esomeprazole magnesium (perprazole, S-omeprazole)

(ess oh me' pray zol)

Nexium

Pregnancy Category C

Drug classes
Antisecretory agent
Proton pump inhibitor

Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of
the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric
parietal cells; blocks the final step of acid production; is broken down less in the first pass
through the liver than the parent compound omeprazole, allowing for increased serum
levels.

Indications
• GERD—treatment of heartburn and other related symptoms
• Erosive esophagitis—short-term (4–8 wk) treatment for healing and symptom
relief. Also used for maintenance therapy following healing of erosive esophagitis
• As part of combination therapy for the treatment of duodenal ulcer associated
with Helicobacter pylori
• Reduction in occurrence of gastric ulcers associated with continuous NSAID use
in patients at risk (> 60 yr, history of gastric ulcers) for developing gastric ulcers

Contraindications and cautions

• Contraindicated with hypersensitivity to omeprazole, esomeprazole, or other
proton pump inhibitor.
• Use cautiously with hepatic dysfunction, pregnancy, lactation.

Available forms
DR capsules—20, 40 mg

Dosages
ADULTS
• Healing of erosive esophagitis: 20–40 mg PO daily for 4–8 wk. An additional 4–
8 wk course of therapy can be considered for patients who have not healed.
• Maintenance of healing erosive esophagitis: 20 mg daily.
• Symptomatic GERD: 20 mg daily for 4 wk. An additional 4-wk course of therapy
can be considered if symptoms have not resolved.
• Duodenal ulcer: 40 mg/day PO for 10 days with 1,000 mg PO bid ampicillin and
500 mg PO bid clarithromycin.
• Reduction of risk of gastric ulcers with NSAID use: 20–40 mg/day PO for 6 mo.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC DYSFUNCTION
Do not exceed 20 mg/day in patients with severe hepatic dysfunction.

Pharmacokinetics
Route Onset Peak Duration
Oral 1–2 hr 1.5 hr 17 hr

Metabolism: Hepatic; T1/2: 1–1.5 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and bile

Adverse effects
• CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy,
anxiety, paresthesias, dream abnormalities
• Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue
atrophy, flatulence
• Respiratory: URI symptoms, sinusitis, cough, epistaxis

Interactions
Drug-drug
• Increased serum levels and potential increase in toxicity of benzodiazepines
and phenytoin when taken concurrently
• May interfere with absorption of drugs dependent upon presence of acidic
environment (eg ketoconazole, iron salts, digoxin)

Nursing considerations
CLINICAL ALERT!
Potential for name confusion exists between esomeprazole and omeprazole;
use caution.

Assessment
• History: Hypersensitivity to any proton pump inhibitor; hepatic dysfunction;
pregnancy, lactation
• Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal
examination; respiratory auscultation, liver function tests

Interventions
• WARNING: Arrange for further evaluation of patient after 4 wk of therapy
for gastroesophageal reflux disorders. Symptomatic improvement does not rule
out gastric cancer.
• If administering antacids, they may be administered concomitantly
with esomeprazole.
• Ensure that the patient swallows capsule whole; do not crush, or chew; patients
having difficulty swallowing may open capsule and sprinkle in applesauce or
disperse in tap water, orange or apple juice, or yogurt; do not crush or chew
pellets.
 • Obtain baseline liver function tests and monitor periodically during therapy.
• Maintain supportive treatment as appropriate for underlying problem.
• Provide additional comfort measures to alleviate discomfort from GI effects and
headache.
• Establish safety precautions if dizziness or other CNS effects occur (use side rails,
accompany patient).

Teaching points
• Take the drug at least 1 hr before meals. Swallow the capsules whole; do not
chew or crush. If you cannot swallow the capsule, it can be opened and sprinkled
in applesauce or mixed in tap water, orange or apple juice, or yogurt; do not crush
or chew the pellets. This drug will need to be taken for 4–8 wk, at which time
your condition will be reevaluated.
• Arrange to have regular medical follow-up while you are using this drug.
• Maintain all of the usual activities and restrictions that apply to your condition. If
this becomes difficult, consult with your nurse or physician.
• You may experience these side effects: Dizziness (avoid driving a car or
performing hazardous tasks); headaches (consult with your health care provider if
these become bothersome, medications may be available to help); nausea,
vomiting, diarrhea (proper nutrition is important, consult with your dietitian to
maintain nutrition; ensure ready access to bathroom facilities); symptoms of URI,
cough (it may help to know that this is a drug effect, do not self-medicate, consult
with your health care provider if this becomes uncomfortable).
• Report severe headache, worsening of symptoms, fever, chills, darkening of the
skin, changes in color of urine or stool.

Adverse effects in Italic are most common; those in Bold are life-threatening.