Esomeprazol

Esomeprazole—Swallow whole at least 1 hour before eating. If you have difficulty swallowing, tiie capsule may be opened and tiie granules sprinkled on a small amount of applesauce... 

Omeprazole 20-40 mg enterally daily ° Esomeprazole 20-40 mg enterally daily or ql2h ° Lansoprazole 30 mg enterally or IV daily ° Pantoprazole 40 mg enterally or IV daily or 12h ° Rabeprazole 20 mg enterally daily... 

PPIs (taken once daily) for 4-8 weeks - Esomeprazole 20 mg - Lansoprazole 1 5-30 mg - Omeprazole 20 mg - Pantoprazole 40 mg - Rabeprazole 20 mg therapy. 

Comparable daily doses of PPIs are omeprazole 20 mg = esomeprazole 20 mg = lansoprazole 30 mg = rabeprazole 20 mg = pantoprazole 40 mg. The PPIs degrade in acidic environments and are therefore formulated in delayed-release capsules or tablets.16 Lansoprazole, esomeprazole, and omeprazole contain enteric-coated (pH-sensitive) granules in a capsule form. For patients unable to swallow the capsule or in pediatric patients, the contents of the capsule can be mixed in applesauce or placed in orange juice. If a patient has a nasogastric tube, the contents of an omeprazole capsule can be... 

Pantoprazole, lansoprazole, and esomeprazole are available in intravenous formulations, which offer an alternative route for patients unable to take oral medications. The intravenous product is not more effective than the oral forms and is significantly more expensive. 

While generally not of major concern, omeprazole may inhibit the metabolism of warfarin, diazepam, and phenytoin lansoprazole may decrease theophylline concentrations. Drug interactions with omeprazole are of particular concern in patients who are considered slow metabolizers, as are approximately 3% of the Caucasian population. Unfortunately, it is unclear which patients have the polymorphic gene variation that makes them slow metabolizers.17 The metabolism of esomeprazole may also be altered in patients with this polymorphic gene variation. Patients on potentially interacting drugs should be monitored for development of drug-related problems. 

Proton Pump Inhibitors Esomeprazole 300 mg at bedtime 20-40 mg daily 20-40 mg daily... 

The histamine2-receptor antagonists or H2RAs (cimetidine, famotidine, nizatidine, and ranitidine) and proton pump inhibitors (omeprazole, esomeprazole, lansoprazole, pantopra-zole, and rabeprazole) reduce the amount of acid secreted into the stomach by gastric parietal cells. These agents are also helpful for nausea and vomiting related to gastric acid secretion. 

Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec) Panloprazole (Protonix) Rabeprazole (Aciphex)... 

JAN2004 10JAN2004 Abdominal Pain 09JAN2004 10MAR2004 Esomeprazole... 

Lansoprazole, esomeprazole, and pantoprazole are available in IV formulations for patients who cannot take oral medications, but they are not more efficacious than oral preparations and are significantly more expensive. 

Most patients require standard doses to prevent relapses. H2RAs may be an effective maintenance therapy in patients with mild disease. The PPIs are the drugs of choice for maintenance treatment of moderate to severe esophagitis. Usual once-daily doses are omeprazole 20 mg, lansoprazole 30 mg, rabeprazole 20 mg, or esomeprazole 20 mg. Lower doses of a PPI or alternate-day regimens may be effective in some patients with less severe disease. 

Nexium (esomeprazole magnesium, AstraZeneca) is a drug termed as a proton pump inhibitor. It turns off the secretions of acid into the stomach. When less acid is produced, there is a reduced amount of acid that can flow back up from the stomach into the esophagus to cause reflux symptoms. 

Esomeprazole is the S-isomer of omeprazole (Prilosec), which is a mixture of the S- and R-isomers. Prilosec, for many years a best selling drug, is 5-methoxy-2-[[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-IH-benzimidazole. Its empirical formula is (Ci7Hi8N303S)2Mg-3H20 with a molecular weight of 767.2 as a trihydrate and 713.1 on an anhydrous basis. 

It should be noted that there are normally three names associated with a drug the trade or proprietary name (e.g., Nexium), generic or nonproprietary name (esomeprazole), and a specific chemical name for the active ingredient. In the case of esomeprazole, the active ingredient is the S-isomer of benzimidazole. 

Esomeprazole (Nexium, AstraZeneca) proton pump inhibitor for the prevention of relapse in reflux esophagitis... 

AstraZeneca launched omeprazole in 1988. It is a safe and effective drug for acid reflux, functioning as a proton pump inhibitor. However, the patent has expired and AstraZeneca has to compete against generics. The company developed the active isomer and called it esomeprazole. It was approved by the Mutual Recognition process in Europe in July 2000, and by the US Food and Drug Administration in February 2001. The chemical formulas for omeprazole and esomeprazole are shown below. 

It was reported that healing of reflux esophagitis with 40mg/day of esomeprazole is effective in 78% of patients after 4 weeks of treatment and in 93% of patients after 8 weeks, compared to 65% and 87% of patients treated with 20mg/day of omeprazole. 

Omeprazole and esomeprazole. The two S atoms are chiral centers. Source Agranat I, Caner H, Caldwell J. Putting chirality to work the strategy of chiral switches of drug molecules, Nature Reviews Drug Discovery 1 753-768 (2002). Used with permission.)... 

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