Esomeprazole

Generic Name

Esomeprazole

Other Names

• Nexium

Drug Class

• Proton pump inhibitor

Chemical Formula

C17H19N3O3S

Molecular Weight

345.42 g/mol

Mechanism of Action

• Inhibits the H+/K+ ATPase enzyme system in the gastric parietal cells, leading to a reduction in gastric acid secretion.

Indications

• Gastroesophageal reflux disease (GERD)
• Peptic ulcers
• Helicobacter pylori eradication therapy
• Zollinger-Ellison syndrome

Common Dosage Forms

• Capsules
• Tablets
• Powder for oral suspension

Typical Dosage

• 20-40 mg once daily for GERD

Pediatric Dosage

• Safety and efficacy not established in children under 1 year old

Geriatric Dosage

• No dosage adjustment necessary for elderly patients

Side Effects

• Headache
• Nausea
• Abdominal pain
• Diarrhea
• Vitamin B12 deficiency with long-term use

Contraindications

• Hypersensitivity to esomeprazole or substituted benzimidazoles

Pregnancy Category

• Category C - Risk cannot be ruled out

Lactation Safety

• Compatible with breastfeeding, minimal risk expected

Drug Interactions

• May interact with drugs that require gastric acid for absorption (e.g., ketoconazole, atazanavir)

Overdose Symptoms

• Confusion
• Drowsiness
• Blurred vision
• Dry mouth

Antidote for Overdose

• No specific antidote, treatment is supportive

Storage Conditions

• Store at room temperature (15-30°C)
• Protect from light and moisture

Pharmacokinetics

• Absorption: Rapidly absorbed from the gastrointestinal tract
• Distribution: Protein binding is approximately 97%
• Metabolism: Primarily hepatic via CYP2C19 and CYP3A4 enzymes
• Excretion: Mainly excreted in the urine

Precautions

• Monitor magnesium levels with long-term use
• Avoid abrupt discontinuation to prevent rebound acid hypersecretion

Warnings

• Increased risk of Clostridium difficile-associated diarrhea
• Possible increased risk of bone fractures with long-term therapy

Others

• May increase the risk of community-acquired pneumonia