- Esomeprazole reduces stomach acid production and is commonly used to manage reflux, erosive esophagitis, and acid-related ulcers.
- Treatment doses vary by condition and age, and it may be combined with antibiotics to eradicate Helicobacter pylori.
- While generally well tolerated, esomeprazole can cause side effects and is not recommended for certain groups or when used with specific medications.
Esomeprazole is a medication used to treat gastroesophageal reflux disease, erosive reflux esophagitis, stomach ulcers, Zollinger–Ellison syndrome, and duodenal ulcers associated with infection by the bacterium H. pylori. It is widely prescribed in the United States and recognized for its effectiveness in reducing stomach acid.
This medication works by lowering the amount of acid produced in the stomach through inhibition of the proton pump in the stomach lining cells. As a result, it helps relieve symptoms such as heartburn, stomach pain, and the backflow of stomach acid into the throat.
Esomeprazole is available in pharmacies and drugstores as 20 mg or 40 mg tablets, either as the generic form esomeprazole magnesium or under brand names such as Nexium. It should only be used under medical guidance, usually prescribed by a gastroenterologist.
Indications for use
Esomeprazole is prescribed for the treatment of:
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Gastroesophageal reflux disease
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Erosive reflux esophagitis
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Duodenal ulcer associated with Helicobacter pylori
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Healing of stomach ulcers caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs)
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Zollinger–Ellison syndrome
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Eradication of the bacterium H. pylori when used together with antibiotics
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Prevention of recurrent bleeding caused by ulcers in the stomach or intestine
In addition, esomeprazole may be prescribed to relieve gastrointestinal symptoms or to prevent stomach or intestinal ulcers in people who require ongoing treatment with NSAIDs.
How to take
Esomeprazole tablets of 20 mg or 40 mg should be taken by mouth with a glass of water, before or after meals, according to the schedule and duration recommended by a doctor.
Dosage may vary depending on the condition being treated and includes the following situations:
1. Gastroesophageal reflux disease
For adults and adolescents aged 12 to 18 years who do not have esophagitis, the usual dose is 20 mg once daily.
If symptoms do not improve after 4 weeks of treatment, medical reassessment is recommended.
2. Erosive reflux esophagitis
For adults and adolescents aged 12 to 18 years, the commonly recommended dose is 40 mg once daily for 4 weeks.
If healing is incomplete or symptoms persist, the doctor may extend treatment for another 4 weeks. In adolescents, treatment duration should not exceed 8 weeks. For maintenance therapy in adults to prevent recurrence, 20 mg once daily is typically recommended.
3. Ulcers associated with NSAID use
Esomeprazole for the treatment or prevention of stomach or intestinal ulcers related to NSAID use is indicated only for adults.
Common dosing recommendations include:
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Treatment of gastrointestinal symptoms related to NSAIDs: 20 mg once daily for 4 weeks, with reassessment if symptoms persist
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Healing of stomach ulcers caused by NSAIDs: 20 mg to 40 mg once daily for 4 to 8 weeks
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Prevention of ulcers during NSAID use: 20 mg once daily for the period determined by the doctor
This use is generally reserved for individuals who require long-term NSAID therapy.
4. Duodenal ulcer associated with H. pylori
For adults, the recommended regimen is 20 mg of esomeprazole combined with 1 g of amoxicillin and 500 mg of clarithromycin, all taken twice daily for 7 days.
5. Zollinger–Ellison syndrome
The usual starting dose for adults is 40 mg of esomeprazole twice daily.
The doctor may adjust this dose based on individual response to treatment.
6. Prevention of recurrent ulcer bleeding
To prevent new bleeding episodes in adults with stomach or intestinal ulcers, the usual dose is 40 mg once daily for 4 weeks.
This oral treatment is started after initial hospital management with intravenous esomeprazole sodium, given as an 80 mg infusion over 30 minutes, followed by continuous intravenous infusion at 8 mg per hour for 3 days.
Possible side effects
Common side effects of esomeprazole include abdominal pain, diarrhea, gas, nausea, vomiting, constipation, and headache.
More serious side effects require immediate medical attention and may include severe abdominal pain, watery diarrhea, blood in the stool or urine, reduced urine output, fever, loss of appetite, joint pain, or seizures.
Symptoms of low magnesium levels, such as dizziness, tremors, rapid heartbeat, agitation, muscle spasms, coughing, or shortness of breath, should also be reported to a doctor.
Esomeprazole may also trigger new symptoms or worsen existing symptoms of lupus, including joint pain or skin redness on the face or arms.
Who should not use it
Esomeprazole should not be used by children under 12 years of age, pregnant or breastfeeding women, or individuals with kidney or respiratory disorders, glucose-galactose malabsorption, fructose intolerance, or sucrase-isomaltase deficiency.
It is also contraindicated in people with known allergy to esomeprazole, omeprazole, lansoprazole, pantoprazole, or certain antiparasitic medications such as albendazole, mebendazole, thiabendazole, or cambendazole.
In addition, esomeprazole should not be used together with atazanavir, nelfinavir, saquinavir, warfarin, or clopidogrel.
Caution and medical supervision are required for people with osteoporosis, liver disease, lupus, low magnesium levels, or those using medications such as ketoconazole, itraconazole, erlotinib, digoxin, diazepam, phenytoin, amoxicillin, naproxen, or St. John’s wort.