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Related to Nexium: omeprazole

esomeprazole magnesium


Pharmacologic class: Proton pump inhibitor

Therapeutic class: Antiulcer agent

Pregnancy risk category C


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


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

Powder for delayed-release oral suspension: 2.5-mg, 5-mg, 10-mg, 20-mg, 40-mg packets

Indications and dosages

Treatment of gastroesophageal reflux disease (GERD); healing of erosive esophagitis

Children ages 1 month to younger than 1 year weighing 3 kg (6.5 lb) to 5 kg: 2.5 mg P.O. daily for up to 6 weeks

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

Children ages 1 month to younger than 1 year weighing more than 7.5 kg to 12 kg (16.5 to 26 lb): 10 mg P.O. daily for up to 6 weeks

Children ages 1 month to younger than 1 year weighing more than 5 kg (11 lb) to 7.5 kg: 5 mg P.O. daily for up to 6 weeks

Children ages 1 to 11 weighing 20 kg (44 lb) or more: 10 or 20 mg P.O. daily for 8 weeks

Children ages 1 to 11 weighing less than 20 kg (44 lb): 10 mg P.O. daily for 8 weeks

Treatment of GERD; maintenance of healing of erosive esophagitis

Adults: 20 mg P.O. once daily

Symptomatic GERD

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

Children ages 12 to 17: 20 or 40 mg P.O. daily for up to 8 weeks

Children ages 1 to 11: 10 mg P.O. daily for up to 8 weeks

Helicobacter pylori eradication to decrease risk of duodenal ulcer recurrence

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 pathological hypersecretory conditions including Zollinger-Ellison syndrome

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

Risk reduction of NSAID-associated gastric ulcer

Adults: 20 or 40 mg P.O. once daily for up to 6 months


• Hypersensitivity to proton pump inhibitors


Use cautiously in:

• severe hepatic impairment

• increased risk of hip, wrist, and spine fractures

• pregnant or breastfeeding patients

• children younger than age 18 (safety not established).


• 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.

• Be aware that hypomagnesemia has been reported rarely in patients treated with proton pump inhibitors for at least 3 months. For patients expected to be on prolonged treatment or who take proton pump inhibitors with drugs such as digoxin or drugs that may cause hypomagnesemia (such as diuretics), consider monitoring magnesium level before starting treatment.

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

Metabolic: hypomagnesemia

Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)

Respiratory: upper respiratory tract infection, cough

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


Drug-drug. CYP2C19 or CYP3A4 inducers (such as rifampin): reduced esomeprazole level

Digoxin, iron salts, ketoconazole: altered absorption and effects of these drugs

Methotrexate: increased serum methotrexate level

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

Serum chromogranin A (CgA): increased level (may cause falsepositive results in diagnostic investigations for neuroendocrine tumors)

Drug-herbs. St. John's wort: reduced esomeprazole level

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.

• Continue to monitor patients periodically who are expected to be on prolonged treatment or who take proton pump inhibitors with drugs such as digoxin or drugs that may cause hypomagnesemia.

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.

• Instruct patient to recognize and report signs or symptoms of hypomagnesemia.

• 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(es-o-mep-ra-zole) ,


(trade name)


Therapeutic: antiulcer agents
Pharmacologic: proton pump inhibitors
Pregnancy Category: B


Oral: Intravenous: GERD/erosive esophagitis (IV therapy should only be used if PO therapy is not possible/appropriate). Oral: Hypersecretory conditions, including Zollinger-Ellison syndrome. Oral: With amoxicillin and clarithromycin to eradicate Helicobacter pylori in duodenal ulcer disease or history of duodenal ulcer disease. Oral: Decrease risk of gastric ulcer during continuous NSAID therapy.


Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Therapeutic effects

Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux.
Healing of duodenal ulcers.
Decreased incidence of gastric ulcer during continuous NSAID therapy.


Absorption: 90% absorbed following oral administration; food ↓ absorption.
Distribution: Unknown.
Protein Binding: 97%.
Metabolism and Excretion: Extensively metabolized by the liver (cytochrome P450 [CYP450] system, primarily CYP2C19 isoenzyme, but also the CYP3A4 isoenzyme) genetic implication (the CYP2C19 enzyme system exhibits genetic polymorphism; 15–20% of Asian patients and 3–5% of Caucasian and Black patients may be poor metabolizers and may have significantly ↑ esomeprazole concentrations and an ↑ risk of adverse effects); <1% excreted unchanged in urine.
Half-life: Children 1–11 yrs: 0.42–0.88 hr; Adults: 1.0–1.5 hr.

Time/action profile (blood levels*)

POrapid1.6 hr24 hr
IVrapidend of infusion24 hr
*Resolution of symptoms takes 5–8 days


Contraindicated in: Hypersensitivity; Lactation: Not recommended;Concurrent use of atazanavir or nelfinavir.
Use Cautiously in: Severe hepatic impairment;Patients using high-doses for >1 year (↑ risk of hip, wrist, or spine fractures); Obstetric: Use only if clearly needed.

