Esomeprazole

Aka: Esomeprazole, Nexium

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II. Indications

  1. Peptic Ulcer Disease
  2. Gastroesophageal Reflux
  3. Erosive Esophagitis
  4. Zollinger-Ellison Syndrome

III. Contraindications

  1. Hypersensitivity to Proton Pump Inhibitors
  2. Use with caution in severe liver disease
    1. Limit to maximum dose of 20 mg/day (except in Zollinger Ellison Syndrome)

IV. Medications

  1. Esomeprazole Magnesium (Nexium)
    1. Standard, original Esomeprazole and generic in 2014
    2. Esomeprazole Delayed Release OTC 20 mg
    3. Esmeprazole Delayed Release 40 mg and oral suspension are trade name and prescription only
  2. Esomeprazole Strontium
    1. Dose 49.3 mg orally daily is equivalent to Esomeprazole Magnesium (Nexium) 40 mg
    2. Created as a patent extender in 2014 by changing the Esomeprazole salt from Magnesium to strontium
    3. Do not use in children due to possible bone adverse effects with Strontium
    4. Very expensive ($150/month in 2014) and no advantage over soon to be generic Esomeprazole Magnesium (Nexium)
    5. (2014) Presc Lett 21(2): 8

V. Dosing: Adults

  1. See Helicobacter Pylori Treatment
  2. Background
    1. Take at least one hour before meals
    2. Capsule contents may be sprinkle on apple sauce (and may be given via NG tube)
  3. Erosive Esophagitis
    1. Take 40 mg orally daily for 4 to 8 weeks, and then 20 mg orally daily for up to 6 months
  4. Gastroesophageal Reflux
    1. Take 20 mg orally daily for up to 4 weeks
  5. Zollinger-Ellison Syndrome
    1. Take 40 mg orally twice daily
  6. Gastrointestinal Prophylaxis of Peptic Ulcer Disease
    1. Take 20 to 40 mg orally daily for up to 6 months

VI. Dosing: Children

  1. Indicated in Pediatric Gastroesophageal Reflux
  2. Weight 3 to 5 kg
    1. Give 2.5 mg orally daily for up to 6 weeks
  3. Weight 5 to 7.5 kg
    1. Give 5 mg orally daily for up to 6 weeks
  4. Weight 7.5 to 20 kg
    1. Give 10 mg orally daily for up to 6 weeks
  5. Weight >20 kg and age <11 years
    1. Give 20 mg orally daily for up to 8 weeks
  6. Age <12 to 17 years
    1. Take 20 to 40 mg orally daily for up to 8 weeks

VII. Pharmacokinetics

  1. All PPIs have short plasma half life of 1-2 hours
  2. Effect is delayed 5-7 days until proton pumps are fully blocked
  3. Metabolized by CYP2C19 and CYP3A4
  4. Inhibits CYP2C19

VIII. Mechanism

  1. See Proton Pump Inhibitor

IX. Adverse Effects:

  1. See Proton Pump Inhibitor

X. Precautions

  1. See Proton Pump Inhibitor

XI. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

XII. Efficacy

  1. See Proton Pump Inhibitor

XIII. Drug Interactions

  1. See Proton Pump Inhibitor
  2. Methotrexate (high dose)
  3. Voriconazole
    1. Doubles the serum levels of Esomeprazole

XIV. Resources

  1. Esmeprazole Magnesium delayed release (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f4853677-1622-4037-688b-fdf533a11d96

XV. References

  1. (2022) Comparison of Proton Pump Inhibitors, Presc Lett, #380327
  2. (2012) Prescr Lett 19(3): 14 [PubMed]
  3. (2013) Prescr Lett 20(5): 30 [PubMed]
  4. (2001) Med Lett Drugs Ther 43(1103):36-7 [PubMed]
  5. Ament (2012) Am Fam Physician 86(1): 66-70 [PubMed]
  6. Vanderhoff (2002) Am Fam Physician 66(2):273-80 [PubMed]

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Related Studies

Cost: Medications

esomeprazole (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ESOMEPRAZOLE DR 10 MG PACKET Generic $7.17 each
ESOMEPRAZOLE DR 20 MG PACKET Generic $6.97 each
ESOMEPRAZOLE DR 40 MG PACKET Generic $6.93 each
ESOMEPRAZOLE MAG DR 20 MG CAP Generic $0.16 each
ESOMEPRAZOLE MAG DR 40 MG CAP Generic $0.17 each
nexium (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NEXIUM DR 10 MG PACKET Generic $7.17 each
NEXIUM DR 2.5 MG PACKET $9.20 each
NEXIUM DR 20 MG PACKET Generic $7.28 each
NEXIUM DR 40 MG CAPSULE Generic $0.17 each
NEXIUM DR 40 MG PACKET Generic $6.74 each
NEXIUM DR 5 MG PACKET $9.19 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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