Nexium 40mg Astrazeneca injection powder treats antimicrobial, gastroesophageal reflux - esophagus (1 bottle)

Dosage form Bottle
Specifications Esomeprazol

Ingredient

Composition information	Content
Esomeprazol	40mg

Uses

indications

Nexium 40mg drug is indicated in the following cases:

Treatment of gastric secretion when oral therapy is inappropriate, such as:

Gastroesophageal reflux disease (GERD) in patients with esophagitis or severe reflux symptoms.

Treatment of stomach ulcers due to the use of NSAID drugs. Prevention of stomach and duodenum ulcers due to the use of nonsteroidal anti -inflammatory drugs (NSAID) in patients at risk.

Prevention of re -hemorrhage after acute endoscopy treatment due to stomach or duodenal ulcer.

Teenagers and adolescents from 1 to 18 years old:

Treatment of gastric secretion when oral therapy is not appropriate, for example:

Gastroesophageal reflux disease (GERD).

Patients with esophageal inflammation due to reflux or severe reflux symptoms.

Pharmacokological

Esomeprazole is the isomorphic form of Omeprazole and reduces the secretion of stomach acid with a specialized mechanism of impact in target cells. The drug is a specific inhibitor of acid pump in the wall of the wall. Both the isomers R and S of Omeprazole have the same pharmacological effect.

Position and impact mechanism

Esomeprazole is a weak alkaline, concentrated and transformed into a form of high acidic environmental activity in the sub-gesture tube of the cell's secretion into H+K+K+-atpase (acid pump) and inhibits basic fluid and stimulating fluid.

Acting on gastric acid secretion

After 5 days of taking the oral dose of Esomeprazole 20mg and 40mg, the pH in the stomach> 4 has been maintained within an average time of 13 and 17 hours in 24 hours in patients with gastroesophageal reflux (GERD) symptoms. This impact is the same regardless of whether eSomeprazole is taken orally or venous.

When using AUC as a parameter representing the plasma concentration, it has been proved to have a relationship between acid secretion and drug concentration and the time of exposure to the drug after taking oral esomeprazole. During the 80mg high -dose intravenous period, Esomeprazole in about 30 minutes and followed by continuous veins of 8mg/hour for 23.5 hours, gastrointestinal pH> 4 and pH> 6 were maintained in the average time of 21 hours and 11 - 13 hours in 24 hours of watches in healthy volunteers.

The therapeutic effect of acid inhibition

When using Esomeprazole 40mg oral, about 70% of patients with reflux disease are healed after 4 weeks and 93% of patients are healed after 8 weeks.

In a randomized, double -blind, fuel study with placebo, the patient diagnosed with gastrointestinal hemorrhage through endoscopy according to the classification of Forrest LA, B, LA or ILB (accounting for the corresponding proportion of 9%, 43%, 38%and 10%) to be randomly treated with Nexium infusion solution (N = 375) or placebo (N = 389). After laparoscopic treatment for hemostasis, the patient is given placebo or 80mg Esomeprazole high -dose intravenous infusion for 30 minutes and continuous intravenous infusion 8mg/hour for 72 hours.

After the first 72 hours of treatment, all patients are continued to treat anti -acid secretion with Nexium 40mg oral, opened label for 7 days. The rate of hemorrhage occurred within 3 days is 5.9% in the group treated with Nexium compared to the placebo group of 10.3%. On the 30th day after treatment, the ratio of hemorrhage in the Nexium treatment group compared to the placebo is 7.7% compared to 13.6%.

Other effects related to acid inhibition

During the treatment of anti -acid antimicrobial drugs, serum gastrin concentration responds to a decrease in gastric acid. CGA concentration also increases due to reduced gastric acid. Increased CGA levels can interfere with the detection of endocrine nerve tumors. Medical reports indicate that it is advisable to stop treating the proton pump inhibitors at least 5 days before quantifying CGA. If CGA concentration and gastrin concentration do not return to normal after 5 days, quantitative should be conducted after 14 days after stopping using Esomeprazole.

Increasing the number of ECL cells is probably due to increased serum gastrin levels that have been recorded in both children and adults when treated with long -term with Esomeprazole. This finding is considered not clinically significant.

