Esomeprazole

What is Esomeprazole?

Esomeprazole magnesium belongs to a class of medications known as proton pump inhibitors (PPI), which are used to treat numerous gastrointestinal conditions caused by excess stomach acid. Approved by the FDA in 2001, Esomeprazole is available in capsule, tablet, liquid or granule form and is sold under the brand names Nexium, Nexium 24HR and Nexium IV.

How does Esomeprazole work?

PPI drugs such as Esomeprazole work by reducing the amount of acid produced in the stomach wall by blocking the enzyme hydrogen potassium that is responsible for acidifying the stomach. As a result, the medication helps to heal the stomach and esophagus whilst preventing further acid damage as well as providing relief from its associated symptoms.

What is Esomeprazole used for?

Generic forms of Esomeprazole are most commonly used to treat the following conditions:

• Gastroesophageal reflux disease (GERD), or chronic acid reflux
• Heartburn
• Indigestion
• Inflamed/damaged oesophagus
• Peptic ulcer disease
• Zollinger-Ellison syndrome (pancreatic tumor)

Where can I buy Esomeprazole?

Esomeprazole is available via prescription and over the counter, depending on the dose you require. Nexium 24HR contains a 20mg dose of Esomeprazole and can be purchased over the counter, whereas Nexium and Nexium IV contain a higher dose of 40mg and can only be obtained through a doctor’s prescription.

Both 20mg and 40mg doses of generic Nexium are available at Medzino in capsule form. We are able to offer first and repeat prescriptions to those who are seeking treatment for acid reflux and other related conditions. Our doctor’s will assess your symptoms through our online consultation service and subsequently advise you on the best treatment and dosage.

Active ingredients

The active ingredients in Esomeprazole capsules are either 22.3mg or 44.5 mg of Esomeprazole magnesium trihydrate.

Inactive ingredients

The inactive ingredients in Esomeprazole capsules are crospovidone, hydroxypropyl cellulose, mannitol, methacrylic acid copolymer type C, sucrose, sugar spheres, talc, titanium dioxide, triethyl citrate and gelatin.

Please note: Inactive ingredients can vary between different manufacturers.

Which ingredients can cause an allergic reaction?

While a serious allergic reaction to this medication is rare, if you notice swelling of your throat, hives, dizziness or difficulty breathing you should seek immediate medical attention as this could mean you are having a serious allergic reaction to Esomeprazole. If you have previously taken Esomeprazole and experience these symptoms, you should not take this medication again. Please let your prescribing doctor know. 

Dosage

The dosage and length of treatment with Esomeprazole vary depending on your symptoms and response. You must always follow the instructions provided on the patient information leaflet or as advised by your doctor.

How to take Esomeprazole

Esomeprazole delayed-release capsules must be taken orally at least 1 hour before meals. It is usually taken once a day, at the same time each day, although some conditions may require two daily doses spread evenly throughout the day.

It is important not to crush or chew the capsule – you must swallow it whole for it to take full effect. The delayed-release capsule prevents the medicine from being released too quickly, which would otherwise be broken down by stomach acid and render the medication ineffective.

How much Esomeprazole should I take?

For frequent heartburn and acid reflux:

• 20mg a day for 14 days.

For GERD:

• 20mg to 40mg a day for 4 to 8 weeks, depending on the severity of the condition.

For stomach ulcers:

• 20mg a day.

For Zollinger-Ellison syndrome:

• 40mg taken twice a day, although this can be increased to up to 4 times a day, depending on your response to the medicine.

Depending on your condition, you may be prescribed a higher or lower dose to begin with which will subsequently be adjusted in accordance with your response. Doses are considerably lower for children and those with liver problems.

How long should I take Esomeprazole for?

Continue to take the medication for the prescribed length of time, even if you experience relief from your symptoms – this may be a few weeks or months, depending on your illness. If you are self-medicating with an over-the-counter version, do not take it for more than 14 days unless instructed otherwise by your doctor. Inform your doctor if your condition persists or worsens.

What are the side effects from Esomeprazole?

Esomeprazole magnesium and other PPI drugs are generally well tolerated in both short and long term use. The most common side effects include (more than 1 in 100 people):

• Diarrhea
• Nausea/vomiting
• Headaches
• Dizziness
• Abdominal pain
• Dry mouth

These effects are usually mild and fade away once you stop taking Esomeprazole. If the symptoms become bothersome or do not disappear, inform your doctor right away.

