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03/03/2021

Esomeprazole - Australian Medicines Handbook

Australian Medicines Handbook (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2021 January. Available from: https://amhonline-amh-net-au.ezproxy.lib.uts.edu.au

Esomeprazole For additional information see Proton pump inhibitors For drug interactions see Proton pump inhibitors, Esomeprazole

Mode of action Mode of action from Proton pump inhibitors Bind to the hydrogen/potassium ATPase enzyme system (proton pump), inhibiting both stimulated and basal acid secretion.

Indications GORD Zollinger-Ellison syndrome (and other pathological hypersecretory conditions) H. pylori eradication, as part of an effective regimen Treatment of NSAID-induced gastric ulcer, prevention of NSAID-induced peptic ulcer and short-term treatment of upper GI symptoms associated with NSAIDs Prevention of peptic ulcer rebleeding Indications from Proton pump inhibitors Peptic ulcer disease (PUD) GORD Dyspepsia Zollinger-Ellison syndrome H. pylori eradication, as part of an effective regimen Prevention and/or treatment of upper GI adverse effects of NSAIDs In selected patients for stress ulcer prophylaxis, acute upper GI bleeding, prevention of acid aspiration

Precautions Allergy to esomeprazole or omeprazole—contraindicated. Treatment with cilostazol—avoid combination (contraindicated by manufacturer); esomeprazole inhibits CYP2C19 and increases cilostazol concentration. Precautions from Proton pump inhibitors Gastric carcinoma—exclude before starting treatment for gastric ulcers; PPIs may mask symptoms and delay diagnosis.

Hepatic

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Esomeprazole - Australian Medicines Handbook

There is a risk of accumulation when higher doses are used in hepatic impairment; monitor for adverse effects.

Surgery Continue treatment perioperatively.

Elderly Risk of electrolyte disturbances may be increased in the elderly, see below.

Pregnancy Omeprazole appears safe to use (more human data).

Breastfeeding Safe to use; all are acid labile; small amount in milk is likely to be destroyed by acid in infant’s stomach.

Adverse effects Rare (1%) headache, nausea, vomiting, diarrhoea, abdominal pain, constipation, flatulence

Infrequent (0.1–1%) rash, itch, dizziness, fatigue, drowsiness, insomnia, dry mouth

Rare (1 year Change from IV to oral treatment as soon as possible. 20 kg, oral/IV infusion 10–20 mg once daily for up to 8 weeks.

Zollinger-Ellison syndrome Adjust dose according to gastric acid output. https://amhonline-amh-net-au.ezproxy.lib.uts.edu.au/chapters/gastrointestinal-drugs/drugs-dyspepsia-reflux-peptic-ulcers/proton-pump-inhibitors/esomeprazole

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Esomeprazole - Australian Medicines Handbook

Adult, oral, initially 40 mg twice daily.

H. pylori eradication See also Table – First-line H. pylori eradication regimens Adult, oral 20 mg twice daily, with 2 antibacterials.

NSAID-associated gastric ulcer Adult, oral/IV 20 mg once daily for 4–8 weeks; change from IV to oral treatment as soon as possible.

Prevention of NSAID-associated peptic ulcer Adult, oral/IV 20 mg once daily; change from IV to oral treatment as soon as possible.

NSAID-associated upper GI symptoms Adult, oral 20 mg once daily for 4 weeks.

Prevention of peptic ulcer rebleeding Adult, IV infusion, initially 80 mg over 30 minutes, then decrease rate to 8 mg/hour for 3 days, then oral 40 mg once daily, seek specialist advice.

Administration advice 40 mg or less: dilute in sodium chloride 0.9% and infuse IV over 10–30 minutes, or, for adults only, give IV over at least 3 minutes.

Counselling Tablet: swallow whole (do not crush or chew) or you can disperse it in water, then drink within 30 minutes. Oral liquid: mix 1 sachet in 15 mL of water and allow to thicken for a few minutes. Stir again, then drink within 30 minutes. Counselling from Proton pump inhibitors Tell your doctor if you develop symptoms such as black stools or vomit that looks like coffee grounds.

Practice points esomeprazole is the S‑isomer of omeprazole Practice points from Proton pump inhibitors assess ongoing PPI use regularly; if symptoms are well controlled (after at least 4–8 weeks of treatment), consider: stopping treatment (unless patient has severe oesophagitis or complicated disease, eg Barrett’s, high risk of GI bleeding) intermittent use when symptoms develop step down to lowest effective dose enteric infections (including Clostridium difficile-associated disease) have been associated with PPI use (observational data) although data are conflicting, some observational studies suggest possible associations between long-term PPI therapy and decreased serum vitamin B12 concentration, pneumonia, fracture, iron deficiency and chronic kidney disease

Products Search for Esomeprazole on the PBS tab, 20 mg (enteric coated), 30, Nexazole, Nexium, Nexolea, PBS‑A1,2,3 https://amhonline-amh-net-au.ezproxy.lib.uts.edu.au/chapters/gastrointestinal-drugs/drugs-dyspepsia-reflux-peptic-ulcers/proton-pump-inhibitors/esomeprazole

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tab, 20 mg (enteric coated), 7, 14, Nexium 24HR Once Daily Dosinga tab, 20 mg (enteric coated), 14, Noxicid Heartburn Relief tab, 40 mg (enteric coated), 30, Nexazole, Nexium, Nexolea, PBS‑A2,3 cap, 20 mg (enteric coated), 14, Nexium 24HR Once Daily Dosing cap, 20 mg (enteric coated), 30, Noxicida, PBS‑A1,2,3 cap, 40 mg (enteric coated), 30, Noxicida, PBS‑A2,3 oral liquid (granules for), 10 mg, 30, Nexium inj, 40 mg (powder), 10, Nexiuma

Combination packs tab, esomeprazole 20 mg (enteric coated), 14; tab, clarithromycin 500 mg, 14; cap, amoxicillin 500 mg, 28, Nexium Hp7a, PBS‑R4 1

initial treatment of peptic ulcer, see PBS

2

scleroderma oesophagus; pathological hypersecretory conditions, see PBS

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GORD, see PBS

4

eradication of H. pylori associated with peptic ulcer disease

a

generic brands available © Australian Medicines Handbook Pty Ltd Last modified by AMH: January 2021

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