Esomeprazole

Esomeprazole belongs to a family of medicines called proton pump inhibitors (PPIs). These medicines work by reducing the acid your stomach makes. It treats several conditions, including: Gastro-oesophageal reflux disease (GORD). This is when acid escapes from your stomach back into your oesophagus (the tube that connects your throat to your stomach), causing pain, inflammation and heartburn. Stomach ulcers and ulcers in the upper part of your gut (duodenal ulcers). This includes ulcers caused by a Helicobacter pylori infection (usually treated with a course of antibiotics alongside esomeprazole), as well as ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Too much acid in the stomach caused by a growth in the pancreas, a rare condition called Zollinger-Ellison syndrome. Prevention of rebleeding of ulcers after you have received intravenous treatment in hospital. Esomeprazole can also be bought without a prescription for short-term treatment of reflux symptoms, such as heartburn and acid regurgitation. Those over-the-counter versions are typically a 14-day course. If you buy it yourself and feel no better, or worse, after 14 days, you must see a doctor.

The cells that line your stomach contain tiny pumps called proton pumps. These pumps release acid to help you digest your food. In people with acid-related problems – such as heartburn, GORD or ulcers – these pumps can be overactive and produce too much acid. Esomeprazole blocks the proton pumps, effectively turning them off. Once the pumps are blocked, your stomach makes far less acid. Less acid means your oesophagus, stomach and intestines are no longer being irritated and can start to heal. Because esomeprazole switches the pumps off for a long time, you only need to take it once a day to get around-the-clock relief. After you take it, the effect lasts until your body naturally builds new pumps to replace the blocked ones.

The routine is straightforward, but following it carefully will help the medicine work best. How often You will usually take esomeprazole once a day, first thing in the morning. If you are prescribed it twice a day, take one dose in the morning and one dose in the evening. You can take it with or without food. However, taking it before a meal – ideally about an hour before you eat – gives the best results because the medicine has time to start working before your stomach produces acid in response to food. How to swallow the tablets Swallow the tablets whole with a glass of water. Do not crush, break or chew the tablets. The coating is gastro-resistant, which means it protects the medicine from being destroyed by your stomach acid. If you crush or chew the tablet, the coating will be damaged and the medicine will not reach your small intestine intact, so it will not work properly. If you have difficulty swallowing If you are prescribed capsules and struggle to swallow them, you can open the capsule and mix the granules inside with half a glass of water, or with non-carbonated water or fruit juice. Stir the mixture just before you drink it, and drink it within 30 minutes. Rinse the glass with half a glass of water and drink that too. Do not crush or chew the granules. Tablets cannot be opened in the same way. What about antacids? Antacids (such as Gaviscon) can be taken at the same time as esomeprazole, but they may stop esomeprazole working as well. If you need an antacid, take it at least two hours before or two hours after your esomeprazole dose.

The length of treatment depends on what you are being treated for, and you should always follow your doctor's instructions. For short-term heartburn or reflux (over-the-counter use): Take the tablets for up to 14 days. You should start to feel better within 2–3 days. If you have seen no improvement after 14 days, or if your symptoms get worse, you must see a doctor. Do not just buy another pack. For prescribed treatment of GORD or ulcers: You will be given a course length by your doctor. For a first diagnosis, this is often 4–8 weeks. Even if you feel better before the course ends, do not stop early unless your doctor tells you to. Stopping too soon could allow the condition to come back. For maintenance therapy (preventing relapses): Some people need to take esomeprazole for months or years to keep their condition under control. Your doctor will prescribe the lowest effective dose and will review you regularly. For Helicobacter pylori eradication: You will be prescribed esomeprazole alongside two antibiotics, usually for 7–14 days. Complete the full course even if you feel better after a few days. Key rule: Take esomeprazole for the shortest possible time. Long-term use comes with extra risks, so the goal is always to step down to the lowest dose that controls your symptoms, or to stop altogether if you no longer need it.

If you take it once a day: If you forget a dose, take it as soon as you remember, unless your next dose is due in less than 12 hours. In that case, skip the missed dose and take your next dose at the usual time. Do not take a double dose to make up for a missed one – this will not work faster and could increase your risk of side effects. If you take it twice a day: If you forget a dose, take it as soon as you remember, unless your next dose is due in less than 4 hours. Then skip the missed dose and take your next dose at the usual time.

If you have been taking esomeprazole for more than a few weeks, your stomach may have become accustomed to having less acid. When you stop, your stomach can temporarily produce more acid than usual. This is called acid rebound. Symptoms of acid rebound include heartburn, indigestion or a burning feeling in your chest. These symptoms usually settle down on their own within two to four weeks. You can manage them with antacids (such as Gaviscon) during that time. If you have been taking esomeprazole for a long time (months or years), do not stop suddenly. Your doctor can help you step down your dose gradually – for example, from once a day to every other day, then to twice a week, before stopping completely. This minimises the rebound effect.

