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
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
Medication Safety Issues: Esomeprazole
Drug Interactions: Esomeprazole
Adverse Reactions: Esomeprazole
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.