Esomeprazol 20mg medicine for gastroesophageal reflux treatment (10 blisters x 10 tablets)
Dosage form Box of 10 blisters x 10 tablets
Specifications Esomeprazol
Ingredient
| Composition information | Content |
| Esomeprazol | 20mg |
Uses
indicated
adults
Gastroesophageal reflux disease (GERD):
Healing duodenal ulcer contaminated with Helicobacter pylori.
Prevention of stomach -duodenal recurrence in patients with Helicobacter pylori infected.
Patients need to be treated with nonsteroidal anti -inflammatory drugs (NSAID) continuously:
adolescents 12 years and older
Gastroesophageal reflux disease (GERD):
Pharmacokic
ATC code: A02B C05.
Pharmacological group: Proton pump inhibitors.
Esomeprazole is the isomorphic form of omeprazole, used similar to omeprazole in the treatment of gastroesus ulcers, gastroesophageal reflux disease - esophagus and Zollinger syndrome - Ellison. Hey, prevent the final step of the excretion of hydrochloric acid into the stomach. Therefore, Esomeprazole has the effect of inhibiting the stomach secretion of basic acid and even when stimulated by any agent. The drug works strongly, lasting.
Proton pump inhibitors have an inhibitory effect but do not deduct Helicobacter pylori, so it must be coordinated with antibiotics (such as amoxicillin, tetracycline and clarithromycin) to effectively deduct this bacteria.
pharmacokinetics
absorption:
Esomeprazole absorbs quickly after drinking, reaching the highest concentration in plasma after 1-2 hours. Esomeprazole'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. Esomeprazole's slow and absorbing food, but does not change the effects of the drug to the acidity in the stomach. Therefore Esomeprazole should drink at least 1 hour before meals.
Distribution:
About 97% Esomeprazole attaches to plasma proteins. The distribution of healthy people is about 0.22i/ kg of weight.
Metabolism:
The drug is metabolized in the liver thanks to the cytochrom P450 enzyme system, isenzyme CYP2C19 into hydroxyl and desmethyl metabolites that are no longer active, the rest is converted through isenzyme CYP3A4 into Esomeprazole sulfon.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.
Era:
Sell waste time in plasma is about 1.3 hours. About 80% of oral doses are eliminated in the form of inactive 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 may have to consider and reduce the dose of Esomeprazole in these patients.
Before taking Esomeprazol 20mg medicine for gastroesophageal reflux treatment (10 blisters x 10 tablets)
How to use
prescribed drugs, used as directed by the physician, oral use.
Should swallow the whole ball with water. Do not chew or crush capsules.
For patients with difficulty swallowing, it is possible to open capsules and dispersed seeds in half a glass of water without carbonate. Do not use other liquids because the intestinal soluble layer may be dissolved. Stir and disperse disperse fluid containing this micro -seeds immediately or within 30 minutes. Rinse with half a glass of water and drink. Do not chew or crush these seeds.
For patients who cannot be swallowed, can be dispersed in carbonate -free particles and used through gastric catheter. It is important to carefully check the suitability of the type of syringe and selected catheter.
Dosage
adults and adolescents aged 12 and older
Gastroesophageal reflux disease (GERD)
Treatment of Zollinger Ellison syndrome
The recommended starting dose is Esomeprazole 40 mg, 2 times/day. Then adjust the dose according to the response of each patient and continue treatment when clinically indicated.
Clinical data shows that most patients are controlled with Esomeprazole from 80-160 mg/day. When daily is greater than 80 mg, the dose should be divided into 2 times/day.
adolescents 12 years and older
Treatment of duodenal ulcerative by Helicobacter pylori
When choosing appropriate coordination 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 the neck is up to 14 days), and the use of appropriate antibacterial drugs. The treatment process should be monitored by medical experts.
The recommended dose is:Patients with 30-40 kg weight: Combining 2 simultaneous antibiotics Esomeprazole 20 mg, Amoxicillin 750 mg and Clarithromycin 7.5 mg/kg weight, all use 2 times/day, for 1 week.
Patients with a weight> 40 kg: combined with 2 antibiotics, simultaneous use of Esomeprazole 20 mg amoxicillin 1 g and Clarithromycin 500 mg, all use 2 times/ day, for 1 week,
No need to adjust the dose in patients with renal function damage. Due to less experience in using drugs in patients with severe renal impairment, caution should be careful when treating these patients.
Other objects
Patients with liver function damage: No need to adjust the dose in patients with liver damage from mild to medium. In patients with severe liver failure, maximum overdose should not be used as Esomeprazole 20 mg.
Elderly: No need to adjust the dose in the elderly.
Children under 12 years of age: The form of preparation is not suitable for 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 overdose? The described symptoms related to the use of 280mg dose are symptoms on the gastrointestinal tract and fatigue. Esomeprazole 80mg single doses are still safe to use.
Management: There is no specific detoxification. Esomeprazole is strongly connected to plasma proteins and thus not easily fertilized. In case of overdose, symptomatic treatment and use of general support measures.