Most people tolerate esomeprazole very well, especially for short courses. However, like all medicines, side effects can occur. Common side effects (affect up to 1 in 10 people) These are usually mild and often settle down as your body gets used to the medicine. Headache Diarrhoea – this is the most common side effect. If you get diarrhoea, drink plenty of fluids to prevent dehydration. If you take the contraceptive pill and you have severe or prolonged diarrhoea, your contraception may not protect you from pregnancy, so check the pill packet for advice. Stomach pain Constipation Wind (flatulence) Nausea (feeling sick) or vomiting Uncommon side effects (affect up to 1 in 100 people) Dizziness or feeling sleepy Blurred vision Dry mouth Itching or skin rash If you experience dizziness or blurred vision, do not drive, cycle or use machinery or tools until you feel better. Rare but serious side effects Severe or persistent diarrhoea – especially if it contains blood or mucus. This could be a sign of a bacterial infection in your gut called Clostridioides difficile. Swelling of your face, lips, tongue or throat – a sign of a severe allergic reaction. Stop taking esomeprazole and seek emergency medical help. A widespread rash, blistering or peeling of the skin – very rare but serious. Stop taking esomeprazole and see a doctor urgently. Black or tarry stools – this could indicate bleeding in your stomach or intestines. Unexplained bruising or bleeding – especially if you are taking warfarin. Fever, rash, and reduced urine output – signs of kidney inflammation. Muscle twitching, shaking, unusual tiredness, or an irregular heartbeat – signs of low magnesium levels. Long-term risks (if you take esomeprazole for more than 12 months) Low magnesium levels (hypomagnesaemia) – Reported in patients taking PPIs for at least 3 months, and most often after a year. Symptoms include feeling tired, confused and dizzy, muscle twitching, shaking, and an irregular heartbeat. Low vitamin B12 levels – Taking PPIs for more than a year may reduce the absorption of vitamin B12. Symptoms include extreme tiredness, a sore and red tongue, mouth ulcers, and pins and needles. Bone fractures – Long-term, high-dose PPI use has been associated with a small increase in the risk of fractures of the hip, wrist or spine. Increased risk of gut infections – PPIs reduce stomach acid, which may allow certain bacteria (such as Clostridioides difficile) to survive in your gut.

Do not take esomeprazole if any of the following apply to you: You are allergic (hypersensitive) to esomeprazole or to any of the other ingredients listed on the pack. You are allergic to other proton pump inhibitors, such as pantoprazole, lansoprazole, rabeprazole or omeprazole. You are taking nelfinavir – a medicine used to treat HIV infection. You have ever had a severe skin rash or skin peeling, blistering or mouth sores after taking esomeprazole or another PPI. If you are unsure, talk to your doctor or pharmacist before taking this medicine. Use with caution (and tell your doctor) if: You have severe liver disease. The recommended maximum dose is 20 mg once a day. You have severe kidney problems. There is limited experience in people with severe kidney disease, so caution is needed. You have ever had a skin reaction after treatment with a PPI. You are pregnant, trying to conceive or breastfeeding. You are taking clopidogrel (a blood-thinning medicine to prevent strokes and heart attacks). Esomeprazole can reduce the effectiveness of clopidogrel. If you need a PPI while taking clopidogrel, your doctor will usually prescribe lansoprazole or pantoprazole instead.

Yes, esomeprazole can interact with several other medicines. Some interactions can reduce how well a medicine works, and others can increase the risk of side effects. Do NOT take esomeprazole with nelfinavir (an HIV medicine). Tell your doctor before starting esomeprazole if you are taking any of the following: Clopidogrel – Esomeprazole reduces the anti-platelet effect of clopidogrel. Many doctors prescribe a different PPI (such as lansoprazole) if you are taking clopidogrel. Warfarin – Taking these together may increase the risk of bleeding. Your doctor may need to check your INR more often when you start or stop esomeprazole. Digoxin (a heart medicine) Cilostazol (for peripheral arterial disease) Antifungal medicines such as itraconazole, ketoconazole, posaconazole or voriconazole Methotrexate (for psoriasis or rheumatoid arthritis) Phenytoin (an epilepsy medicine) Rifampicin (an antibiotic) Antidepressants and anxiety medicines such as citalopram, diazepam and imipramine HIV medicines Do not take St John's wort, a herbal remedy for depression, while you are taking esomeprazole. It can stop esomeprazole working properly. Tell your doctor or pharmacist about all medicines you are taking, including those you have bought without a prescription, as well as any herbal remedies, vitamins or supplements.