For a long time, oral acid anti -acid treatment has a slight increase in the frequency of gastric hiring follicles. These changes due to the inhibition of physiological acid secretion are benign and recovered.

Reducing stomach acid for any cause, including using proton pump inhibitors, increasing the number of permanent bacteria in the digestive tract.

Proton pump inhibitors may increase the risk of gastrointestinal tract infections caused by Salmonella and Campylobacter and possibly Clostridium difficile in boarding patients.

Children

Effectiveness and safety in patients with signs and symptoms of gastroesophageal reflux have been assessed in a place of placebo control (including 98 patients from 1 to 11 months old). The patient is used. Esomeprazole oral 1mg/kg, once a day, for 2 weeks (fuzzy label) and 80 diseases, multiplied by 4 weeks (double blind mixed, withdrawal from treatment). There is no significant difference between the Esomeprazole group and the Certificate of the main outcome of the treatment time due to bad symptoms.

Effective and safety in patients with symptoms of gastroesophageal reflux have been assessed in a study with an elderly control (including 52 patients Results from children's studies show that the dose of 0.5mg/kg and 1.0mg/kg Esomeprazole respectively in children

pharmacokinetic pharmacokinetics

Distribution

Expected distribution volume in the state of health on healthy people is about 0.22/kg body weight. Esomeprazole connects 97% to plasma proteins.

Metabolism and excretion

Esomeprazole is completely metabolized through the Cytochrome P450 (CYP) system. The main part of the Esomeprazole metabolism depends on the morphological polymorphic CYP2C19 enzyme, forming hydroxy and desmethyl metabolites of Esomeprazole. The rest of the metabolic process depends on a different specific substance, CYP3A4, forming Esomeprazole sulphone, the main metabolite in plasma.

The following parameters mainly reflect the dynamic in individuals with CYP2C19 function yeast, a group of strong metabolic people.

Total plasma clearance is about 17L/hour after single dose and about 9 hours after the dose is repeated. Selling time for plasma is about 13 hours after the dose is repeated once a day.

Increasing concentration and contact time (AUC) increased after repeated Esomeprazole. This increase depends on the dose and resulting in the non -linear relationship between AUC and the dose after the dose is repeated. This time and dosage dependence is due to the decrease in the first stage of the liver and a reduction in the body clearance is probably due to the inhibition of Esomeprazole's CYP2C19 enzyme and or sulphone metabolites.

Esomeprazole completely eliminates plasma between doses without tend to accumulate when used once a day. After the dose repeated 40mg intravenously, the average peak concentration in plasma was about 13.6mmol/l, the average communal concentration of the drug in the corresponding oral form in plasma is about 4.6mmol/l, which can record a slight increase rate (about 30%) in terms of exposure according to the concentration and time after intravenous injection compared to oral form.

There is a linear increase according to the dose of concentration and the time of exposure to the drug after the Esomeprazole intravenous infusion for 30 minutes (40mg, 80mg or 120mg) and followed by continuous intravenous infusion (4mg/hour or 8mg/hour) for 23.5 hours. The main metabolites of Esomeprazole do not affect the secretion of stomach acid. About 80% of Esomeprazole oral doses are excreted in the urine in the form of metabolites, parts, and the rest of the feces. It is more than 1% of the constant drug found in the urine.

Special patient groups

about 2,911.5% of the population does not have CYP2C19 function yeast and is called a group of poor metabolic people. In these individuals, the metabolism of Esomeprazole is catalyzed mainly by CYP3A4. After repeating the dose of Esomeprazole 40mg oral, 1 time/day, increasing concentration and average contact time in people with a less than 100% less metabolic people than patients with CYP2C19 function yeast (group of people moving, strongly). The average peak concentration in plasma increased by about 60%. The same difference is also recorded for intravenous Esomeprazole. These records do not affect the dose of Esomeprazole.

Esomeprazole's metabolism has not changed significantly in elderly patients (71 - 80 years old). After using the single dose of Esomeprazole 40mg oral, the total concentration and the average contact time in women are about 30%higher than that of men. There is no difference in concentration and contact time between the two sexes after the dose is repeated once a day. The same difference is recorded when using venous esomeprazole. These records do not affect the dose of Esomeprazole.

