Esomeprazole
Reviewed by Dr Bipin B. 
-
- Drug class: Proton pump inhibitors
- Generic name: Esomeprazole
- Brand name: NEXPRO, IZRA
1.introduction
Esomeprazole belongs to a class of drugs called PPI, which work by reducing the amount of acid produced by the stomach. It is available both over-the-counter and by prescription in country like India. It is available in markets in capsules and sachet form. Esomeprazole has been used to treat stomach ulcers, Gastric & Duodenal ulcer,Zollinger-Ellison syndrome, Erosive esophagitis and gastroesophageal reflux disease (GERD). Esomeprazole has also been used with antibiotic in H-pylori infection.
2. Eye opening and easiest way to understand: how Esomeprazole works.
Esomeprazole is an anti-ulcer drug available in the market under various brand names such as IZRA. Before discussing about Esomeprazole let us talk about how acidity occurs in our stomach.
When we eat food, the pH of our stomach increases and becomes more alkaline. In response, acid is triggered to be recognized to aid in the digestion of food. However, excessive acid secretion can damage the inner lining of our stomach, known as the mucosa, resulting in various diseases such as Peptic ulcer and gastroesophageal reflux disease (GERD). Anti-ulcer medications are used to prevent and treat tis condition.
A group of drugs known as anti-ulcer drugs are known as proton pump inhibitors . This group includes drugs such as Omeprazole, Pantoprazole, Rabeprazole and Esomeprazole. Esomeprazole, specifically works by reducing stomach acid.
In our gastric mucosa, there are parietal cells that are responsible for acid secretion. HistamineH2 receptor play a role in this process. When activated, it trigger the secretion of histamine, which then activate the proton pumps. proton pump produces hydrogen ions which leads to production of an acid.
Esomeprazole acts as a PPI. When taken, it stops the activation of the pumps within about half an hour. This means no ion production and ultimately no acid production. In cases of acidity, where acid production is either high or normal, reducing acid production is an important step in treating the condition. As the acid is reduced, ulcers and wounds begin to heal.
I hope this explanation has helped you understand how Esomeprazole works as an anti-ulcer drug.
3.5 important feature of Esomeprazole:-
-
- It inhibit the final common step in gastric acid secretion, so better than Ranitidine.
-
- inactive at neutral pH, so should not be taken with Digene.
-
- insignificant drug interaction
-
- lower side effects
- available as over the counter drugs.
4. Uses of Esomeprazole:-
- Heartburn
- Duodenal ulcer
- Gastric ulcer
- Stress ulcer
- Gastritis
- Zollinger Ellison syndrome
- Gastroesophageal reflux disease: It is a condition in which gastric acid backs up from the stomach into the esophagus. Irritation caused by gastric acid to the esophagus is known as Heartburn. Long exposure of the esophagus to gastric juice may lead to permanent damage to the esophagus. Esomeprazole reduces gastric juice production by blocking HK ATPase in the parietal cell of the stomach.
- Aspiration pneumonia
5. Adverse effects of Esomeprazole:-
overall incidence of side effects is lower, however, the following can be noticed:-
- nausea, abdominal pain, and loose stools.
- Headache and dizziness
- Muscle and joint pain
- Rashes(1.5%)
- Hepatic injury is rare
- Don’t use this medicine if you have an allergic reaction or kidney problem.
Stop using this medicine if you have severe side effects and visit the nearest hospital for further management.
6. Esomeprazole long-term uses warning:-
While Esomeprazole is generally considered safe, long-term use of the medication may lead to certain complications. Some commonly reported side effects of Esomeprazole include:
- Vitamin and mineral deficiencies – Esomeprazole can reduce the absorption of certain vitamins and minerals including calcium, magnesium, and vitamin B12. Long-term use of the medication can lead to deficiencies in these nutrients and increase the risk of osteoporosis, fractures, anemia, and other health conditions.
- Increased risk of infections – Esomeprazole can increase the risk of infections such as Community-acquired pneumonia, and C difficile, particularly in elderly and hospitalized patients.
- Increased risk of kidney disease – Long-term use of Esomeprazole can increase the risk of kidney problems, including acute kidney injury, chronic kidney disease, and an increased risk of kidney failure.
- Increased risk of fractures – Long-term use of Esomeprazole has been associated with an increased risk of osteoporosis and fractures of bone as it reduces absorption of calcium.
- Risk of electrolyte disbalance.
- Use of Esomeprazole can mask features of gastric cancer or other gastric problems.
