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Sompraz (esomeprazole) is a proton pump inhibitor (PPI). ## Primary Indications * Gastroesophageal reflux disease (GERD): erosive esophagitis healing and maintenance, symptomatic GERD * *Helicobacter pylori* eradication (in combination with antibiotics) * Zollinger-Ellison syndrome * Prevention of NSAID-induced gastric ulcers ## Adult Dosing * **GERD (healing erosive esophagitis):** 20 mg or 40 mg orally once daily for 4-8 weeks. * **GERD (maintenance of healing):** 20 mg orally once daily. * **Symptomatic GERD:** 20 mg orally once daily for 4 weeks. * ***H. pylori* eradication:** 20 mg orally twice daily for 10 days (in combination with amoxicillin and clarithromycin). * **Zollinger-Ellison syndrome:** Starting dose 40 mg orally twice daily, titrate to lowest dose that controls symptoms; doses up to 240 mg daily have been given. * **Prevention of NSAID-induced gastric ulcers:** 20 mg orally once daily. ## Pediatric Dosing Dosing varies by indication and age. Consult specific pediatric guidelines. * **GERD (healing erosive esophagitis):** * Ages 1-11 years: 10 mg orally once daily for 8 weeks. * Ages 12-17 years: 20 mg orally once daily for 4-8 weeks. * **GERD (maintenance of healing):** * Ages 1-11 years: 10 mg orally once daily. * Ages 12-17 years: 20 mg orally once daily. * **Symptomatic GERD:** * Ages 12-17 years: 20 mg orally once daily for 4 weeks. ## Dose Adjustments * **Hepatic Impairment:** * Severe hepatic impairment: Maximum dose of 20 mg orally once daily. ## Contraindications * Known hypersensitivity to esomeprazole, other substituted benzimidazoles, or any component of the formulation. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, constipation, flatulence, dry mouth. Less Common: Dizziness, insomnia, rash, fatigue. Rare: Severe skin reactions (e.g., Stevens-Johnson syndrome), liver enzyme abnormalities, interstitial nephritis, C. difficile-associated diarrhea. Long-term use (over 1 year) may be associated with an increased risk of: * Bone fractures (hip, wrist, spine) * Magnesium deficiency (hypomagnesemia) * Vitamin B12 deficiency ## Key Drug Interactions * **Clopidogrel:** Esomeprazole may decrease the antiplatelet effect of clopidogrel; consider alternative PPIs or separate administration by at least 12 hours. * **CYP2C19 Substrates:** Esomeprazole is a moderate inhibitor of CYP2C19, potentially increasing serum concentrations of drugs metabolized by this enzyme (e.g., citalopram, diazepam, warfarin). * **Methotrexate:** PPIs may increase methotrexate levels; monitor for toxicity. * **Drugs Dependent on Gastric pH for Absorption:** Esomeprazole can decrease gastric acidity, potentially affecting absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors. ## Monitoring * Monitor for resolution of GERD symptoms. * Monitor for signs and symptoms of *H. pylori* eradication failure. * Monitor for potential long-term adverse effects (fractures, magnesium levels, vitamin B12 levels) with prolonged use. * Monitor for drug interactions. ## Clinical Pearls * Administer at least 1 hour before meals for optimal efficacy. * Do not crush or chew delayed-release capsules; they can be opened and contents mixed with applesauce or water for administration. * The 24-hour acid suppression is greater with esomeprazole compared to omeprazole at equivalent doses. * Long-term PPI use should be re-evaluated regularly and limited to the shortest duration necessary. *** **Disclaimer:** This information is for educational purposes and is not a substitute for professional medical advice. Always verify current prescribing information with the official drug monograph or relevant clinical guidelines before making any treatment decisions.