Esomeprazole's metabolism may be impaired in patients with dysfunction dysfunction to average. The metabolic rate decreases in patients with severe liver dysfunction, leading to doubling the concentration and contact time of Esomeprazole. Therefore, do not overdose a maximum of 20mg in patients with GERD severe liver dysfunction. For patients with gastrointestinal bleeding with severe liver failure, after 80mg high doses, continuous doses of transmission up to 4mg/hour for 71.5 hours can be sufficient for effective. Esomeprazole or main metabolites do not tend to accumulate when used 1 time/day.

No studies have been conducted in patients with renal function. Because the kidney is responsible for excreting the metabolites of Esomeprazole but not responsible for the elimination of drugs in a constant form, it is considered that the metabolism of Esomeprazole is unchanged in patients with kidney function.

Children

In a multinational study, the label randomly opened the dose, the patient was used for 3 -minute Esomeprazole, once a day, within 4 days. The study was conducted on a total of 59 patients from 0 to 18 years old, of which 50 patients (7 children in the group from 1 to 5 years old) have completed the study and were evaluated for pharmacokinetics of Esomeprazole.

Predict that CSS and Max after Esomeprazol intravenously for 10 minutes, 20 minutes, 30 minutes will be reduced average 37% to 49%, 54% to 66% and 61% to 72% at all age groups and dose groups compared to 3 -minute intravenous lines.

Before taking Nexium 40mg Astrazeneca injection powder treats antimicrobial, gastroesophageal reflux - esophagus (1 bottle)

How to use

Use intravenously.

To prepare the injection solution.

Dosage

NEXIUM can be used for young children and minors aged 1-18 and adults, including the elderly.

Adults

The doctor will be the prescription for you and decide how dosage should be used.

Nexium's recommended dose is 20ng or 40mg once a day.

If you have serious liver problems, NEXIUM's maximum dose is 20mg a day (in the case of "thick reflux disease
The esophagus
is used by injecting or intravenously transmitted.

Injecting/transmission time lasts up to about 30 minutes.

Dosage recommended to prevent re -hemorrhage due to stomach ulcers or duodenum ulcers is 80mg of intravenous infusion for 30 minutes,
followed by continuous veins of 8mg/hour for 3 days.

If you have serious liver problems, continuous intravenous infusion 4mg/hour for 3 days is appropriate.

Children from 1 to 18 years old

The doctor will be the prescription for you and decide how dosage should be used.

For children from 1 to 11 years old, the recommended dose is 10 or 20mg once a day.

For children aged 12-18, the recommended dose is 20 or 40mg once a day. The drug is used by injecting or intravenously.

Time to spread for about 30 minutes.

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? The described symptoms related to the use of 280mg oral dose are symptoms on the gastrointestinal tract and weakness.

Esomeprazole single doses of oral oral 80mg and veins 308mg Esomeprazole during 24 hours do not cause unwanted effects.

Without 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 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 Nexium 40mg , you may experience unwanted effects (ADR).

The following unwanted effects have been recorded or suspected in Esomeprazole's clinical research programs for oral and intravenous injection and after oral circulation.

Blood disorders and lymphatic systems

Rare: leukopenia, platelet reduction.

Very rare: Losing leukocytes, reduced hematoma.

immune system disorders

Rare: Hypersensitivity reactions such as fever, angioedema, reaction/anaphylaxis .

Metabolic and nutrition disorders

Uncommon: Peripheral coverage.

Rarely: Hematrum reduction.

Unknown

Unknown: Magnesi hypoglycemia, severe reduction of blood magnesium may be associated with hypocalcemia. Magnesi reduction can also lead to hypokalemia.

Mental disorders

Less: insomnia.

Rare: agitated, confused, depression .

Very rare: impatient, hallucinations.

Nervous system disorders

Common: headache.

Less: dizziness, paresthesia, chicken sleep.

Rare: taste disorders.

Eye disorders

Rare: blurred vision.

Disorders of and mesmerizing

Less: dizziness.

Respiratory, chest and mediastinum disorders

Rare: Bronchospasm.

Gastrointestinal disorders

Common: abdominal pain, constipation, diarrhea, bloating, nausea/vomiting.

Less: dry mouth.

