esomeprazole magnesium (perprazole, S-omeprazole)
(ess oh me' pray zol)
Nexium
Pregnancy Category C
Drug classes
Antisecretory agent
Proton pump inhibitor
Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium
ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid
production; is broken down less in the first pass through the liver than the parent compound omeprazole,
allowing for increased serum levels.
Indications
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GERD—treatment of heartburn and other related symptoms
Erosive esophagitis—short-term (4–8 wk) treatment for healing and symptom relief. Also used for
maintenance therapy following healing of erosive esophagitis
As part of combination therapy for the treatment of duodenal ulcer associated with Helicobacter pylori
Reduction in occurrence of gastric ulcers associated with continuous NSAID use in patients at risk (> 60
yr, history of gastric ulcers) for developing gastric ulcers
Contraindications and cautions
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Contraindicated with hypersensitivity to omeprazole, esomeprazole, or other proton pump inhibitor.
Use cautiously with hepatic dysfunction, pregnancy, lactation.
Pharmacokinetics
Route
Oral
Onset
1–2 hr
Peak
1.5 hr
Duration
17 hr
Metabolism: Hepatic; T1/2: 1–1.5 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and bile
Adverse effects
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CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream
abnormalities
Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy, flatulence
Respiratory: URI symptoms, sinusitis, cough, epistaxis
Interactions
Drug-drug
 Increased serum levels and potential increase in toxicity of benzodiazepines and phenytoin when taken
concurrently
 May interfere with absorption of drugs dependent upon presence of acidic environment (eg
ketoconazole, iron salts, digoxin)
Nursing considerations
CLINICAL ALERT!
Potential for name confusion exists between esomeprazole and omeprazole; use caution.
Assessment
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History: Hypersensitivity to any proton pump inhibitor; hepatic dysfunction; pregnancy, lactation
Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal examination; respiratory
auscultation, liver function tests
Interventions
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WARNING: Arrange for further evaluation of patient after 4 wk of therapy for gastroesophageal reflux
disorders. Symptomatic improvement does not rule out gastric cancer.
If administering antacids, they may be administered concomitantly with esomeprazole.
Ensure that the patient swallows capsule whole; do not crush, or chew; patients having difficulty
swallowing may open capsule and sprinkle in applesauce or disperse in tap water, orange or apple juice,
or yogurt; do not crush or chew pellets.
Obtain baseline liver function tests and monitor periodically during therapy.
Maintain supportive treatment as appropriate for underlying problem.
Provide additional comfort measures to alleviate discomfort from GI effects and headache.
Establish safety precautions if dizziness or other CNS effects occur (use side rails, accompany patient).
Teaching points
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Take the drug at least 1 hr before meals. Swallow the capsules whole; do not chew or crush. If you
cannot swallow the capsule, it can be opened and sprinkled in applesauce or mixed in tap water, orange
or apple juice, or yogurt; do not crush or chew the pellets. This drug will need to be taken for 4–8 wk, at
which time your condition will be reevaluated.
Arrange to have regular medical follow-up while you are using this drug.
Maintain all of the usual activities and restrictions that apply to your condition. If this becomes difficult,
consult with your nurse or physician.
You may experience these side effects: Dizziness (avoid driving a car or performing hazardous tasks);
headaches (consult with your health care provider if these become bothersome, medications may be
available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult with your dietitian
to maintain nutrition; ensure ready access to bathroom facilities); symptoms of URI, cough (it may help
to know that this is a drug effect, do not self-medicate, consult with your health care provider if this
becomes uncomfortable).
Report severe headache, worsening of symptoms, fever, chills, darkening of the skin, changes in color of
urine or stool.
Adverse effects in Italic are most common; those in Bold are life-threatening.