Esomaxcare 20 Square Treatment Treatment of benign peptic ulcer (3 blisters x 10 tablets)
Dosage form Box of 3 blisters x 10 tablets
Specifications Esomeprazol
Ingredient
| Composition information | Content |
| Esomeprazol | 20mg |
Uses
Indications
Esomaxcare 20 mg drugs are indicated in the following cases:
Adults
Gastrointestinal ulcer - benign duodenum.
Zollinger-Elison syndrome.
Destroy Helicobacter pylori in duodenal ulcer and prevent the risk of recurrence in patients with duodenal ulcer Helicobacter pylori.
Gastroesophageal reflux disease (serious esophagitis, ulcers or narrowed ulcers is determined by laparoscopy).
Prevention and treatment of stomach - duodenal ulcer due to nonsteroidal anti -inflammatory drugs.
Adolescents 12 years and older
Combined with antibiotics in the treatment of duodenal ulcer caused by Helicobacter pylori.
Gastroesophageal reflux disease (GERD):
Pharmacokology
Esomeprazol is an omeprazole isomer, used similar to omeprazol in the treatment of gastric ulcer and gastroesophageal reflux disease - esophagus.
Acting on acid secretion: Esomeprazol is attached to H+/K+ - ATPase (also known as proton pump) in the stomach wall, inhibiting this enzyme system, preventing the final step of acid secretion into the stomach heart. So Esomeprazol has the effect of inhibiting the basic acid secretion and even when stimulated by any agent.
Effects on H.P (Helicobacter pylori).
Stomach ulcers caused by NSAID, Esomeprazol drugs can be used to prevent the ulcer forming when using NSAID drugs.
pharmacokinetic
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 the dose of 20 mg and 89% when taking the dose of 40 mg.
Food slows down and reduces the absorption of Esomeprazol, the area under the curve (AUC) after taking a single dose of Esomeprazol 40 mg at meals compared to when hunger drops from 33% to 53%. Therefore, Esomeprazol has to drink at least 1 hour before meals.
About 97% Esomeprazol attaches to plasma proteins. The volume of distribution when the drug concentration is stable in healthy volunteers of 16 liters. The metabolic drug is mainly in the liver thanks to isenzyme CYP29C19, the cytochrom P450 enzyme system, into hydroxyl and desmethyl metabolites. The rest is converted through isenzyme CYP3A4 to Esomeprazol Sulfon.
When used repeated, initially metabolized through the liver and the clearance of the drug reduced, possibly due to the inhibited isoenzyme 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.
Sell waste time in plasma 1 - 1.5 hours. About 80% of oral doses are eliminated in the form of metabolites that are not active in urine. In people with severe liver failure, AUC value is 2-3 times higher than that of people with normal liver function, so Esomeprazol is reduced in patients, the dose does not exceed 20 mg a day.
Adolescents 12-18 years old: After using the dose of 20 mg and 40 mg Esomeprazol, the total concentration and contact time (AUC) and the maximum concentration time in plasma (TMAX) in children 12 - 18 years old are similar to adults for both doses of Esomeprazol.
Before taking Esomaxcare 20 Square Treatment Treatment of benign peptic ulcer (3 blisters x 10 tablets)
How to use
oral medications, swallow pills with water, no chewing or crushing pills. Use as directed by the treating doctor.
Esomeprazol tablets should be taken at least 1 hour before meals.
Time to use proton pump inhibitors must be based on the level of safety and effectiveness of treatment with indications and dose as directed by instructions.
Dosage
Dosage for adults
Treatment of stomach - duodenal ulcer has Helicobacter pylori: Esomeprazol is an ingredient in the treatment regimen along with antibiotics, for example 3 drug regimen (along with amoxicillin and clarithromycin), oral ecomeprazol every 20 mg, twice a day for 7 days, or every day 40 mg in 10 days (amoxicillin at 1.0 g, 2 g, 2 g, 2 g, 2 g, 2 g, 2 g, 2 g, 2 times and 2 times and 2 times Clarithromycin at 500 mg, twice a day for 7 or 10 days).