Adverse Reactions/Side Effects

Central nervous system

  • headache


  • pseudomembranous colitis (life-threatening)
  • abdominal pain
  • constipation
  • diarrhea
  • dry mouth
  • flatulence
  • nausea

Fluid and Electrolyte

  • hypomagnesemia (especially if treatment duration ≥3 mo)


  • bone fracture


Drug-Drug interaction

May ↓ levels of atazanavir and nelfinavir (avoid concurrent use with either of these antiretrovirals).May ↑ levels and risk of toxicity of saquinavir (may need to ↓ dose of saquinavir).May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin, and iron salts.May ↑ risk of bleeding with warfarin (monitor INR and PT).Voriconazole may ↑ levels.May ↓ the antiplatelet effects of clopidogrel ; avoid concurrent use.May ↑ levels of cilostazol ; consider ↓ dose of cilostazol from 100 mg twice daily to 50 mg twice daily.Rifampin may ↓ levels and may ↓ response (avoid concurrent use).Hypomagnesemia ↑ risk of digoxin toxicity.May ↑ levels of tacrolimus and methotrexate.St. John's wort may ↓ levels and may ↓ response (avoid concurrent use).


Gastroesophageal Reflux Disease
Oral (Adults) Healing of erosive esophagitis—20 mg or 40 mg once daily for 4–8 wk; Maintenance of healing of erosive esophagitis—20 mg once daily; Symptomatic GERD—20 mg once daily for 4 wk (additional 4 wk may be considered for nonresponders).
Oral (Children 12–17 yr) Short-term treatment of GERD—20–40 mg once daily for up to 8 wk.
Oral (Children 1–11 yr) Short-term treatment of GERD—10 mg once daily for up to 8 wk; Healing of erosive esophagitis—<20 kg: 10 mg once daily for 8 wk; ≥20 kg: 10–20 mg once daily for 8 wk.
Oral (Infants and Children 1 mo–<1 yr) >7.5–12 kg—10 mg once daily for up to 6 wk; >5–7.5 kg—5 mg once daily for up to 6 wk; 3–5 kg—2.5 mg once daily for up to 6 wk;
Intravenous (Adults) 20 or 40 mg once daily.
Intravenous (Children 1–17 yr) <55 kg—10 mg once daily; ≥55 kg—20 mg once daily.
Intravenous (Children 1 mo-<1 yr) 0.5 mg/kg once daily.
H. pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence (Triple Therapy)
Oral (Adults) 40 mg once daily for 10 days with amoxicillin 1000 mg twice daily for 10 days and clarithromycin 500 mg twice daily for 10 days.
Decrease Gastric Ulcer During Continuous NSAID Therapy
Oral (Adults) 20 or 40 mg once daily for up to 6 mo.
Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome
Oral (Adults) 40 mg twice daily.

Hepatic Impairment

Oral Intravenous (Adults) Severe hepatic impairment—Dose should not exceed 20 mg/day.

Availability (generic available)

Delayed-release capsules: 20 mg, 40 mg Cost: 20 mg $713.55 / 90, 40 mg $731.22 / 90
Delayed-release oral suspension packets: 10 mg/pkt, 20 mg/pkt, 40 mg/pkt Cost: All strengths $268.01 / 30 pkts
Powder for injection (requires reconstitution): 20 mg/vial, 40 mg/vial
In combination with: naproxen (Vimovo).

Nursing implications

Nursing assessment

  • Assess routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis.
  • Lab Test Considerations: May cause ↑ serum creatinine, uric acid, total bilirubin, alkaline phosphatase, AST, and ALT.
    • May alter hemoglobin, WBC, platelets, serum sodium, potassium, and thyroxine levels.
    • May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Potential Nursing Diagnoses

Acute pain (Indications)


  • Do not confuse Nexium with Nexavar.
  • Antacids may be used while taking esomeprazole.
  • Oral: Administer at least 1 hr before meals. Capsules should be swallowed whole.
    • Delayed-release capsules: For patients with difficulty swallowing, place 1 tbsp of applesauce in an empty bowl. Open capsule and carefully empty the pellets inside onto applesauce. Mix pellets with applesauce and swallow immediately. Applesauce should not be hot and should be soft enough to swallow without chewing. Do not store applesauce mixture for future use. Tap water, orange juice, apple juice, and yogurt have also been used. Do not crush or chew pellets.
    • For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60-mL syringe and mixed with 50 mL of water. Replace plunger and shake syringe vigorously for 15 sec. Hold syringe with tip up and check for granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately after mixing.
    • For Delayed-release oral suspension: Mix contents of packet with 1 tbsp (15 mL) of water, leave 2–3 min to thicken, stir and drink within 30 min.
    • For Delayed-Release Oral Suspension Nasogastric or Gastric Tube: Add 15 mL of water to a syringe and then add contents of packet. Shake the syringe, leave 2–3 min to thicken. Shake the syringe and inject through the nasogastric or gastric tube within 30 min.
  • Intravenous Administration
  • Reconstitute each vial with 5 mL of 0.9% NaCl, LR, or D5W. Do not administer solutions that are discolored or contain a precipitate. Stable at room temperature for up to 12 hr.
  • Rate: Administer over at least 3 min.
  • Intermittent Infusion: Diluent: Dilute reconstituted solution to a volume of 50 mL with D5W, 0.9% NaCl, or LR for adults and with 0.9% NaCl for pediatric patients.Concentration: 0.8 mg/mL (40-mg vial) or 0.4 mg/mL (20-mg vial). Solutions diluted with 0.9% NaCl or LR are stable for 12 hr and those diluted with D5W are stable for 6 hr at room temperature.
  • Rate: Administer over 10–30 min.
  • Y-Site Compatibility: ceftaroline, doripenem
  • Y-Site Incompatibility: tacrolimus, telavancin. Do not administer with other medication or solutions. Flush line with 0.9% NaCl, LR, or D5W before and after administration.

