Goldesome 20mg Valpharma medicine for benign peptic ulcer (4 blisters x 7 tablets)

Pharmacokological

Esomeprazol is the isomorphic form of omeprazol, used similar to omeprazol in the treatment of gastric ulcer - duodenum and gastroesophageal reflux disease. Esomeprazol is associated with H+/K+ - ATPase (also called proton pump) in the stomach wall cell, inhibiting this enzyme system, preventing the final step of acid secretion into the stomach. So Esomeprazol has the effect of inhibiting the basic acid secretion and even when stimulated by any agent.

Dynamic pharmacokinetics

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 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 decreases from 33% 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 16 liters.

Metabolism: The drug is mainly metabolic in the liver thanks to the isenzyme CYP2C19, the cytochrom P450 enzyme system, into hydroxy and desmethyl metabolites that are no longer active.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), should slow down the metabolism of Esomeprazol, resulting in an increase in AUC value about 2 times compared to people with enough enzymes.

Elimination: Half lifetime elimination in plasma 1 - 1.5 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 mother 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 is reduced in patients, the dose does not exceed 20 mg a day.

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?

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.

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.

Be cautious when used

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 lactating. Precautions must be used when using Esomeprazol for prolonged because it can cause gastritis.

The drug is not recommended for children.

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.

The ability to drive and operate machinery

should be cautious because Esomeprazol can cause adverse effects such as headache, dizziness .

Pregnancy

There is no adequate study when using Esomeprazol in pregnant women. On animals, white rats oral Esomeprazol dose 280 mg/kg/day (57 times the dose on humans calculated by body surface area) and oral rabbit dose of 86 mg/kg/day (35 times the dose on humans calculated by body surface area) did not see evidence of reproductive or toxic fetus due to Esomeprazol. However, only use Esomeprazol when really necessary during pregnancy.

Nursing period

It is unknown whether esomeprazole will excrete in human milk or not. However, the concentration of omeprazol in women's milk has been measured after taking 20 mg of omeprazol. As Esomeprazol has the ability to cause serious unwanted effects 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.

Drug interaction

Due to the inhibition of acid excretion, Esomeprazol increases the gastric pH, affecting the bioavailability of pH -dependent absorption drugs: ketoconazol, iron salt, digoxin.

Simultaneous use of ecomeprazol, clarithromycin and amoxicillin increases the concentration of ecomeprazol and 14-hydroxyclarithromycin in the blood.

Esomeprazol interact with pharmacokinetics with metabolic drugs by the cytochrom P450 enzyme system, liver isoenzyme.