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Nexium (esomeprazole)

Indications

Nexium is indicated for:

• Short-term treatment in the healing of erosive esophagitis (EE) in adults and pediatric patients aged 12 to 17 years.
• Maintenance of healing of EE in adults.
• Short-term treatment of heartburn and other symptoms associated with gastroesophageal reflux disease (GERD) in adults and pediatric patients aged 12 to 17 years.
• Risk reduction of nonsteroidal anti-inflammatory drugs (NSAID)-associated gastric ulcer in adults at risk for developing gastric ulcers due to age (60 years and older) and/or a documented history of gastric ulcers.
• Helicobacter pylori eradication in adult patients to reduce the risk of duodenal ulcer recurrence in combination with amoxicillin and clarithromycin.
• Long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome in adults.

Dosage and Administration

• Take Nexium by mouth as directed by your healthcare provider, usually once daily, at least 1 hour before a meal. If needed, antacids may be taken along with this medication.
• Use this medication regularly to get the most benefit from it. Take it at the same time each day.
• Do not crush, chew, or break the tablets.

Mechanism of Action

Nexium works by inhibiting the proton pump in the stomach lining. This reduces the production of stomach acid, which helps heal acid damage to the stomach and esophagus, prevents ulcers, and may prevent cancer of the esophagus.

Contraindications

• Known hypersensitivity to substituted Benzimidazoles or any component of the formulation.
• Patients receiving rilpivirine-containing products.

Side Effects

Common Side Effects:

• Headache
• Nausea
• Abdominal pain
• Constipation
• Diarrhea
• Flatulence
• Dry mouth

Serious Side Effects:

• Kidney problems
• Low magnesium levels
• Bone fractures
• Allergic reactions
• Acne
• Liver problems
• Hypomagnesemia
• Pneumonia

Precautions

• Gastric Malignancy: Even if Nexium helps with symptoms, it doesn’t rule out the possibility of stomach cancer. Follow up with your doctor for further testing.
• Acute Tubulointerstitial Nephritis: Stop taking Nexium and see your doctor if you experience any kidney problems. 
• Clostridium difficile-Associated Diarrhea: Using Nexium might increase your risk of a severe gut infection. Contact your doctor if you develop persistent diarrhea.
• Bone Fracture: Long-term use of Nexium, especially in high doses, can increase the risk of bone fractures in the hip, wrist, or spine. Use the lowest effective dose for the shortest time possible.
• Cutaneous and Systemic Lupus Erythematosus: Nexium can cause or worsen lupus. If you develop symptoms like a rash or joint pain, stop taking it and consult a specialist.
• Interaction with Clopidogrel: Avoid using Nexium with clopidogrel as it can reduce the effectiveness of clopidogrel. 
• Vitamin B-12 Deficiency: Long-term use of Nexium (more than 3 years) can lead to low vitamin B-12 levels. Discuss with your doctor if you need supplements.
• Hypomagnesemia: Prolonged use of Nexium can lead to low magnesium levels. Regular monitoring may be needed. 
• Interaction with St. John’s Wort or Rifampin: Avoid taking Nexium with these medications as they can decrease its effectiveness.
• Interactions with Diagnostic Tests for Neuroendocrine Tumors: Nexium can affect certain lab tests. Stop taking it at least 14 days before tests measuring chromogranin A levels.
• Interaction with Methotrexate: Taking Nexium with methotrexate (especially in high doses) can increase methotrexate levels in the blood, possibly causing toxicity. Your doctor may advise stopping Nexium temporarily.
• Fundic Gland Polyps: Long-term use of Nexium can increase the risk of developing stomach polyps. Use the medication for the shortest duration necessary.

Storage Instructions

• Store at 25°C (77°F).

References

https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021153s056,021957s023,022101s020lbl.pdf