Home Drug Guide Esomeprazole Magnesium

Drug Guide

Generic Name

Esomeprazole Magnesium

Brand Names Nexium, Nexium 24HR

Classification

Therapeutic: Proton pump inhibitor (PPI)

Pharmacological: Proton pump inhibitor, suppresses gastric acid secretion

FDA Approved Indications

Erosive esophagitis due to acid reflux
Gastroesophageal reflux disease (GERD)
Erosive esophagitis healing
Helicobacter pylori eradication (as part of combination therapy)
Zollinger-Ellison syndrome

Mechanism of Action

Esomeprazole inhibits the H+/K+ ATPase enzyme system of gastric parietal cells, leading to a profound and sustained reduction in gastric acid secretion.

Dosage and Administration

Adult: Typically 20-40 mg once daily before a meal. Duration varies based on condition.

Pediatric: Dosing based on weight and condition; consult specific guidelines.

Geriatric: Adjustments generally not required but monitor for adverse effects.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Reduce dose in severe hepatic impairment.

Pharmacokinetics

Absorption: Absorption is pH-dependent; food may delay absorption but not reduce extent.

Distribution: Extensively protein-bound (~97%), primarily to plasma proteins.

Metabolism: Metabolized in the liver via CYP2C19 and CYP3A4 enzymes.

Excretion: Primarily in urine as metabolites, minor in feces.

Half Life: 1-2 hours, but acid suppression lasts longer due to irreversible binding to proton pumps.

Contraindications

Hypersensitivity to esomeprazole or other PPIs.

Precautions

Use with caution in patients with osteoporosis or at risk of osteoporosis-related fractures; may increase fracture risk with long-term use.
Monitor magnesium levels during prolonged therapy.
Potential risk of Clostridioides difficile-associated diarrhea.

Adverse Reactions - Common

Headache (Common)
Diarrhea (Common)
Nausea (Common)
Abdominal pain (Common)

Adverse Reactions - Serious

Severe allergic reactions, including anaphylaxis (Rare)
Clostridioides difficile-associated diarrhea (Rare)
Interstitial nephritis (Rare)
Osteoporotic fractures with long-term use (Potential)

Drug-Drug Interactions

Clopidogrel (may reduce effectiveness)
Diazepam (may increase levels)
Methotrexate (may increase toxicity)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for relief of symptoms, and adverse effects, especially in long-term therapy.

Diagnoses:

Risk for injury (fractures), imbalance in electrolyte levels

Implementation: Administer before meals; monitor magnesium, B12 levels during prolonged use.

Evaluation: Assess symptom relief and monitor for adverse events.

Patient/Family Teaching

Take medication 30-60 minutes before meals.
Do not crush or chew delayed-release capsules.
Report symptoms of hypomagnesemia (muscle weakness, arrhythmias).
Use in conjunction with lifestyle modifications for GERD.

Special Considerations

Black Box Warnings:

Long-term use may increase risk of fractures, hypomagnesemia, C. difficile infection.

Genetic Factors: CYP2C19 polymorphisms can affect drug metabolism.

Lab Test Interference: May interfere with serum chromogranin A testing.

Overdose Management

Signs/Symptoms: Nausea, vomiting, tachycardia.

Treatment: Supportive care; no specific antidote. Symptomatic treatment and monitoring.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable in original container for specified shelf life.