Rare: stomatitis, gastrointestinal candidiasis.

Unknown: Micro colitis.

Liver disorders

It meets: increasing liver enzymes.

Rare: Hepatitis has or no jaundice.

Very rare: liver failure, brain disease in patients with liver disease.

Skin and tissue disorders

Common: reaction at the injection site.

Uncommon: Dermatitis, itching, rash, urticaria.

Rare: baldness, light sensitivity

Very rare: Diverse roses, Stevensjohnson syndrome, toxic epidermal necrosis (ten)

Musculoskeletal and connective tissue disorders

Uncommon: hip fracture, wrist bone and spine.

Rare: joint pain, muscle pain.

Very rare: weak muscle.

Magic and urinary disorders

Very rare: interstitial nephritis , there is a report on body failure on some patients.

Reproductive and mammary disorders

Very rare: female mammary glands.

General and local disorders

Rare: Difficult to live, increase sweating.

The local infusion reaction is mainly recorded in a 3 -day high -dose study (72 hours).

The non -recovery visual lesions have been recorded in a very rare number of serious patients with Omeprazole (racemate) intravenously, especially when high doses.

However, there is no establishment of the causal relationship between drug use and unwanted effects.

Use in children

A multinational, open, random label study was conducted to evaluate the pharmacokinetics of the intravenous injection to repeat Esomeprazole, once a day, for 4 days in patients from 0 to 18 years old.

The total number of 57 patients (8 children in the age group 1-5) has been assessed for safety.

Results of safety in accordance with the known safety data of Esomeprazole and no new safety signs.

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

Nexium 40mg drug contraindicated in the following cases:

Hypothesis hypersensitivity to the main active ingredient Esomeprazole or other substances belonging to the Benzimidazole group or any excipients of this drug.

Do not use Esomeprazole simultaneously with Nelfinavir.

Precautions when used

When there is a presence of vigilant symptoms (such as: significant weight loss, recurrent vomiting, difficulty swallowing, vomiting of blood or black bowel movements) and when there is a suspected stomach ulcer, eliminating malignant micro micro -treatment with Nexium treatment can reduce symptoms and delay in diagnosis.

Proton pump inhibitors may increase the risk of gastrointestinal tract infections caused by Salmonella and Campylobacter.

It is not recommended to simultaneously use Esomeprazole with Atazanavir. If the combination of Atazanavir with proton pump inhibitors is inevitable, it is necessary to closely monitor clinically when increasing the dose of Atazanavir to 400mg combined with 100mg of ritonavir, should not use more than 20mg Esomeprazole.

Esomeprazole - as well as other acid -secreting drugs, can reduce the absorption of vitamin B12 (cyanocobalamin) due to reduced gastric acid. This should be considered in patients with reduced reserves or risk of reducing vitamin B12 absorption when long -term treatment.

Esomeprazole is CYP2C19 inhibitor. When starting or ending treatment with Esomeprazole, the risk of drug interaction with metabolic drugs should be considered through CYP2C19. The interaction between clopidogrel and Esomeprazole. The clinical relationship of this interaction is uncertain. As a cautious measure, it is not recommended to simultaneously use Esomeprazole and Clopidogrel.

There have been reports on serious blood lower blood in patients treated with proton pump inhibitors (PPI) such as Esomeprazole for at least 3 months and in most cases of using PPI for 1 year. The serious symptoms of the blood magnesi such as fatigue, muscle spasms, delirium, jerky, dizziness and ventricular arrhyths may occur, but may be silently and not concerned. In the majority of patients, the condition of lowering the blood magama is improved after using Magnesi instead and stop using PPI.

For patients who must treat for a long time with PPI or patients who have to use ppi along with digoxin or other drugs may harm blood magnesia (such as diuretics, medical experts should consider measuring blood magnesium levels before starting treatment with PPI and periodic testing during treatment).

Proton pump inhibitors, especially when high doses and long -term (> 1 year), may increase the risk of hip fractures, wrist bones and spine, especially in elderly patients or when there is a presence of known 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 need to be cared for in accordance with current clinical instructions and should be used enough vitamin D and calcium.

