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# Esomeprazole
## Overview
Esomeprazole is a proton pump inhibitor (PPI) that reduces the amount of acid produced in the stomach.
## Primary Indications
* Healing of erosive esophagitis associated with GERD.
* Maintenance of healing of erosive esophagitis.
* Symptomatic GERD.
* Reduction of risk of NSAID-associated gastric ulcers in patients with a history of such ulcers.
* Part of combination therapy for *Helicobacter pylori* eradication.
## Adult Dosing
* **Healing of Erosive Esophagitis:** 20 mg or 40 mg orally once daily for 4 to 8 weeks.
* **Maintenance of Healing of Erosive Esophagitis:** 20 mg orally once daily.
* **Symptomatic GERD:** 20 mg orally once daily for 4 weeks.
* **NSAID-Associated Gastric Ulcer Prevention:** 20 mg or 40 mg orally once daily.
* ***H. pylori* Eradication:** 20 mg orally twice daily in combination with amoxicillin and clarithromycin for 10 days.
## Pediatric Dosing
Dosing varies by indication and age/weight. Consult specific pediatric guidelines. For example:
* **1 to 11 years:**
* Healing of Erosive Esophagitis: 10 mg or 20 mg once daily for 8 weeks.
* Symptomatic GERD: 10 mg once daily for 4 weeks.
* **12 to 17 years:**
* Healing of Erosive Esophagitis: 20 mg or 40 mg once daily for 4 to 8 weeks.
* Symptomatic GERD: 20 mg once daily for 4 weeks.
## Dose Adjustments
* **Hepatic Impairment:**
* Severe impairment: Maximum dose of 20 mg once daily.
* **Renal Impairment:** No dose adjustment generally needed.
## Contraindications
* Known hypersensitivity to esomeprazole, substituted benzimidazoles, or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, flatulence, and constipation.
Long-term use may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), vitamin B12 deficiency, and hypomagnesemia.
## Key Drug Interactions
* **Clopidogrel:** Esomeprazole may decrease the efficacy of clopidogrel. Consider alternative PPIs or avoidance.
* **CYP2C19 Substrates:** Esomeprazole inhibits CYP2C19 and can increase concentrations of drugs metabolized by this enzyme (e.g., citalopram, diazepam, phenytoin).
* **Drugs Dependent on Gastric pH:** PPIs can decrease gastric acidity, affecting absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors.
* **Methotrexate:** Concurrent use may increase methotrexate levels.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile* infection.
* Consider monitoring serum magnesium levels periodically, especially with prolonged use or concurrent diuretic use.
* Assess for bone fracture risk factors.
* Monitor for symptoms of vitamin B12 deficiency with long-term therapy.
## Clinical Pearls
* Administer at least 1 hour before meals.
* Tablets and oral suspension can be opened and mixed with water, applesauce, or yogurt; do not chew or crush delayed-release granules.
* The 40 mg dose is typically for healing erosive esophagitis; 20 mg is often sufficient for GERD symptom management and maintenance.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your institution's protocols before making any treatment decisions.
