Top 300 Pharmacy Drug Cards

ESOMEPRAZOLE: Nexium

Class: Proton Pump Inhibitor

Dosage Forms. Capsule, Delayed Release: 20 mg, 40 mg; Granules: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg

Common FDA Label Indication, Dosing, and Titration.

1. Helicobacter pylori GI infection: 40 mg po daily × 10-14 d in combination with amoxicillin 1000 mg and clarithromycin 500 mg po bid

2. Erosive esophagitis, gastroesophageal reflux disease treatment: Children 1-11 y and <20 kg, 10 mg po daily × 8 wk; Children ≥20 kg, 10-20 mg po daily × 8 wk; Adults, 20-40 mg po daily × 4-8 wk

3. Erosive esophagitis, heartburn: Children 1-11 y old, 10 mg po daily × 8 wk; Children 12 y and older and Adults, 20-40 mg po daily × up to 8 wk

4. Prevention of NSAID-induced gastropathy: 20-40 mg po daily × up to 6 mo

5. Zollinger-Ellison syndrome: 40 mg po bid up to 240 mg/d

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Off-Label Uses. None

MOA. Esomeprazole is a proton pump inhibitor (PPI) that, when protonated in the secretory canaliculi of the parietal cells, covalently bind to H+/K+-ATPase (proton pump), which is the final pathway for acid secretion. Esomeprazole produces a profound and prolonged antisecretory effect and inhibit basal, nocturnal, pentagastrin-stimulated, and food-stimulated gastric acid secretion.

Drug Characteristics: Esomeprazole

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Medication Safety Issues: Esomeprazole

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Drug Interactions: Esomeprazole

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Adverse Reactions: Esomeprazole

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Efficacy Monitoring Parameters. Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of Helicobacter pylori, negative urea breath test.

Toxicity Monitoring Parameters. Severe headache or blistering skin rash.

Key Patient Counseling Points. Should be taken 1 h before meals.

Clinical Pearls. Multiple Helicobacter pylori regimens contain different combinations of PPIs and antibiotics; complete full regimen if prescribed for Helicobacter pylori treatment. Many PPI and H2 antagonists available OTC; warn patients not to take multiple products concurrently. Also available in injectable formulation. Increased risk of fractures, use lowest effective dose in patients at risk for osteoporosis.