Mode of action
Irreversibly inactivate the hydrogen/potassium ATPase enzyme system (proton pump), suppressing both stimulated
and basal acid secretion. When PPIs are stopped, acid secretion is restored by synthesis of new hydrogen/potassium
ATPase.
Indications
Gastro-oesophageal reflux disease (GORD); H. pylori eradication, as part of an effective regimen treatment of gastric
ulcer; prevention of peptic ulcer and short term treatment of upper GI symptoms associated with NSAIDs; Dyspepsia;
Zollinger–Ellison syndrome; Scleroderma oesophagus.
Specific considerations
Gastric carcinoma: exclude before starting treatment for gastric ulcers; PPIs may mask symptoms and delay
diagnosis.
Hepatic impairment: Risk of accumulation when higher doses are used; monitor for adverse effects; dosage
adjustment not usually required.
Surgery: Continue treatment perioperatively.
Pregnancy: Avoid use, ranitidine preferred; ADEC category B3.
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
Common: headache, nausea, diarrhoea, abdominal pain, fatigue, dizziness.
Infrequent: rash, itch, flatulence, constipation, decreased absorption of cyanocobalamin (vitamin B12) may occur
with long term use.
Rare: confusion, agitation, aggression, arthralgia, agranulocytosis, PPIs are generally well tolerated.
gynaecomastia, myalgia, interstitial nephritis, raised liver enzymes, hepatitis, jaundice, thrombocytopenia,
leucopenia, erythema multiforme, Stevens–Johnson syndrome, toxic epidermal necrolysis, hypersensitivity reactions.
Dosage
GORD
Initially, oral/IV 20–40 mg once daily; change from IV to oral treatment as soon as possible.
Maintenance, reduce to minimum required.
H. pylori eradication
See also Table 01–01 Recommended H. pylori eradication regimens
Oral, 20 mg twice daily for 1 week, with 2 antibiotics.
NSAID-associated upper GI symptoms
Oral, 20 mg once daily for 4 weeks.
Prevention of NSAID-associated peptic ulcer
Oral, 20 mg once daily.
Patient counselling
Swallow tablet whole; do not crush or chew. Alternatively, the tablet may be dispersed in water and taken within
30 minutes.
Tell your doctor if you develop symptoms such as black stools or coffee-coloured vomit.
Practice points
esomeprazole is the S-isomer of omeprazole
esomeprazole tablets may be dispersed in water and taken within 30 minutes.
Products
ESOMEPRAZOLE TABS 20 MG (NEXIUM®)
ESOMEPRAZOLE TABS 40 MG (NEXIUM®, PUMPINOX®)
ESOMEPRAZOLE VIAL 40 MG (NEXIUM®)