Interaction with tests

Increased chromgranin A (CGA) concentration may interfere with the detection of endocrine nerve tumors. In order to avoid this intervention, it is recommended to stop treating with Esomeprazole at least 5 days before quantifying CGA.

The ability to drive and operate machinery

does not affect the ability to drive and operate the machine.

Pregnancy

Data in contact with Esomeprazole during pregnancy is limited. Animal studies using Esomeprazole do not show that the drug has a direct or indirect effect on the development of the fetal coordination.

Animal studies with Racemic mixture do not show that the drug has a direct or indirect effect on pregnancy, birth or postpartum development. Should be cautious when prescribing Nexium for pregnant women.

Breastfeeding period

It is not known whether Esomeprazole is secreted through breast milk or not. Research on breastfeeding women has not been conducted. Therefore, do not use nexium during breastfeeding.

Medicinal interaction

Medicine interaction studies are only done in adults.

Esomeprazole's effects on the kineticness of other drugs

Drugs with absorption depend on pH

The reduction of stomach acidity when treated with Esomeprazole and other PPIs may increase or decrease the absorption of absorption drugs depending on gastric pH. Like other medications that reduce other gastric pH, the absorption of drugs such as ketoconazole, iTraconazole and erlotinib may decrease and the absorption of digoxin may increase during treatment with ecomeprazole.

Simultaneous use Omeprazole (20mg/day) and Digoxin in healthy objects that increase the bioavailability of digoxin about 10% (up to 30% in 2 out of 10 research objects). There are rare reports on Digoxin toxicity. However, be careful when using high doses of Esomeprazole in the elderly. Need to increase monitoring treatment with digoxin.

There has been reported 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 protease inhibitors. Another possible interactive mechanism is through CYP 2C19 enzyme inhibitors. For Atazanavir and Nelfinavir, the serum concentration has been recorded when used with omeprazole, so it is not recommended to simultaneously use these drugs.

In healthy volunteers, simultaneous use of omeprazole (40mg, 1 time/day) and Atazanavir 300mg/ritonavir 100mg significantly reduces the concentration and time of Atazanavir contact (reducing AUC, CMAX and Cmin by about 75%). Increasing the dose of Atazanavir to 400 mg has not compensated for the effects of omeprazole on concentration and contact time Atazanavir .

Use combined omeprazole (20mg, 1 time/day) with Atazanavir 400mg/Ritonavir 100mg in healthy volunteers reduces about 30% of the concentration and time of Atazanavir contact when compared to the concentration and contact time recorded in the case of using Atazanavir 300mg/Ritonavir 100mg, 1 time/day, without Omeprazole 20mg 1 time/day.

Used in combination with omeprazole (40mg, 1 time/day) reduces the average value of AUC, CMAX and CMIN of NELFINAVIR by about 35 - 39% and decreases about 75 - 92% of the average AUC, CMAX and CMIN values of active metabolites that have pharmacological effects. For Saquinavir (simultaneously used with ritonavir), increase the concentration of drugs in serum (80 - 100%) when used simultaneously with omeprazole (40mg, 1 time/day).

Treatment with omeprazole 20mg, 1 time/day, does not affect the contact of Darunavir (when used simultaneously with Ritonavir) and Amprenavir (when used, simultaneously with Ritonavir). Treatment with Esomeprazole 20mg, 1 time/day, does not affect the contact of Amprenavir (used or not used simultaneously with Ritonavir). Treatment with omeprazole 40mg, 1 time/day, does not affect the contact of Lopinavir (simultaneously used with Ritonavir). Due to the impact of the same force and pharmacokinetic properties of Omeprazole and Esomeprazole, it is not recommended to use Esomeprazole simultaneously with Atazanavir and contraindicated using Esomeprazole simultaneously with Nelfinavir.

Metabolic drugs through CYP2C19 enzymes

Esomeprazole inhibits CYP2C19, the main enzyme metabolizes Esomeprazole. Therefore, when Esomeprazole is used with metabolic drugs through CYP2C19 such as diazepam, citalopram, imipramine, clomipramine, phenytoin ..., the concentration of these drugs in plasma can increase and need to decrease the dose. Simultaneous use with Esomeprazole 30mg oral form reduces 45% of Diazepam clearance (a substrate of CYP2C19). When simultaneously used with esomeprazole 40mg oral and phenytoin, increases 13% of the bottom plasma level (trough plasma level) of phenytoin in plasma in patients, epilepsy. Should monitor phenytoin concentration in plasma when starting or stopping treatment with Esomeprazole.

omeprazole (40mg, 1 time/day) increases CMAX and AUCT of Voriconazole (a substrate of CYP2C19) to 15% and 41% respectively.

