Names and pronunciation
(es′oh-mep′rah-zohl) NexIUM, NexIUM 24HR, NexIUM I.V.
Source page 515
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Individual generic drug information
Extracted information for esomeprazole only.
(es′oh-mep′rah-zohl) NexIUM, NexIUM 24HR, NexIUM I.V.
Source page 515
Func. class.: Antiulcer
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Chem. class.: Proton pump inhibitor, benzimidazole
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Do not confuse: esomeprazole/omeprazole
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ACTION: Suppresses gastric secretions by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibi- tor because it blocks the final step of acid production
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USES: Gastroesophageal reflux dis- ease (GERD), adult/child/infant; severe erosive esophagitis, adult/child; treat- ment of active duodenal ulcers in combination with anti-infectives for Heli- cobacter pylori infection; long-term use for hypersecretory conditions
Source page 515
Extracted information for esomeprazole only.
CONTRAINDICATIONS: Hyper- sensitivity to proton pump inhibitors (PPIs) Precautions: Pregnancy, breastfeeding, children, geriatric patients, hypomagne- semia, osteoporosis
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SIDE EFFECTS CNS: Headache, dizziness GI: Diarrhea, flatulence, abdominal pain, constipation, dry mouth, hepatic failure, hepatitis, microscopic colitis, Clostridium difficile–associated diarrhea (CDAD) INTEG: Rash, dry skin GU: Nephritis MISC: Fractures, SLE, vitamin B12 deficiency SYST: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
Source page 516
INTERACTIONS Increase: effect, toxicity of diazePAM, digoxin, penicillins, saquinavir, cilostazol, clo- ZAPine, those drugs metabolized by CYP2C19 Increase: effect of methotrexate, tacroli- mus, warfarin Decrease: effect—atazanavir, nelfinavir, dapsone, iron, itraconazole, ketoconazole, indinavir, calcium carbonate, vitamin B12, clopidogrel, iron salts, mycophenolate Drug/Lab Test Interference: sodium, HB, WBC, plate- lets, magnesium False-positive: CgA
Source page 516
Extracted information for esomeprazole only.
DOSAGE AND ROUTES Active duodenal ulcers associated with H. pylori • Adult: PO 40 mg/day × 10-14 days in combination with clarithromycin 500 mg bid × 10 days and amoxicillin 1000 mg bid × 10 days GERD/erosive esophagitis • Adult: PO 20 or 40 mg/day × 4-8 wk; no adjustment needed in renal/liver fail- ure, geriatric patients; IV 20 or 40 mg/ day up to 10 days • Adolescent and child 12-17 yr: PO 20 or 40 mg/day 1 hr prior to meals for ≤8 wk • Child 1-11 yr and ≥20 kg: PO 10 mg/ day 1 hr prior to meals for ≤8 wk • Infant ≥1 mo: IV 0.5 mg/kg over 10- 30 min • Infant 1-11 mo (>7.5-12 kg): PO 10 mg daily × up to 6 wk • Infant 1-11 mo (>5-7.5 kg): PO 5 mg daily × up to 6 wk • Infant 1-11 mo (3-5 kg): PO 2.5 mg daily × up to 6 wk Gastric ulcer prophylaxis, NSAID-associated gastropathy • Adult: PO 20-40 mg/day up to 6 mo Zollinger-Ellison syndrome • Adult: PO 40 mg bid, up to 240 mg/day Dyspepsia (unlabeled) Adult: PO 40 mg daily × 8 wk Hepatic dose • Adult: PO/IV max 20 mg/day (severe hepatic disease)
Source pages 515, 516
Available forms: Delayed-release cap- sules 20, 40 mg; powder for IV injec- tion 20, 40 mg/vial; delayed-release powder for oral suspension 2.5, 5, 10, 20, 40 mg
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Administer: PO route • Swallow capsules whole; do not crush or chew; capsule may be opened and sprinkled over Tbsp of applesauce • Same time daily, 1 hr before meal • Oral suspension (delayed release): empty contents of packet into container with 1 Tbsp of water, let stand 2-3 min to thicken, restir, give within 30 min of mixing; any residual product should be flushed with more water, taken immediately • NG tube (delayed-release oral sus- pension): add 50 mL water to contents of packet in syringe, shake, leave 2-3 min to thicken, shake, inject through NG tube within 30 min, make sure granules are dissolved IV, direct route • Reconstitute each vial with 5 mL 0.9% NaCl, D5W, LR; give over 3 min Intermittent IV INFUSION route • Dilute reconstituted solution to 50 mL, give over 30 min, do not admix, flush line with D5W, 0.9% NaCl, LR after infusion Continuous IV route • Use 2 (40-mg vials) with 5 mL of 0.9% NaCL for 80-mg loading dose, further dilute in 100 mL 0.9% NaCL give over 30 min, then infusion at 8 mg/hr Y-site compatibility: Ceftaroline, fen- tanyl, furosemide, regular insulin, nitroglycerin
Source page 516
Extracted information for esomeprazole only.
