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
• Gastroesophageal reflux disease—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

Contraindications and cautions

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

Available forms
Delayed-release capsules—20, 40 mg

Dosages
ADULTS
• Healing of erosive esophagitis: 20–40 mg PO daily for 4–8 wk. An additional
course of therapy can be considered for patients who have not healed.
• Maintenance of healing erosive esophagitis: 20 mg daily.
• Symptomatic gastroesophageal reflux disease: 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.
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; body temperature; reflexes, affect; urinary output,
abdominal exam; respiratory auscultation, liver function tests

Interventions
• 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; 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.
• These side effects may occur: 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 upper
respiratory tract infection, 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.