Pregnancy There is very little information about taking esomeprazole during pregnancy. Because of this, it is not recommended. If you need a PPI while you are pregnant, your doctor will usually suggest a similar medicine called omeprazole instead. Omeprazole has been used by many pregnant women and has a larger amount of safety information. If you are pregnant, planning to become pregnant, or think you might be pregnant, speak to your doctor before taking esomeprazole. Breastfeeding You may be able to take esomeprazole while you are breastfeeding, but you must check with your doctor first. Small amounts of esomeprazole pass into breast milk, but the amount is probably too small to be harmful to your baby. It is rare for breastfed babies to get any side effects from medicines their mothers are taking. However, you should monitor your baby closely. Contact a healthcare professional or call NHS 111 if you notice that your baby is not feeding as well as usual, having constipation, diarrhoea or being sick, being irritable or unsettled, not sleeping well, or developing a rash. Fertility There is no evidence to suggest that taking esomeprazole reduces fertility in either men or women. However, if you are trying to get pregnant, speak to a pharmacist or your doctor – they may want to review your treatment.

Yes, children can take esomeprazole, but it must be prescribed by a doctor. For children aged 12 years and above, the licensed uses are the same as for adults – GORD and Helicobacter pylori eradication. For children aged 1 year to 11 years, esomeprazole is available in granules for oral suspension for use via nasogastric or PEG gastrostomy tubes, for children who cannot take medicines orally. For children under 1 year of age, use is restricted to specialist paediatric care only. If a doctor prescribes esomeprazole for your child, follow their instructions carefully. The dose will be calculated according to your child's age and weight.

Esomeprazole, omeprazole and lansoprazole are all PPIs – they work by blocking the acid pumps in your stomach. However, there are a few differences. Esomeprazole is the S-enantiomer of omeprazole. In plain language, omeprazole is a 50/50 mixture of two mirror-image molecules. Esomeprazole is just one of those molecules. This gives esomeprazole a longer half-life and more predictable acid control. Effectiveness – Some studies suggest that esomeprazole 40 mg may heal erosive oesophagitis slightly faster or in a few more patients than omeprazole. However, for most people, all PPIs are similarly effective. Cost – In many NHS formularies, omeprazole is the first choice because it is the most cost-effective. Esomeprazole is often restricted for use in patients who have not responded to omeprazole or lansoprazole, or for treating severe erosive oesophagitis. Clopidogrel interaction – Esomeprazole can reduce the antiplatelet effect of clopidogrel. Lansoprazole is the PPI of choice for patients taking clopidogrel because it does not have the same interaction. In summary: If you are starting a PPI for the first time, your GP will usually prescribe omeprazole or lansoprazole. If those do not work well for you or cause side effects, or if you need a higher dose for severe acid damage, your doctor may then consider esomeprazole.

Esomeprazole treats the acid, but lifestyle changes can make a big difference. These changes may help you keep your symptoms under control with a lower dose of medicine, or even stop taking it altogether. Raise the head of your bed – Place 10–20 centimetre (4–8 inch) blocks under the legs at the head of your bed. Gravity then helps keep acid from flowing back up your oesophagus while you sleep. Avoid eating late at night – Do not eat for at least 2–3 hours before you lie down or go to bed. Eat smaller, more frequent meals – Large meals stretch your stomach and can push acid back up. Identify and avoid your trigger foods – Common triggers include fatty or fried foods, spicy foods, chocolate, caffeine, alcohol, carbonated drinks, citrus fruits, tomatoes, and onions. Keep a food diary to find yours. Lose excess weight – Being overweight increases pressure on your stomach. Losing just 5–10% of your body weight can make a noticeable difference. Stop smoking – Smoking relaxes the valve that keeps acid in your stomach and also damages your oesophagus. Wear loose-fitting clothing – Tight belts or waistbands put pressure on your stomach and can trigger reflux. Eat slowly and sit up straight – Eating on the go or slouching while you eat can make reflux worse. For occasional heartburn that does not happen often enough to need a PPI, antacids or alginates (such as Gaviscon) can provide effective short-term relief.

Store below 25°C (room temperature) in a dry place, away from direct sunlight and heat. Keep the bottle or blister pack in its outer carton to protect it from moisture. Keep the medicine out of the sight and reach of children. Do not use the tablets after the expiry date printed on the packaging. The active ingredient becomes less effective over time. If you have any leftover medicine, do not throw it away in household waste or pour it down the sink. Take it to your local pharmacy, where it will be disposed of safely.