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Nexium/esomeprazole tablets are a type of medicine called proton pump inhibitors (PPI). PPIs were discovered in 1979 and have been in patient use for more than 30 years. They are safe and effective treatments for acid reflux/heartburn, Gastro-oesophageal reflux disease (GORD), and are also used for a range of other gastric and duodenal conditions, including dyspepsia/indigestion. Nexium (esomeprazole) is a newer generation PPI developed as a mirror image chemical of the original PPI omeprazole.

Further information: NHS - Esomeprazole.

Generic esomeprazole

Nexium is the original brand name for the medication esomeprazole, the active ingredient.

Lower cost generic esomeprazole 20mg is also available. Generic medicines work in the same way and contain the same quantity of the active ingredient but are usually lower cost than brand-name medicines.

How does esomeprazole relieve acid indigestion symptoms?

The 'proton pump' is the process which is used by the cells lining the stomach to produce digestive acid. The pump is usually triggered in response to eating. In acid reflux/heartburn/GORD, the acid leaks from the top of the stomach irritating the lower oesophagus (gullet). In functional dyspepsia there is gut/brain miscommunication and too much acid production.

Esomeprazole and other PPIs block the action of the proton pump and so reduce the level of acidity in the stomach contents. If there is less acid then symptoms of acid reflux, heartburn, and dyspepsia are reduced.

How to take Nexium/esomeprazole

• Take one 20mg tablet once a day at the same time. They can be taken at any time.
• Swallow your tablets whole with a drink of water.
• Do not chew or crush the tablets. The tablets contain coated pellets which stop the medicine from being broken down by the acid in your stomach. It is important not to damage the pellets.
• If you cannot swallow tablets, the tablets can be stirred into a glass of still (not fizzy) water (no other liquid). They will break up but not dissolve - the cloudy mixture should be drunk within 30 minutes. Stir again before drinking, and rinse the glass with more water and drink again to ensure none is left in the glass. Do not chew any solid pieces of tablet.
• Use daily for up to 4 weeks. If symptoms have not settled after 2 weeks, consult a GP to discuss further investigation.
• If symptoms have settled, but come back, continue to use 20mg once a day, as needed.
• If you continue to need them regularly, more than 4 times a week for over a month, consult a GP.

How soon is Nexium/esomeprazole effective?

It may take a few days to notice an effect from Nexium/esomeprazole. For best results follow the instructions carefully on how to take it - see above and read the patient leaflet supplied in packs. Consult a GP if symptoms have not significantly settled after 2 weeks.

Who might be suitable for Nexium/esomeprazole?

Dr Fox supplies Nexium/esomeprazole to treat gastro-oesophageal reflux disease (GORD), with symptoms of acid reflux, acid indigestion, heartburn, and to treat dyspepsia/indigestion in adults over 18.

Nexium/esomeprazole can also be used to:

• Treat erosive reflux oesophagitis.
• Prevent relapse in healed oesophagitis
• Prevent or aid healing of gastric and duodenal ulcers due to taking NSAID (non steroidal anti-inflammatory) therapy.
• Treat Zollinger Ellison Syndrome (caused by a growth in the pancreas).

Helicobacter pylori (H. pylori)

H. pylori is a bacterium found in some people's stomachs. It is known to be linked with gastritis, gastric and duodenal ulcers, and gastric cancer. Nexium/esomeprazole can be used in combination with certain antibiotics, to clear H. pylori from the stomach. If there are persistent acid related symptoms a GP may test and treat for H. pylori. The test is usually either a simple stool (poo) or a breath test. For the test to be reliable, you must not have taken a PPI in the past 2 weeks, or antibiotics in the past 4 weeks.

Who should not take Nexium/esomeprazole?

There are checks in the online consultation to confirm if Nexium/esomeprazole is suitable or may affect other medications taken.

If taking phenytoin (for fits) or warfarin type anticoagulants (blood thinners requiring regular blood tests) speak to the GP about extra monitoring before taking Nexium/esomeprazole.

If taking medication to treat HIV/AIDS or cancer chemotherapy, including high dose methotrexate, do not take Nexium/esomeprazole without discussing with your specialist. Nexium/esomeprazole may make your treatment less effective.

