esomeprazole magnesium

es·o·mep·ra·zole magnesium (s-mpr-zl, s-)

n.

A drug of the proton pump inhibitor class.

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esomeprazole magnesium

Nexium

Pharmacologic class: Proton pump inhibitor

Therapeutic class: Antiulcer agent

Pregnancy risk category C

Action

Reduces gastric acid production by inhibiting enzyme activity in gastric parietal cells, preventing transport of hydrogen ions into gastric lumen

Availability

Capsules (delayed-release): 20 mg, 40 mg

Powder for delayed-release oral suspension: 20 mg packets, 40 mg packets

⊘Indications and dosages

➣ Gastroesophageal reflux disease (GERD)

Adults: 20 to 40 mg P.O. once daily for 4 to 8 weeks

➣ Symptomatic GERD

Adults: 20 mg P.O. once daily for 4 to 8 weeks p.r.n.

➣ Prevention of erosive esophagitis

Adults: 20 mg P.O. once daily

➣ Duodenal ulcer associated with Helicobacter pylori infection (as part of triple therapy)

Adults: 40 mg P.O. once daily for 10 days, given in combination with amoxicillin 1,000 mg b.i.d. for 10 days and with clarithromycin 500 mg b.i.d. for 10 days

➣ Treatment of Zollinger-Ellison Syndrome

Adults: 40 mg P.O. b.i.d.

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• severe hepatic impairment
• pregnant or breastfeeding patients
• children younger than age 18 (safety not established).

Administration

• Give 1 hour before or 2 hours after a meal.
• Know that contents of capsules may be mixed with applesauce.
• Don't crush capsules or pellets.

Route	Onset	Peak	Duration
P.O.	Rapid	1.6 hr	24 hr

Adverse reactions

CNS: headache, dizziness, asthenia, vertigo, apathy, anxiety, paresthesia, insomnia, abnormal dreams

EENT: sinusitis, epistaxis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dry mouth

Respiratory: upper respiratory tract infection, cough

Skin: rash, inflammation, urticaria, pruritus, alopecia, dry skin

Interactions

Drug-drug. Digoxin, iron salts, ketoconazole: altered absorption and effects of these drugs

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, creatinine, uric acid: increased levels

Hemoglobin, platelets, potassium, sodium, thyroxine, white blood cells: altered levels

Patient monitoring

• Monitor neurologic status, especially for dizziness, headache, paresthesia, and asthenia.
• Watch for signs and symptoms of EENT and respiratory infections.
• Assess nutritional and hydration status in light of adverse GI effects.
• Check for rash and other signs of hypersensitivity.
• Monitor liver function test results if patient is on long-term therapy.

Patient teaching

• Instruct patient to take drug 1 hour before or 2 hours after a meal.
• If patient has trouble swallowing capsule, tell him to open it, sprinkle pellets into soft food (such as applesauce), and take right away.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise female patient to tell prescriber if she's pregnant or breastfeeding.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.