Drug A.T Esomeprazol 20 treat peptic ulcer (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Esomeprazol

Ingredient

Composition information	Content
Esomeprazol	20mg

Uses

Indications

Esomeprazol 20mg drugs are indicated in the following cases:

Treatment:

Stomach ulcer - duodenum.

Zollinger syndrome - Ellison.

Gastroesophageal reflux disease (esophagitis, ulcerative or narrowed ulcer is determined by laparoscopy).

Prevention and treatment of stomach - duodenal ulcer due to nonsteroidal anti -inflammatory drugs.

Prevention and ulcerative treatment due to stress.

Hemorrhage caused by stomach - duodenal ulcer, after laparoscopic treatment (to prevent recurrent hemorrhage).

Pharmacy

Esomeprazol is the isomorphic form of omeprazol, used similar to omeprazol in the treatment of gastric ulcer and gastroesophageal reflux disease.

Esomeprazol is associated with H+K+-atpase (also called proton pump) in the cell wall of the stomach, inhibiting this enzyme system, preventing the final step of the excretion of acidic into the stomach. Therefore, Esomeprazol has the effect of inhibiting the basic acid secretion and even when stimulated by any agent. The drug works strongly, lasting.

pharmacokinetic

absorption

Esomeprazol absorbs quickly after drinking, reaching the highest concentration in plasma after 1-2 hours. Esomeprazol's bioavailability increases according to the dose and when used to repeat, reaching about 68% when taking 20mg dose and about 89% when using 40mg dose. Food slows down and reduces the absorption of Esomeprazol, but does not change the effect of the effect of the drug on the acidity in the stomach. The area under the curve (AUC) after taking a single dose Esomeprazol 40mg at meals compared to the hunger decreased from 43% to 53%. Therefore, Esomeprazol has to drink at least 1 hour before meals.

Distribution

About 97% Esomeprazol attaches to plasma proteins. The volume of distribution when the drug concentration is stable in healthy volunteers of 16L.

Metabolism

Maximum metabolic drugs are mainly in the liver thanks to isenzyme CYP2C19, cytochrom P450 enzyme system, into hydroxyl and desmethyl metabolites that are no longer active. The rest is converted through ISOENZYM CYP3A4 to Esomeprazol Sulfon. When used repeated, initially metabolized through the liver and the clearance of the drug reduced, possibly due to the inhibited ISOENZYM CYP2C19. However, there is no phenomenon of accumulation of drugs when used once a day. In some people because of the lack of CYP2C19 due to genetics (15-20% of Asians), they should slow down the metabolism of esomeprazol, resulting in an increase in AUC value about 2 times compared to people with enough enzymes.

Elimination

Sell waste time in plasma is about 1.3 hours. About 80% of oral doses are eliminated in the form of non -active metabolites in the urine, the rest is eliminated in the feces. Under 1% of the drug is eliminated in the urine. In people with severe liver failure, AUC value is 2-3 times higher than that of people with normal liver function, so Esomeprazol must be reduced in the patients.

Before taking Drug A.T Esomeprazol 20 treat peptic ulcer (10 blisters x 10 tablets)

How to use

Esomeprazole is not stable in acidic environment, so it must be taken in the form of tablets in the intestine so as not to be destroyed in the stomach and increase bioavailability. Must swallow the tablet, not crushed or chewed. Take medicine at least 1 hour before meals. Can be used with antacids when necessary to relieve pain.

Dosage

Dosage for adults

Treatment of stomach ulcers - duodenum due to Helicobacter pylori infection

Esomeprazol is a component in the treatment regimen along with antibiotics. Regimen 3 or 4 (along with amoxicilin and clarithromycin or clarithromycin, metronidazol and bismuth). Esomeprazol at 20mg, 2 times a day for 14 days, or 40mg once a day for 10 days. Depending on the rate of resistance for each locality to choose the appropriate treatment regimen.

Treatment of gastroesophageal reflux disease (esophagitis)

Take 40mg once a day for 4 weeks, can take another 4 weeks if needed, or otherwise: Take Esomeprazol 20 or 40mg once a day, for 4-8 weeks, can use orally 4 - 8 weeks if there is still symptom or appearance of laparitis. Severe cases may increase the dose to 80mg/day divided 2 times.

Maintain treatment when the esophagus or symptomatic treatment is not treated in the absence of esophagitis

Esomeprazol 20mg once a day.

Treatment of stomach - duodenal ulcer due to nonsteroidal anti -inflammatory drugs or stress prevention

Take Esomeprazol 20mg once a day, for 4 - 8 weeks.

Preventive gastric ulcer prevention in people with high risk of stomach - duodenal complications, but required to continue treatment with nonsteroidal anti -inflammatory drugs

Take 20mg or 40mg daily.

Treatment of Zollinger-Elison syndrome

Depending on the individual and the degree of acidic increasing of the gastric juice, the dosage per day may be higher in other cases, used once or divided into 2 times a day. The starting dose is 40mg, 2 times a day, then adjust the dose as needed. Most patients can control at 80 - 160mg daily. Doses greater than 80mg/day must be divided into 2 times.

Hepatic failure

No dose reduction in patients with mild and medium liver failure. For patients with severe liver failure, maximum overdose of 20mg Esomeprazol should be used every day in adults and children> 12 years and 10mg in children 1 - 11 years old.

Renal failure

There is no need to reduce the dose in mild and medium liver failure people, cautious in people with severe renal failure because the experience used in these patients is limited.

Elderly

No need to reduce the dose in the elderly.

Dosage for children

Children> 12 years old

Can use the dose as adults.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when using overdose?