Nexium/esomeprazole may not be suitable for people with severe liver or kidney problems - consult with a GP.

During treatment with Nexium/esomeprazole, if new symptoms develop such as unintended weight loss, vomiting, swallowing difficulties, blood in vomit, or dark and tarry stools, or new stomach pains you must seek urgent medical attention.

Inform the doctor or nurse if undergoing investigations or blood tests that you are taking Nexium/esomeprazole. You may be asked to stop taking Nexium/esomeprazole as it may affect the blood test results or hide problems that should be seen on an endoscopy.

Are there any drugs which might interact with Nexium/esomeprazole?

There are a few medicines which interact with Nexium/esomeprazole, making one or other less or more effective. Checks for these are carried out in the online consultation.

Do not take Nexium/esomeprazole if taking:

• Nelfinavir, rilpivirine, atazanavir, saquinavir and ritonavir, tipranivir, or similar - for HIV

Discuss with your GP/specialist before taking Nexium/esomeprazole if taking:

• Cilostazol - poor blood supply to legs.
• Citalopram, escitalopram, imipramine, clomipramine - for depression.
• Clarithromycin - antibiotic.
• Clopidogrel - antiplatelet drug.
• Dasatinib, gefitinib, neratinib, erlotinib - cancer chemotherapy.
• Diazepam - anxiety, muscle relaxant or epilepsy.
• Digoxin - heart disease.
• Ketoconazole, posaconazole, voriconazole and itraconazole - antifungals.
• Methotrexate - cancer chemotherapy.
• Phenytoin - fits.
• Rifampicin - tuberculosis.
• St John's Wort - herbal remedy for low mood.
• Tacrolimus - for organ transplant only.
• Warfarin - blood thinning.

Any special warnings/precautions for use?

The following have been reported with long-term (over a year) regular use of PPIs including Nexium/esomeprazole:

• Slight increase in the risk of fractures at the hip, wrist, and spine, hence patients are recommended to follow national guidelines for prevention and treatment of osteoporosis, and to have an adequate intake of calcium and vitamin D. Risk is further increased if also taking regular steroid medication.
• Reduced absorption of vitamin B12 if taking regularly for more than 2-3 years.
• Low magnesium levels. Symptoms include fatigue, dizziness, delirium, convulsions and cardiac arrhythmias. More likely if taken with other drugs (e.g. digoxin) which can also lower magnesium levels. Periodic checks of blood magnesium levels may be recommended if taking for longer than 3 months continuously.
• A rare condition 'subacute cutaneous lupus erythematosus' (SCLE). Consult your GP promptly if you develop a skin rash on sunlight exposed areas.
• A slightly higher risk of gastroenteritis such as Campylobacter and Salmonella.

Is Nexium/esomeprazole safe in pregnancy and/or breastfeeding?

There is no information about safety in pregnancy or breastfeeding so Nexium/esomeprazole should not be used.

Allergy to Nexium/esomeprazole

Very rarely Nexium/esomeprazole and other PPIs can trigger an allergic reaction.

The allergy is often shared with other PPIs so do not take Nexium/esomeprazole if you have experienced a previous allergic reaction to a PPI.

If you have any symptoms or signs suggestive of an acute allergic reaction (anaphylaxis), you must get medical help immediately (telephone 999 if in the UK).

Symptoms/signs of an acute allergic reaction include:

• Difficulty breathing, tight chest, wheezing.
• Swelling of the face, lips, or tongue.
• Skin rash – urticaria/hives.
• Confusion/collapse/unconsciousness.

For more information see NHS - Anaphylaxis.

Possible side effects of Nexium/esomeprazole

All medications can cause side effects but not everyone gets them.

The most common side effects reported with Nexium/esomeprazole (up to 1 in 10 users) include:

• Headache.
• Constipation or diarrhoea.
• Flatulence (wind).
• Nausea/vomiting.
• Stomach pains.
• Small harmless stomach polyps (only seen on endoscopy and disappear on stopping the medication).

Very rare effects:

• Dizziness, visual disturbances, and muscular weakness - if affected do not drive or operate heavy machinery.
• Reduction in white blood cells leading to susceptibility to infection. If fever develops with signs of severe infection contact a GP urgently.

For further information on potential side effects see the manufacturer's patient leaflet.

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