Patient/Family Teaching

  • Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Advise patient to read the Patient Information sheet prior to starting therapy and with each Rx refill in case of changes.
  • Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
  • Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's wort.
  • Advise patient to notify health care professional if signs of hypomagnesemia (seizures, dizziness, abnormal or fast heartbeat, jitteriness, jerking movements or shaking, muscle weakness, spasms of the hands and feet, cramps or muscle aches, spasm of the voice box) occur.
  • Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy.
  • Decrease in symptoms of GERD and erosive esophagitis. Sustained resolution of symptoms usually occurs in 5–8 days. Therapy is continued for 4–8 wk after initial episode.
  • Decreased incidence of gastric ulcer during continuous NSAID therapy.
  • Eradication of H. pylori in duodenal ulcer disease.
  • Decrease in symptoms of hypersecretory conditions, including Zollinger-Ellison.
Drug Guide, © 2015 Farlex and Partners


A trademark for the magnesium salt of the drug esomeprazole.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Esomeprazole, the Purple pill Internal medicine An agent used to manage diagnostically confirmed erosive esophagitis
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
(+0.6%) DRUGSTORES $164.1 mil.(-1.3%) LEADING BRANDS ** Market Dollar Dollar sales share sales % change (000) Private Label 40.8% 866,949 + 5.1 Nexium 24HR 11.0% $18,004 - 15.4 Prilosec OTC 8.9% $14,618 3.3 Zantac 150 6.6% $10,869 + 7.0 Gas X 3.9% $6,419 + 6.3 Turns 3.8% $6,229 + 18.8 Pepcid AC 2.9% $4,801 + 5.6 Pepcid Complete 2.7% $4,435 + 2.5 Turns Smoothies 2.1% $3,508 4.2 Turns Ultra 1.7% $2,795 + 0.0 Source: IRI For the 12 weeks ended December 2,2018
Also, Nexium has lost compound patent protection in the majority of global markets.
With Nexium Defence Cloud, Thales is expanding the armed forces' arsenal with a new digital power that allows them to make decisions quickly and efficiently in real time at each decisive moment," said Marc Darmon, Thales executive vice president, Secure Communications and Information Systems.
Commenting on the issue, Dr Ameen Hussain Al Amiri, assistant undersecretary for Public health and Licensing Sector and vice-chairman of the Medical Licensing Committee at the ministry, said, "Nexium is a drug class used in the treatment of stomach ulcers and gastroesophageal reflux disease (GERD).
Nexium, which had prescription sales of $3.9 billion in 2013, "should get an initial bump from prescription customers who can now purchase the product over the counter," says Lentz.
Thales, a provider of services and solutions for aerospace, defence, transportation and security markets, announced on Wednesday that its NEXIUM Wireless broadband 4G/LTE standard professional mobile radio (PMR) solution has been successfully evaluated, under operational conditions, by operational users at electric utility EDF.
AstraZeneca Plc and three generic drugmakers must face class-action allegations they overcharged consumers by delaying low-cost versions of the heartburn medication Nexium for six years, a judge ruled.
C and EN Associate Editor Carmen Drahl explained that until 1961 there was no standard for assigning drugs generic names, which are different from brand names like Tamiflu (oseltamivir), Nexium (esomeprazole) and Herceptin (trastuzumab).
AstraZeneca said inspections at its premises concerned the ulcer drug Nexium. "We have the responsibility to ensure that consumers are not charged unjustified bills for their medical needs," said EU Competition Commissioner Joaquin Almunia, in the text of a speech in Brussels.
The biopharmaceutical company AstraZeneca's effort in Canada to stop the launch of a generic version of its patented, stomach-acid-relief drug Nexium (esomeprazole), was rejected by the Court.
NORDIC BUSINESS REPORT-17 June 2010-AstraZeneca loses case to block entry of generic Nexium in Canada(C)1994-2010 M2 COMMUNICATIONS
The ruling comes three months after Astra settled with Indian pharmaceutical giant Ranbaxy over an attempt to make copies of Astra's best-selling ulcer pill Nexium. Ranbaxy also wanted to market cheaper versions before the firm's patent expired in 2014.