Treatment of gastroesophageal reflux disease - serious esophagitis: Take 20 - 40 mg daily for 4 - 8 weeks, can take 4 - 8 weeks if there are still symptoms or manifestations of endoscopic inflammation.
Treatment is maintained after gustary inflammation: taken once a day 20 mg, can last up to 6 months.
Preventive prevention of stomach ulcers in people with high risk of stomach - duodenal complications, but there is a requirement to continue treatment with nonsteroidal anti -inflammatory drugs: 20 mg daily.
Treatment of gastroesophageal reflux disease - symptomatic but not esophagitis: Take 20 mg once a day for 4 weeks, can take 4 more weeks if the symptoms are not completely cured.
Treatment of stomach ulcers due to nonsteroidal anti -inflammatory drugs: Take 20 mg once a day for 4 - 8 weeks.
Treatment of Zollinger-Eleson syndrome: Depending on the individual and the level of acid secretion of the gastric juice, the daily dose is higher daily in other cases, used one-time or divided into 2 times a day. When symptoms are controlled, surgery may be used to cut tumors. If the tumor is not completely removed, the medication must be used for a long time.
Treatment of liver failure
People with severe liver failure do not use more than 20 mg a day.
There is no need to reduce the dose in mild and medium liver failure people, kidney or elderly people.
adolescents 12 years and older
Gastroesophageal reflux disease (GERD)
Treatment of duodenal ulcer caused by Helicobacter pylori
When choosing the appropriate combination therapy, it is necessary to consider the official guidance of the nation, the region and the locality on the resistance of bacteria, the treatment time (usually 7 days but sometimes it can be up to 14 days), and how to use appropriate antibacterial drugs. The treatment process should be monitored by medical experts.
The recommended dose is:
weight Dosage
30 - 40 kg Combining Esomeprazol 20 mg, Amoxicillin 750 mg and Clarithromycin 7.5 mg/kg weight, 2 times/day, for 1 week.
40 kg
Combined with two antibiotics: simultaneous use of Esomeprazol 20 mg, amoxicillin 1 g and Clarithromycin 500 mg, 2 times/day for 1 week.
Children under 1 year of age have not had research, so they do not recommend using this object.
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 you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.
Side Effects
When using Esomaxcare 20 mg, you may experience unwanted effects (ADR).
Overall, Esomeprazol is well tolerated even when used in a short time or a long time.
Common, ADR> 1/100
Instructions on how to handle ADR
When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
Contraindicated
Esomaxcare 20 mg contraindicated in the following cases:
Hypersensitivity to proton pump inhibitors or hypersensitivity to any ingredients of the drug.
Precautions when using
When there is a presence of any alert symptoms (such as significant weight loss, recurrent vomiting, difficulty swallowing, vomiting or black defecation) and when suspected or stomach ulcers should eliminate malignant diseases because treated with Esomeprazol 20 mg can reduce symptoms and delay.
Patients with long -term treatment (especially those who have been treated for more than 1 year) should be monitored regularly.
Patients treated according to the regime when necessary should contact the doctor if there are symptoms that change in characteristics.
When prescribing Esomeprazol to eliminate Helicobacter pylori, drug interactions should be considered in the 3 -drug treatment regimen. Clarithromycin is a strong CYP3A4 inhibitor and therefore should consider contraindicated and interact with Clarithromycin when using a 3 -drug regimen for patients who are taking other drugs metabolized through CYP3A4 as Cisaprid.
Proton pump inhibitors may increase the risk of gastrointestinal tract infections caused by Salmonella and Campylobacter.
Esomeprazol, as well as other antacids, can reduce the absorption of vitamin B12 (Cyanocobala - Min) due to a reduction or lack of gastric acid. This should be considered in patients with reduced vitamin B12 reserves or have risk factors for reducing vitamin B12 absorption when long -term treatment.
