Esomeprazole (PPI)

What is Esomeprazole?

Esomeprazole is available as both a Pharmacy Only Medicine and a Prescription Only Medicine, depending on the dosage. It is widely used to reduce gastric acid secretion and manage gastrointestinal conditions such as gastroesophageal reflux disease (GERD), erosive esophagitis, and peptic ulcers.

As the S-isomer of omeprazole, esomeprazole exhibits higher oral bioavailability and greater acid inhibition than its predecessor. It is a proton pump inhibitor (PPI) that works by covalently binding to the proton pump enzyme in the stomach's parietal cells, thereby preventing the final step of acid production.

Generic Names:

• Esomeprazole Magnesium: The most common oral salt formulation globally.
• Esomeprazole Sodium: Typically utilised for intravenous injection formulations.
• Esomeprazole Strontium: An alternative salt formulation used in specific regions.

Global Brand Names:

Esomeprazole is marketed under several brand names globally and in Hong Kong:

• Nexium (耐信): Innovator brand by AstraZeneca, widely available in tablet, sachet, and injection forms.
• Esomep: Common generic available in various strengths.
• Esomax: Registered generic formulation in Hong Kong.
• Sompraz: Registered generic formulation.

These names all refer to the same medication. It's important to note that while the active ingredient is the same, different countries may have different regulations and available medication formulations.

What is Esomeprazole used for?

Esomeprazole is used to relieve:

• Gastroesophageal Reflux Disease (GERD) symptoms such as heartburn and acid regurgitation.
• Erosive esophagitis.
• H. pylori-associated duodenal ulcers, when used with antibiotics.
• Gastric ulcers associated with continuous Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy.
• Pathological hypersecretory conditions like Zollinger-Ellison Syndrome.

How do you use Esomeprazole?

Availability:

• Oral tablets, capsules, oral suspension, and intravenous injections.

Dosage Information:

• Adults: 20 mg to 40 mg once daily, taken at least one hour before a meal.
• Adolescents (12-17 years): 20 mg or 40 mg once daily for GERD treatment.
• Children (1-11 years): 10 mg or 20 mg once daily depending on weight and clinical condition.

Suitability:

• Adults and Elderly: Yes, standard dosages apply.
• Children and Adolescents: Yes, with specific dosing based on age and body weight.

Who cannot take Esomeprazole?

Allergies and unsuitability:

• Rare, but possible allergic reactions to substituted benzimidazoles.

Conditions where the drug should not be used:

• Known hypersensitivity to esomeprazole or any excipients.
• Concomitant use with nelfinavir.

Common side effects of esomeprazole include headache, abdominal pain, diarrhoea, nausea, flatulence, constipation, and dry mouth. These symptoms are generally mild and often subside as the body adjusts to the medication. It is important not to exceed the prescribed dose or duration of treatment to minimise these occurrences.

Prolonged or high-dose use of esomeprazole carries a risk of more severe adverse reactions. Extended acid suppression is linked to an increased risk of bone fractures (hip, wrist, or spine), vitamin B12 deficiency, and hypomagnesemia. Furthermore, PPI use may elevate the risk of severe intestinal infections, such as Clostridioides difficile-associated diarrhoea, and rare cases of acute tubulointerstitial nephritis or lupus erythematosus.

• Do not take alongside nelfinavir due to the risk of significantly reducing HIV medication serum levels.
• Take the medication at least one hour before a meal, preferably breakfast, as food can decrease absorption.
• Report any 'red flag' symptoms like significant unintentional weight loss or recurrent vomiting to a doctor to rule out gastric malignancy.
• Check with a doctor if taking clopidogrel, as esomeprazole may reduce its antiplatelet effect.
• Check with a doctor if taking methotrexate, warfarin, or digoxin to prevent toxicity or altered absorption rates.
• Do not use continuously for long periods without medical supervision due to the risk of bone fractures and magnesium deficiency.

Storage information:

• Store at room temperature (around 25°C).
• Protect from direct light and moisture.
• Keep in a secure place away from children.

Handling instructions:

• Swallow tablets whole; do not crush or chew the enteric-coated pellets.
• Disperse tablets in non-carbonated water if experiencing swallowing difficulties, ensuring pellets remain intact.
• Use the specific measuring device that comes with the oral suspension for an accurate dose.

Where is Esomeprazole available in Hong Kong?

In Hong Kong, Esomeprazole is classified as both a Pharmacy Only Medicine and a Prescription Only Medicine, depending on the exact dosage, formulation, and intended duration of use. Lower-dose formulations intended for short-term relief may be purchased as a Pharmacy Only Medicine at registered pharmacies under the direct supervision of a registered pharmacist, without needing a doctor's script.

Higher doses, injectable forms, and larger quantities intended for long-term management are classified as a Prescription Only Medicine. These must be purchased at a registered dispensary displaying the "Rx" logo with a valid doctor's prescription. Retail locations include independent registered dispensaries and major chain drug stores like Mannings and Watsons that feature a licensed pharmacy counter.