When using 40mg of Esomeprazole oral oral form in a human being treated with Warfarin in a clinical experience shows time, blood clotting is in an acceptable range. However, after bringing the drug to the market, there were some very dangerous cases of significant Inr clinical increase when treated simultaneously damaging the above drugs. The patient should be monitored at the beginning and when the treatment is terminated simultaneously Esomeprazole during treatment with Warfarin or other derivatives of Coumarin.

Omeprazole as well as Esomeprazole acts like CYP2C19 inhibitors. In a cross study, Omeprazole used at a dose of 40mg above, healthy objects increased by 18% CN and 26% AUC of Cilostazol and increased by 29% C, and 69% AUC of one of one of the active metabolites.

In healthy volunteers, when used with 40mg of esomeprazole oral and cisapride form, the area under the curve shows Cisapride concentration in plasma over time (AUC) increases to 32% and the semi -discharged time (large) Cisapride extends by 31% but the Cisapride peak concentration in plasma increases negatively. The QTC range is slightly extended after using individual cisapride, not longer lasting when using Cisapride with Esomeprazole.

Esomeprazole has been shown to not significantly affect the clinical effects of Amoxicillin or Quinidine.

There is no Vivo interactive studies conducted on high doses (80mg + 8mg/hour) using intravenous lines. Esomeprazole's effects on drugs metabolized through CYP2C19 enzymes may be more pronounced when using this high doses and patients need to be closely monitored the harmful reactions of the drug during 3 days of intravenous treatment.

Results from studies on healthy volunteers spent pharmacokinetic interactions - pharmaceutical force between clopidogrel (loading dose 300mg/maintenance dose 75mg) and esomeprazole (40mg/day orally) leads to an average of 40% of the concentration and contact time of clopidogreled metabolites and an average 14% of the maximum of the maximum supply of platelets.

In a study on healthy objects, when using Clopidogrel simultaneously with a coordination | Esomeprazole fixed dose combination of 20mg + ASA 81mg compared to solitary clopidogrel, concentration and contact time of metabolites that are active of clopidogrel decrease by nearly 40%. However, the maximum level of platelets inhibitors (caused by ADP) on these objects is the same in the single clopidogrel and the group uses Clopidogrel and Esomeprazole + ASA.

The inconsistent data on clinical manifestations of pharmacokinetic /pharmaceutical interactions of Esomeprazole on the main cardiovascular events have been reported from both clinical observation and research research. For careful purpose, simultaneous use with clopidogrel is not recommended.

Unknown mechanism

Concomitant use with Esomeprazole has been reported to increase the serum levels of tacrolimus .

When used simultaneously with PPIs, methotrexate levels are reported to increase in some patients. When using high doses of methotrexate, it is recommended to temporarily pause Esomeprazole.

The effect of other drugs on the kinetics of Esomeprazole

Esomeprazole is metabolized by CYP2C19 and CYP3A4. When using Esomeprazole oral Esomeprazole with a CYP3A4 inhibitor, Clarithromycin (500mg, 2 times/day) doubled the area under the curve (AUC) of Esomeprazole.

Simultaneous use Esomeprazole along with inhibitors both CYP2C19 and CYP3A4 may increase the concentration and time of Esomeprazole exposure. CYP2C19 and CYP3A4 Voriconazole inhibitors increase AUC, Omeprazole to 280%. No need to adjust the dose of Esomeprazole often in these cases. However, the adjustment of the dose should be considered in patients with severe liver failure or long -term treatment.

CYP2C19 or CYP3A4 induction drugs or both (such as rifampicin and st. John's grass) can reduce serum ecomeprazole due to Esomeprazole metabolism.

Storage

Store in the packaging of the original packaging to avoid light. However, the vials can be stored outside the paper box in the lights for up to 24 hours. No storage at temperatures above 30 ° C.

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