There have been reports on severe blood magnesium reduction in patients treated with proton pump inhibitors (PPI) such as Esomeprazol for at least 3 months, and in most cases is for 1 year. The severe manifestation of blood magnesium decreased such as fatigue, spasticity, delirium, convulsions, dizziness and ventricular arrhyths may occur but silently started and not concerned. In the majority of patients, blood magnesium reduction is improved after using magnesium therapy instead and stop using PPI.
For patients who need prolonged treatment or patients with simultaneous use of ppi and digoxin or other drugs that can cause blood magnesium (such as diuretics), health workers should consider quantifying blood magnesium levels before starting PPI treatment and periodic monitoring during treatment.
Proton pump inhibitors, especially when taking high doses and for a long time (> 1 year), may increase the risk of hip, wrist and spine fractures, especially in elderly patients or when there is a presence of other risk factors. Observatory studies show that proton pump inhibitors may increase the overall risk of fractures by about 10 - 40%. Part of this increase may be due to other risk factors. Patients with osteoporosis should be taken care of under the current clinical instructions and should be added with an appropriate amount of vitamin D and calcium.
It is not recommended to simultaneously use Esomeprazol with Atazanavir. If the combination of Atazanavir with proton pump inhibitors is inevitable, clinically closely monitoring when increasing Atazanavir dose to 400 mg combined with 100 mg of ritonavir; Do not use more than 20 mg Esomeprazol.
Esomeprazol is CYP2C19 inhibitor. When starting or ending treatment with Esomeprazol, the risk of drug interaction with metabolic drugs should be considered through CYP2C19. There has been an interaction between clopidogrel and omeprazol. It is unclear clinical related relationship of this interaction. As a cautious measure, it is not recommended to simultaneously use Esomeprazol and Clopidogrel.
Interacts with tests: an increase in Chromographin A (CGA) level can interfere with the detection of endocrine nerve tumors. In order to avoid this intervention, it is necessary to temporarily stop treatment with Esomeprazol at least five days before quantifying CGA.
The ability to drive and operate machinery
Caution should be cautious because Esomeprazol can cause adverse effects such as headache, dizziness.
Pregnancy
There is no adequate study when using Esomeprazol in pregnant people. On animals, white rats oral Esomeprazol dose 280 mg/kg/day (57 times the dose on humans calculated by body surface area) and rabbit oral dose of 86 mg/kg/day (35 times the dose on humans calculated by body surface area) has shown no evidence of fertility or toxic impairment for pregnancy due to Esomeprazol. However, only use Esomeprazol when really necessary during pregnancy.
Breastfeeding period
It is not known whether esomeprazol is secreted through breast milk or not. However, the concentration of omeprazol in women's milk after taking 20 mg of omeprazol.
Esomeprazol is likely to cause serious unwanted effects in breastfeeding, so it is necessary to decide to stop breastfeeding or stop the medication, depending on the importance of the medication for the mother.
Medicinal interaction
Due to acid excretion inhibition, Esomeprazol increases the gastric pH, affecting the bioavailability of pH -dependent absorption drugs: ketoconazole, iron salt, digoxin.
Simultaneous use of ecomeprazol, clarithromycin and amoxicillin increases the concentration of ecomeprazol and 14-hydroxyclarithromycin in the blood.
Esomeprazol interact with pharmacokinetic pharmacokinetic drugs with metabolic drugs by the cytochrom P450 enzyme system, isenzyme CYP2C19 in the liver. Simultaneous use of Esomeprazol and Diazepam reduces 45% of Diazepam clearance.
Esomeprazol reduces the absorption of acanavir, nelfinavir drugs into the blood and reduces their HIV treatment effect.
Use a combination of esomeprazol with clopidogrel or methotrexate reduces the treatment effect of clopidogrel, methotrexate.
Esomeprazol is used with Tacrolimus, which reduces the blood magnesium levels in the blood. If used for a long time, it will lead to irregular heart rate, tachycardia, muscle spasm, tremor, or convulsions. In addition, this combination also increases the concentration of Tacrolimus in blood in some people, which increases serious side effects such as diabetes, kidney damage, high blood pressure ...
Storage
Store less than 30 ° C, cool dry place. Avoid light.
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