It is important to note that while long-term use of Esomeprazole can have complications, these risks usually outweigh the benefits of the medication for patients with certain conditions. If you have concerns about the long-term use of Esomeprazole, it is important to discuss these with your doctor. They can help you determine if Esomeprazole is the right medication for your condition and if particular strategies (like changing to lower dose or other type of acid suppression therapy) may reduce the risk of adverse effects of long term use.
7. Drug interaction
Drug interaction with other drugs has been reported, but most have no clinical significance. Hence, Esomeprazole is safe to use. However consult a doctor while taking these medicine: clopidogrel, tramadol, escitalopram, erythromycin, and ketoconazole.
8. Dosages of Esomeprazole
- Heartburn: 20 mg once a day for a week
- Stomach/Duodenal ulcer: 20 to 40 mg once a day for 4 to 8 weeks.
- Erosive esophagitis: 20 mg once a day for 4 to 8 weeks.
- Zollinger Ellison syndrome: 60-120 mg once a day
- Gastroesophageal reflux disease: 20 mg a day for 4 to 8 weeks
- When using over-the-counter (OTC) Esomeprazole, it is recommended to take it for a maximum of 14 consecutive days. It is important to follow the directions provided by the manufacturer or consult a health care professional for guidance specific to your situation.
- After starting Esomeprazole, it may take 1 to 4 days before you experience an improvement in your symptoms. It is important to continue taking the medication as directed during this period, even if you do not see immediate relief.
FAQ'S:-
It should be taken orally 30- 60 minutes before meal.
20 mg once a day in the morning empty stomach.
No, it’s not a painkiller. As we know heartburn occurs due to the over secretion of gastric juices and Esomeprazole decreases the secretion of acid produced by our stomach. The mucosal layer of the stomach heals as the secretion of gastric juices reduces.
No, it has no role in relieving gas. It is a medicine for ulcers and acidity.
Simethicone helps the gas to pass through one’s digestive tract.
It neutralizes the acid present inside the stomach immediately. hence, relieves acidity immediately and is useful in acid reflux disease, but inferior to PPI and Ranitidine in ulcer treatment.
A teaspoon of Sodium bicarbonate, also popularly known as Baking soda can be taken with a glass of water. It neutralizes the gastric juice present inside the stomach.
Esomeprazole control acid secretion for up to 12 hours.
Esomeprazole is superior to Ranitidine.
Consult your doctor before taking Esomeprazole for more than 14 days.
Esomeprazole is very frequently used for gastritis however, it takes almost up to one hour to suppress heartburn and acidity. Hence iv PPI is most frequently used in case of Gastritis for immediate pain relives.
Yes, no dose modification required.
It takes at least 60 min to suppress acid secretion however maximum effect will be seen by 2 hr.
-
- Consult your doctor before taking Esomeprazole. Digene syrup is better alternative for mild gastric upset.
-
- For moderate to severe gastric condition generally Esomeprazole is considered safe.
Take the recommended dose as soon as possible. if it’s time for another dose, don’t take double dose.
Pantoprazole, Rabeprazole, Omeprazole, Lansoprazole, Ranitidine
Both Esomeprazole and pantoprazole are PPIs commonly used to treat conditions related to excess stomach acid production, such as reflux esophagitis, gastroesophageal reflux disease (GERD) and peptic ulcers. While they belong to the same class of medications and work in similar ways, there may be some differences between them that can make one more suitable for an individual depending on their specific needs.
Effectiveness: Both drugs are generally effective in reducing stomach acid production. However, individual responses can vary, and what works well for one person may not be as effective for another.
Dosage and Frequency: Esomeprazole is typically taken once a day, whereas pantoprazole is available in both once-daily and twice-daily formulations. The specific dosage and frequency will depend on the condition being treated and the doctor’s recommendation.
Absorption and Onset of Action: Esomeprazole and pantoprazole have different absorption rates, with pantoprazole being more readily absorbed by the body. Pantoprazole also has a slightly faster onset of action, meaning it may provide relief more quickly.
Drug Interactions: Both Esomeprazole and pantoprazole can interact with other medications. It is important to discuss your current medications with your doctor to ensure there are no potential interactions.
Side Effects: Both drugs have similar side effects, like headaches, nausea, diarrhoea, and abdominal pain. However, individual experiences can vary, and some people may tolerate one medication better than the other
Esomeprazole is PPI while Ranitidine is histamine H2 receptor antagonist. Although gastric acid control is better achieved by Esomeprazole and considered better than Ranitidine ; Ranitidine has already been banned in many countries as it causes cancer.
If you are experiencing excess acid, indigestion, heartburn or ulcer symptoms, certain foods and drinks may worsen your symptoms:-
spicy food
fatty food
carbonated drinks
alcohol
large meal/late night meal