump Inhibitor
Pharmacology
Esomeprazole is a PPI that suppresses gastric acid secretion by inhibiting H+/K+ ATPase in the gastric parietal cell. It is the S-isomer of omeprazole.
Dosage
Tablet:
Healing of erosive esophagitis: 20 mg or 40 mg once daily for 4 to 8 Weeks. For those patients who have not healed after 4-8 weeks of treatment, an additional 4-8 weeks course of Esomeprazole may be considered.
Long-term management of esophagitis: 20 mg once daily.
Symptomatic gastroesophageal reflux disease: 20 mg once daily for 4 weeks.
H. pylori eradication for treatment of duodenal ulcer: Triple therapy: 20 mg Esomeprazole once daily with 500 mg Clarithromycin twice daily, and 1 g Amoxicillin twice daily for 7-10 days.
Injection:
The recommended adult dose in GERD with Erosive Esophagitis is either 20 or 40 mg Esomeprazole given once daily by intravenous injection (no less than 3 minutes) or intravenous infusion (10 to 30 minutes).
Pediatric dose (1 to 11 years old):
Short term treatment of symptomatic GERD: 10 mg once daily for up to 8 weeks.
Healing of erosive esophagitis:
Weight <20 kg: 10 mg once daily for up to 8 weeks.
Weight ≥20 kg: 10 mg or 20 mg once daily for up to 8 weeks.
Administration
Preparations for Use and Administration of Esomeprazole 40 IV Injection: A solution for intravenous infusion is prepared by first reconstituting the contents of one vial with 5 ml of 0.9% Sodium Chloride and further diluting the resulting solution to a final volume of 50 ml. The resultant concentration after diluting to a final volume of 50 ml is 0.8 mg/ml.
20 mg dose: Withdraw 25 ml of the final solution and administer as an intravenous infusion over 10 minutes to 30 minutes.
10 mg dose: Withdraw 12.5 ml of the final solution and administer as an intravenous infusion over 10 minutes to 30 minutes.
Interaction
Drug interaction studies have shown that Esomeparzole does not have any clinically significant interactions with Phenytoin, Warfarin, Quinidine, Clarithromycin or Amoxicillin. Esomeprazole inhibits gastric acid secretion. Therefore, Esomeprazole may interfere with the absorption of drugs where gastric pH is an important determinant of bioavailability (eg, Ketoconazole, Iron salts and Dogoxin). Coadministration of oral contraceptives, Diazepam, Phenytoin or Quinidine did not seem to change the pharmacokinetic profile of Esomeprazole.
Contraindications
Esomeprazole is contraindicated in patients with known hypersensitivity to any component of the formulation or to substituted Benzimidazoles.
Side Effects
In general, esomeprazole is well tolerated in both short and long term use. Adverse events reported with esomeprazole include headache, diarrhoea, nausea, flatulence, abdominal pain, constipation and dry mouth.
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