Adult Dosing

GERD with a hx of Erosive Esophagitis

• 20-40 mg IV daily; over no less than 3 min or by infusion 10-30 min

Prevention of gastric/duodenal ulcer rebleeding

• 80 mg IV infused over 30 min, followed by a continuous IV infusion of 8 mg/hr for total treatment duration of 72 hours

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Short term treatment of GERD patients with a history of erosive esophagitis
• Alternative to oral therapy in patients when therapy with esomeprazole delayed released capsule is not possible
• Indicated for risk reduction of rebleeding of gastric or duodenal ulcers following therapeutic endoscopy in adults

• Known hypersensitivity to any component of the product or to substituted benzimidazoles

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

Prevention of gastric/duodenal ulcer rebleeding

• Mild/Moderate hepatic impairment [Child Pugh A/B]: Max 6 mg/hr
• Severe hepatic impairment [Child Pugh class C]: Max 4 mg/hr

GERD with a hx of Erosive Esophagitis

• Mild/Moderate hepatic impairment [Child Pugh A/B]: No dose adjustments
• Severe hepatic impairment [Child Pugh class C]: Max 20 mg qd

• Angioedema and anaphylactic reaction/shock have been reported in patients taking esomeprazole
• Long-term therapy with proton pump inhibitors (omeprazole) may cause atrophic gastritis. This may also occur with esomeprazole
• Relief of symptoms does not preclude the presence of a gastric malignancy. Evaluate for gastric malignancy prior to starting treatment
• Use of proton pump inhibitors may increase risk of gastrointestinal infection
• Women who are taking esomeprazole avoid breastfeeding
• Concomitant use with atazanavir or nelfinavir not recommended
• PPI therapy including esomeprazole may increase risk of Clostridium difficile associated diarrhea, particularly in hospitalized patients
• Avoid concomitant use of esomeprazole with clopidogrel
• Use of PPIs with high dose methotrexate may increase and prolong serum levels of methotrexate and its metabolite leading to methotrexate toxicities. Temporary withdrawal of the PPI must be considered in patients who are on high-dose of methotrexate
• Increased serum chromogranin A (CgA) level due to decreased gastric acidity may cause false positive results in diagnostic investigations for neuroendocrine tumors; temporarily stop the treatment for at least 14 days before assessing CgA levels

Nexium IV interacts with :

	Aptivus
	Atazanavir
	Cefditoren
	Cefpodoxime
	Ceftin
	Cefuroxime
	Crixivan
	DiaBeta
	Edurant
	Extina
	Folotyn
	Fosamprenavir
	Glipizide
	Glucotrol
	Glucotrol XL
	Glucovance
	Glyburide
	Glynase
	Indinavir
	Itraconazole
	Ketoconazole
	Lexiva
	Methotrexate
	Nelfinavir
	Nizoral
	Nizoral A-D Shampoo
	Nizoral Shampoo
	Noxafil
	Onmel
	Otrexup
	Posaconazole
	Pralatrexate
	Reyataz
	Rheumatrex Dose Pack
	Rilpivirine
	Spectracef
	Sporanox
	Tipranavir
	Trexall
	Vantin
	Viracept
	Xolegel
	Zinacef

Pregnancy Category:B

Breastfeeding: Limited information indicates that maternal doses of 20 mg/day produce low levels in breast milk and would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 June 2010).

• GI: Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, mouth dry, nausea, GI candidiasis, pancreatitis, stomatitis
• HEPA: Hepatic encephalopathy
• CNS: Headache, dizziness
• PSYCHIATRIC: Aggression, agitation, depression, hallucination
• DERM: pruritus, alopecia, erythema multiforme, hyperhidrosis, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis
• RESP: Respiratory infection, sinusitis, bronchospasm
• MUSC: Muscular weakness
• EENT: Blurred vision
• HEMA: Agranulocytosis, pancytopenia
• REPRODUCTIVE: Gynecomastia
• GU: Interstitial nephritis
• LOCAL: Application-site reactions including mild local erythema
• MISC: Anaphylactic reaction/shock

• Esomeprazole is a proton pump inhibitor; it prevents transport of hydrogen ions into the gastric lumen by inhibiting gastric parietal cell hydrogen-potassium ATPase
• Extensively metabolized in liver by CYP2C19 and CYP3A4
• Excreted in urine (80% of which <1% is unchanged) and feces (20%)
• Half-life: 1.1-1.4 hrs

US Trade Name(s)

• Nexium IV

US Availability

Nexium IV

• INJ: 20 mg/vial
• INJ: 40 mg/vial

Canadian Trade Name(s)

• Nexium IV

Canadian Availability

Nexium IV

• INJ: 20 mg/vial
• INJ: 40 mg/vial

UK Trade Name(s)

• Nexium IV

UK Availability

Nexium IV

• INJ: 40 mg/vial

Australian Trade Name(s)

• Nexium IV

Australian Availability

Nexium IV

• INJ: 40 mg/vial

[Outline]

Gastrointestinal

Proton Pump Inhibitors