There is no specific antidote for Esomeprazol. Mainly treat symptoms and support. Hemorrhage does not have the effect of increasing the elimination of drugs because the drug is highly attached to the protein.

What to do when forgetting a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

When using Esomeprazol 20 Tab, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Systemic: headache, dizziness, skin extra skin.

digestive: Nausea, vomiting, abdominal pain, diarrhea, constipation, flatulence, dry mouth.

Uncommon, 1/1000

Body: fatigue, insomnia, drowsiness, rash, itching, paresthesia.

Eye: visual disorders.

Rare, 1/10000

Systemic: Fever, sweat, peripheral edema, sensitive to light, hypersensitivity reactions (including urticaria, angioedema, bronchospasm, anaphylactic shock).

Central nerve: agitation, depression, confusion, hallucinations. Hematology: Reducing whole blood, granulocytosis, leukopenia, thrombocytopenia. liver: Increased liver enzyme, hepatitis, jaundice, liver function. digestive: taste disorders, stomatitis. muscle - Bone: joint pain, muscle pain, osteoporosis, fracture. urinary: interstitial nephritis.

Skin: bumper, Stevens-Johnson syndrome, poisoned epidermal necrosis, dermatitis.

Instructions on how to handle ADR

Notify the doctor with unwanted effects when using the drug.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Esomeprazol 20 tabs contraindicated in the following cases:

Hypersensitivity to Esomeprazol or other proton pump inhibitors, or too hypersensitivity to any ingredients of the drug.

Precautions when using

Before taking proton pump inhibitors, it is necessary to eliminate stomach cancer because the drug can cover symptoms, slow down the diagnosis of cancer.

Be cautious when used in people with liver disease, pregnant or nursing.

Be cautious when using ecomeprazol for prolonged because it can cause gastric atrophy or increase the risk of bacterial infections (such as community -suffering pneumonia).

may increase the risk of diarrhea due to Clostridium difficile when using proton pump inhibitors.

When using proton pump inhibitors, especially when taking high and prolonged doses (> 1 year), the risk of pelvic fractures, wrist or spine can be increased by osteoporosis. The mechanism of this phenomenon has not been explained, but it may be due to reducing unanimidated calcium absorption due to gastric pH hypoglycemia. It is recommended to use the lowest doses in the shortest possible time, suitable for clinical status, in patients at risk of fractures due to osteoporosis, they should use enough vitamin D and calcium, assess bone condition and rationality as instructed.

Hypotension (with or asymptomatic) rarely encountered in patients using proton pump inhibitors that last for at least 3 months or most cases of use lasting for more than 1 year.

The ability to drive and operate machinery

The drug can cause some side effects such as dizziness, headache, drowsiness, sleep, dizziness, hallucinations, blur and nausea should be cautious when using Esomeprazol for drivers and machinery.

Pregnancy

There is no adequate study when using Esomeprazol in pregnant people. However, only use Esomeprazol when really necessary during pregnancy.

Breastfeeding period

It is unknown whether esomeprazol has excreted into human milk or not. However, the concentration of Esomeprazol in women's milk after 20mg of Esomeprazol injection has the potential to cause serious unwanted effects in breastfed babies, so they must decide to stop breastfeeding or stop the drug, depending on the importance of the medication for the mother.

Medicinal interaction

Due to the inhibition of acid excretion, Esomeprazol increases the gastric pH, affecting the bioavailability of pH -dependent drugs such as ketoconazole, iron salt, digoxin.

Esomeprazol interact with dynamic pharmacokinetics with metabolic drugs by the cytochrom P450 enzyme system, ISOENZYM CYP2C19 in the liver. Simultaneous use of Esomeprazol with CYLostaxol increases the concentration of cylostazol and its activity metabolites, considering reducing the dosage of Cylostazol. Simultaneous use of Esomeprazol with voriconazole may increase contact with Esomeprazol more than twice as much as possible in patients with high doses of Esomeprazol (240mg/day) as when treating Zollinger - Ellison syndrome.

Use Esomeprazol with CYP2C19 and CYP3A4 induction drugs such as rifampin reduces Esomeprazol levels, avoiding simultaneous use.

may increase the risk of hypoglycemia when using ecomeprazol along with drugs that also cause blood magomesi such as thiazid diuretics or strap diuretics. Check the blood magnesium concentration before starting to use proton pump inhibitors and periodically.

Atazanavir: can change the absorption when taking Atazanavir, reducing this concentration of drugs in plasma, which can reduce antiviral effects. Do not simultaneously inhibit the Proton and Azatanavir inhibitors.

Clopidogel: Using proton pump inhibitors reduces plasma concentrations of clopidogel -active metabolites, reducing platelet resistance.

Digoxin: Lowering blood magnesia due to prolonged use of proton pump inhibitors that cause heart muscle to increase sensitivity to digoxin, may increase the risk of toxicity to the heart of digoxin. In patients who are using digoxin, check the magnesium concentration before starting to use proton pump inhibitors and periodically later.

Sucrafat: Inhibiting absorption and reducing the bioavailability of ecomeprazol. Use proton pump inhibitors at least 30 minutes before using sucrafat.

tacrolimus: Increased serum concentration of tacrolimus.

warfarin: Inrang and prothrombin time when using simfarin simultaneously with proton pump inhibitors, can cause abnormal bleeding and death. Track Inr and prothrombin time when using simultaneously Esomeprazol and Warfarin.

Simultaneously use Esomeprazol and Clarithromycin, increasing the concentration of ecomeprazol and 14-hydroxyclarithromycin in the blood.

Simultaneous use of Esomeprazol and Diazepam reduces diazepam metabolism and increases the plasma diazepam concentration.

Storage

In a dry place, the temperature does not exceed 30 ° C, avoiding light.

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