What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.
Side Effects
When using Esomeprazol often has unwanted effects (ADR).
Common, ADR> 1/100
Blood: Reducing all bloody, leukopenia, thrombocytopenia.
Notify the physician the 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 drugs contraindicated in the following cases:
Hypersensitivity to Esomeprazole or other proton pump inhibitors, or hypersensitivity to any ingredients of the drug.
Do not use Esomeprazole simultaneously with Nelfinavir.
Be cautious when used
The drug contains mannitol so patients with rare genetic disorders such as non -tolerance fructose should not use this drug.
When there is any alarm symptom (such as significant weight loss, recurrent vomiting, difficulty swallowing, vomiting or black stools) and when suspected or stomach ulcers should eliminate malignant diseases because Esomeprazole treatment can reduce symptoms and delay diagnosis.
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 Esomeprazole according to the treatment regime when necessary, it is advisable to consider interaction associated with other drugs due to the concentration of Esomeprazole in plasma that may change.
When prescribing Esomeprazole 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.
Esomeprazole, as well as other antacids, can reduce the absorption of vitamin B12 (cyanocobalamin) due to a reduction or lack of gastric acid. This should be considered in patients who reduce 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 Esomeprazole 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), medical staff 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 at risk of 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 Esomeprazole with Atazanavir. If Atazanavir combination with proton pump inhibitors is inevitable, clinically closely monitored when increasing the dose of Atazanavir to 400mg combined with 100mg of ritonavir; Do not use more than 20mg Esomeprazole.
Esomeprazole is CYP2C19 inhibitor. When starting or ending treatment with Esomeprazole, the risk of drug interaction with metabolic drugs should be considered through CYP2C19. There has been an interaction between clopidogrel and omeprazole.
Unknown clinical relationships of this interaction. As a cautious measure, it is not recommended to simultaneously use Esomeprazole 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 Esomeprazole at least five days before quantifying CGA.
Use drugs for pregnant or lactating women
Pregnant women: There is no enough clinical data on the use of Esomeprazole in pregnant women. When using omeprazole racemic stimulus mixture, a large number of pregnant women use drugs from epidemiological studies that show that drugs are not causing defects or toxicity on the fetus.
Esomeprazole studies on animals do not show that the drug has a direct or indirect harmful effect on the development of embryo/fetus. Animal studies with Racemic mixture do not show that there is a direct or indirect effect on pregnancy, birth or postpartum development. Should be cautious when prescribing pregnant women.
Nursing women: It is unknown whether esomeprazole is excreted in milk or not. However, Omeprazole is distributed into human milk. Esomeprazole is likely to cause ADRs in breastfeeding, so it is necessary to decide to stop breastfeeding or stop the drug, depending on the importance of the medication for the mother.
The effect of the drug on the ability to drive and operate machinery
due to unwanted effects dizziness, headache. Patients need to be cautious when participating in activities that require alertness such as driving or operating machinery.
Drug interaction
The effect of the above Esomeprazole is kinetic of other drugs: The absorbing drugs dependent on pH: The reduction of stomach acid when treated with Esomeprazole and other PPIs can reduce or increase the absorption of other drugs with the absorption mechanism dependent on the stomach pH.
Like other drugs that reduce other gastric acid, the absorption of drugs such as ketoconazole, otraconazole and erlotinib may decrease and the absorption of Digoxin may increase during treatment with ecomeprazole.
Protease inhibitors: There are reports that omeprazole interacts with some protease inhibitors. It is unclear clinical importance and the mechanism of impact of the recorded interactions. Increasing stomach pH during treatment with omeprazole can lead to changes in the absorption of enzyme inhibitors. Other interactive mechanisms can occur through the inhibition of CYP2C19 enzyme. For Atazanavir and Nelfinavir, the serum concentration has been recorded when used with omeprazole, so it is not recommended to simultaneously use these drugs.
methotrexate: When used simultaneously with PPI, methotrexate concentration is reported to increase in some patients. When using high doses of methotrexate, it is recommended to temporarily pause Esomeprazole.
tacrolimus: simultaneously used with esomeprazole increases serum levels of tacrolimus.
Metabolic drugs through CYP2C19: Esomeprazole inhibits CYP2C19, main enzyme metabolic Esomeprazole. Therefore, when Esomeprazole is used with metabolic drugs with CYP2C19 such as Diazepam, Citalopram, Imipramin, Clomipramin, Phenytoin, the concentration of these drugs in plasma can increase and need to decrease the dose.
Voriconazole: Concomplified use of Esomeprazole with voriconazole may increase contact with Esomeprazole 2 times more, considering in patients with high doses of Esomeprazole (240 mg/ day) like Zollinger - Ellison syndrome.
diazepam: simultaneously use Esomeprazole and Diazepam to reduce diazepam metabolism and increase the concentration of diazepam in plasma.
Storage
Leave a cool place, avoid light, temperature below 30⁰C.
To be out of reach of children.
Other drugs
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