Esomeprazole

Esomeprazole Brand Names- Nexium | Nexium 24HR | Nexium 24HR Clear Minis

What is Esomeprazole

Esomeprazole is the S-isomer of omeprazole and is a proton pump inhibitor (PPI).

Esomeprazole is approved for the healing and maintenance of erosive esophagitis, for symptomatic gastroesophageal reflux disease (GERD), for use in combination with antibiotics to eradicate Helicobacter pylori (H. pylori) in patients with active or prior duodenal ulcer disease, for risk reduction of NSAID-associated gastric ulcer, for risk reduction of upper GI rebleeding after therapeutic endoscopy, and for pathological hypersecretory conditions, including Zollinger-Ellison syndrome.

A non-prescription (OTC) form is available for the short-term (14 days or less) treatment of heartburn.

Esomeprazole has a greater bioavailability compared to omeprazole, which may contribute to higher healing rates reported in studies of erosive esophagitis.

Based on available research, no clear advantage has been demonstrated for the use of one PPI over another in the treatment of GERD. Instead, a key to optimizing effectiveness is tailoring dosage timing and considering twice-daily dosing; traditional delayed-release PPIs should be administered 30 to 60 minutes before a meal for maximal pH control. A 1-time switch to a different PPI in a refractory patient may be useful.

The ACG/AGA Guidelines suggest that patients under the age of 60 with dyspepsia should have a non-invasive test for H. pylori, and therapy for H. pylori infection if positive.

Clinicians should allow at least 4 weeks before reassessing symptomatic response to H. pylori eradication therapy.

Eradication of H. pylori offers modest but significant symptom relief in non-ulcer dyspepsia and reduces the risk of developing peptic ulcer disease, atrophic gastritis, and gastric cancer.

Dyspepsia patients aged 60 or over should have an endoscopy to exclude upper gastrointestinal neoplasia.

When compared to omeprazole, esomeprazole has similar efficacy in the eradication of H. pylori, can maintain intragastric pH above 4.0 for a longer period of time, and has a similar time to sustained resolution of heartburn.

PPIs are often used for stress ulcer prophylaxis in critically ill patients; however, evidence for benefit is lacking, and use may increase the risk of adverse reactions such as pneumonia and Clostridioides difficile infection.

Reserve stress ulcer prophylaxis for patients with risk factors for clinically significant gastrointestinal bleeding (e.g., multiple organ dysfunction, prolonged mechanical ventilation, coagulopathy, persistent shock, concomitant corticosteroid therapy).

As with omeprazole, avoid concomitant use of esomeprazole in patients taking clopidogrel therapy; consider using a PPI with less CYP2C19 inhibitory activity

Indications

1. cystinosis
2. dyspepsia
3. eosinophilic esophagitis
4. esophagitis
5. gastric ulcer
6. gastroesophageal reflux disease (GERD)
7. Helicobacter pylori (H. pylori) eradication
8. NSAID-induced ulcer prophylaxis
9. pyrosis (heartburn)
10. stress gastritis prophylaxis
11. upper GI rebleeding prophylaxis
12. Zollinger-Ellison syndrome

Side Effects

1. abdominal pain
2. acne vulgaris
3. agitation
4. agranulocytosis
5. alopecia
6. anaphylactic shock
7. anaphylactoid reactions
8. anemia
9. angioedema
10. anorexia
11. anxiety
12. appetite stimulation
13. arthralgia
14. arthropathy
15. asthenia
16. back pain
17. blurred vision
18. bone fractures
19. bronchospasm
20. candidiasis
21. chest pain (unspecified)
22. colitis
23. confusion
24. conjunctivitis
25. constipation
26. cough
27. cystitis
28. depression
29. diaphoresis
30. diarrhea
31. dizziness
32. drowsiness
33. dysgeusia
34. dysmenorrhea
35. dyspepsia
36. dysphagia
37. dyspnea
38. dysuria
39. edema
40. elevated hepatic enzymes
41. epistaxis
42. eructation
43. erythema
44. erythema multiforme
45. exfoliative dermatitis
46. fatigue
47. fever
48. flatulence
49. flushing
50. gastric polyps
51. GI bleeding
52. glycosuria
53. goiter
54. gynecomastia
55. hallucinations
56. headache
57. hematuria
58. hepatic encephalopathy
59. hepatic failure
60. hepatitis
61. hiccups
62. hot flashes
63. hyperbilirubinemia
64. hyperhidrosis
65. hypertension
66. hypertonia
67. hyperuricemia
68. hypocalcemia
69. hypoesthesia
70. hypokalemia
71. hypomagnesemia
72. hyponatremia
73. impotence (erectile dysfunction)
74. increased urinary frequency
75. infection
76. injection site reaction
77. insomnia
78. interstitial nephritis
79. jaundice
80. leukocytosis
81. leukopenia
82. lupus-like symptoms
83. lymphadenopathy
84. maculopapular rash
85. malaise
86. melena
87. menstrual irregularity
88. migraine
89. muscle cramps
90. myalgia
91. nausea
92. pancreatitis
93. pancytopenia
94. paresthesias
95. parosmia
96. peripheral edema
97. pernicious anemia
98. pharyngitis
99. phlebitis
100. photosensitivity
101. polydipsia
102. polyuria
103. pruritus
104. pruritus ani
105. pseudomembranous colitis
106. rash
107. rhinitis
108. sinus tachycardia
109. sinusitis
110. Stevens-Johnson syndrome
111. stomatitis
112. thrombocytopenia
113. tinnitus
114. toxic epidermal necrolysis
115. tremor
116. urticaria
117. vaginitis
118. vertigo
119. visual impairment
120. vitamin B12 deficiency
121. vomiting
122. weakness
123. weight gain
124. weight loss
125. xerostomia

Monitoring Parameters

• LFTs
• serum magnesium

Contraindications

• abdominal pain
• bone fractures
• breast-feeding
• children
• diarrhea
• dysphagia
• gastric cancer
• geriatric
• GI bleeding
• hepatic disease
• hypomagnesemia
• infants
• laboratory test interference
• long QT syndrome
• neonates
• osteopenia
• osteoporosis
• pregnancy
• proton pump inhibitors (PPIs) hypersensitivity
• pseudomembranous colitis
• rebound acid hypersecretion
• systemic lupus erythematosus (SLE)
• vitamin B12 deficiency
• vomiting

Interactions

• Acalabrutinib
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Alendronate
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• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
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• Aspirin, ASA; Carisoprodol; Codeine
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