Assess: • GI system: bowel sounds, abdomen for pain, swelling, anorexia, bloody stools; CDAD may occur • Hepatic failure, hepatitis: AST, ALT, alkaline phosphatase at baseline and pe- riodically during treatment • Serious skin disorders: Stevens- Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis • Pregnancy/breastfeeding: use only if benefits clearly outweigh risks to fetus; do not breastfeed
Source page 517
Evaluate: • Therapeutic response: absence of epi- gastric pain, swelling, fullness, decreased GERD
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report severe diarrhea, abdominal pain, black tarry stools, rash; product may have to be discontinued • That hypoglycemia may occur if diabetic • To avoid hazardous activities; dizzi- ness may occur • To notify provider if pregnancy is planned or suspected or if breastfeeding • To avoid alcohol, salicylates, NSAIDs; may cause GI irritation • To take ≥1 hr prior to meal; not to crush, chew delayed-release product; if missed, to take as soon as remembered if not almost time for next dose; to take full course prescribed; to read “Patient Information” • That if capsule is unable to be swal- lowed whole, contents may be mixed with a Tbsp of applesauce • To notify provider of all OTC, Rx, or herbal products taken • Hypomagnesemia: to notify prescriber of dizziness, fast heartbeat, tremors, weakness, spasm, cramps
Source page 517
Extracted information for esomeprazole only.
PHARMACOKINETICS Well absorbed 90%; protein binding 97%; extensively metabolized in liver (CYP2C19); terminal half-life 1-1.5 hr; eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased, bioavailability increased
Source page 516
Filter the extracted dose blocks for this individual drug.
Active duodenal ulcers associated with H. pylori
• Adult: PO 40 mg/day × 10-14 days in combination with clarithromycin 500 mg bid × 10 days and amoxicillin 1000 mg bid × 10 days GERD/erosive esophagitis
Candidate age grouping · source pages 515, 516
Active duodenal ulcers associated with H. pylori
• Adult: PO 20 or 40 mg/day × 4-8 wk; no adjustment needed in renal/liver fail- ure, geriatric patients; IV 20 or 40 mg/ day up to 10 days
Candidate age grouping · source pages 515, 516
Active duodenal ulcers associated with H. pylori
• Adult: PO 20-40 mg/day up to 6 mo Zollinger-Ellison syndrome
Candidate age grouping · source pages 515, 516
Active duodenal ulcers associated with H. pylori
• Adult: PO 40 mg bid, up to 240 mg/day Dyspepsia (unlabeled) Adult: PO 40 mg daily × 8 wk Hepatic dose
Candidate age grouping · source pages 515, 516
Active duodenal ulcers associated with H. pylori
• Adult: PO/IV max 20 mg/day (severe hepatic disease)
Candidate age grouping · source pages 515, 516