More serious side effects include (less than 1 in 1000 people):

• Joint pain
• Skin rash/blisters/swelling
• Yellow skin/eyes (jaundice)
• Dark or bloody urine
• Fatigue
• Irregular heartbeat
• Muscle spasms/seizures

In rare cases, some users may experience a serious allergic reaction (anaphylaxis) to Esomeprazole exhibited through swelling of the mouth, lips, tongue or throat, difficulty breathing or talking, tightness in the chest or throat or wheezing.

If you experience any of these symptoms, discontinue use and inform your doctor immediately.

Precautions

Research suggests that the use of PPI drugs, including Esomeprazole may be associated with an increased risk of osteoporosis-related fractures including the hips, wrist and spine. This is due to the drug’s interference with calcium absorption which can weaken the bones.

Prolonged use of Esomeprazole can also inhibit nutritional absorption including vitamin B12 and magnesium, due to reduced levels of gastric acid. Low magnesium levels have also been linked to an increased risk of heart attacks.

The risk of developing Clostridium-difficile – an infection of the colon caused by an increase in bacterial toxins – is also increased with PPI drugs.

Contraindications

Esomeprazole is not suitable for those who:

• Have had an allergic reaction to any ingredients in Esomeprazole or any other PPI drugs, including Omeprazole or Lansoprazole.
• Suffer from liver problems or lupus.
• Are unable to absorb certain types of sugars, including glucose or sucrose.
• Have undergone or are due to undergo surgery or hospital treatment, such as an endoscopy.

Children should not be given Esomeprazole unless it is prescribed by a doctor.

Esomeprazole is not usually recommended during pregnancy or while breastfeeding due to the lack of firm evidence relating to its safety.

Drug interactions

Esomeprazole can interfere with other medications you may be taking, increasing your susceptibility to side effects. Due to decreased levels of stomach acidity, it can also affect the way other drugs are absorbed, therefore reducing efficacy.

Before taking Esomeprazole, inform your doctor about any other prescription or non-prescription drugs you may be taking including any vitamin or herbal supplements, particularly the following:

• Blood thinners
• Antifungal medicines
• Heart medicines
• HIV medicines
• Anti-epilepsy medicines
• Antibiotics
• Antidepressants
• Iron supplements
• St. John’s Wort
• Methotrexate (used to treat cancer, psoriasis or rheumatoid arthritis)
• Tacrolimus (used to treat eczema or to prevent organ rejection following a transplant)

Alternative Treatment Options

While Esomeprazole is one of the most effective drugs available on the market to treat gastric acid-related conditions, some users may need to seek alternative solutions due to the lack of desired results, experiencing adverse side effects or unsuitability. Always consult your doctor about which treatment is best for you.

Alternate proton pump inhibitors

Other PPI drugs include Lansoprazole, Pantoprazole and Rabeprazole. The likelihood of side effects may be considerably lower with some of these medications compared to Esomeprazole. Omeprazole in particular is safe to take during pregnancy or while breastfeeding. It is recommended that you speak with your doctor to establish which one will be best suited to you.

Some research suggests that Esomeprazole may have fewer drug interactions and is more effective at relieving symptoms than its PPI counterparts due to the slower rate at which it is released into the bloodstream; however, many experts agree that in general, PPIs exhibit similar overall effects.

Antacids (Alka-Seltzer, Maalox, Pepto-Bismol, Rolaids)

Antacids can provide quick and effective relief from GERD and heartburn by stabilizing acid production but are not typically recommended for the treatment of serious issues relating to stomach acid. Such medications can be easily obtained from a drugstore or supermarket at an affordable price.

H2 blockers (Tagamet, Pepcid AC, Pepcid, Axid, and Zantac)

H2 blocker medications work by blocking histamine receptors in the body, which helps to reduce the amount of acid created in the stomach. While PPI drugs are more effective than H2 blockers at reducing stomach acid, it is a valuable solution for those who are not suited to PPIs and is easily available without a prescription.

Natural herbs

There are numerous natural alternatives to Nexium if you want to avoid some of its associated side effects. Natural herbs such as licorice, slippery elm, marshmallow and ginger all have proven benefits in relieving symptoms associated with excess gastric-acid production and promote healing of the esophagus. Always check with your doctor before treating yourself with any herbal remedies – particularly if you have an existing medical condition, take any medications, or are pregnant or breastfeeding.