Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

Esomeprazole

GORD, erosive esophagitis, Zollinger-Ellison syndrome

PBSPPINexium20 mg EC tabletS4+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

80 mg/day

Half-life

1-1.5 h

High risk: Plavix Interaction

AVOID

Caution: C. Diff Risk

MODERATE

Cautions

Avoid / Cautions

Co-administration with Clopidogrel. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

The S-enantiomer of Omeprazole. Highly potent PPI providing slightly more aggressive acid suppression than Pantoprazole, but carries a dangerous interaction with Clopidogrel.

Clinical Focus

Never prescribe alongside Clopidogrel due to CYP2C19 inhibition.

Bottom Line

Esomeprazole is the most potent PPI with the highest acid suppression, but carries the same long-term risks as all PPIs and should be regularly reviewed for de-prescribing.

Formulation & Access

Brand Names

Nexium

Oral Routes

Enteric-coated tablets/capsules (20 mg, 40 mg).

Parenteral

Ampoule (40 mg powder) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4). Low dose available S2.

Indications & Use

Primary

PBSTGA

GORD, erosive esophagitis, Zollinger-Ellison syndrome.

Clinical Place

Used when highly potent acid suppression is required.

Quick reference

Class & Role

Proton Pump Inhibitor — The S-enantiomer of Omeprazole.

Route / Formulation

Enteric-coated tablets/capsules (20 mg, 40 mg). (Nexium)

Usual Dose & Max

PO 20-40 mg OD (30 mins before breakfast). Max 80 mg/day.

Key Indication Doses

GORD / PUD: PO 20-40 mg OD (30 mins before breakfast). Severe Bleeding Ulcer: IV 80 mg STAT, then 8 mg/hr infusion for 72 hours.

Best Uses

Esomeprazole is the most potent PPI with the highest acid suppression, but carries the same long-term risks as all PPIs and should be regularly reviewed for de-prescribing.

Key Risks

Gastrointestinal: C. difficile infection risk, microscopic colitis. Metabolic: Hypomagnesemia (chronic use).

Key Interactions

Moderate-to-strong inhibitor of CYP2C19. Blocks the activation of Clopidogrel, leading to fatal stent thrombosis. Use Pantoprazole instead.

Monitoring

Routine Mg2+ checks for long-term users.

Clinical Pearl

Because it is the purified S-enantiomer, Esomeprazole undergoes less hepatic first-pass metabolism than standard Omeprazole, delivering more active drug to the proton pumps.

Access

Nexium20 mg EC tablet

Brand: Nexium
Formulation: Enteric-coated tablets/capsules (20 mg, 40 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

Esomeprazole

GORD, erosive esophagitis, Zollinger-Ellison syndrome

PBSPPINexium20 mg EC tabletS4+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

80 mg/day

Half-life

1-1.5 h

High risk: Plavix Interaction

AVOID

Caution: C. Diff Risk

MODERATE

Cautions

Avoid / Cautions

Co-administration with Clopidogrel. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

The S-enantiomer of Omeprazole. Highly potent PPI providing slightly more aggressive acid suppression than Pantoprazole, but carries a dangerous interaction with Clopidogrel.

Clinical Focus

Never prescribe alongside Clopidogrel due to CYP2C19 inhibition.

Bottom Line

Esomeprazole is the most potent PPI with the highest acid suppression, but carries the same long-term risks as all PPIs and should be regularly reviewed for de-prescribing.

Formulation & Access

Brand Names

Nexium

Oral Routes

Enteric-coated tablets/capsules (20 mg, 40 mg).

Parenteral

Ampoule (40 mg powder) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4). Low dose available S2.

Indications & Use

Primary

PBSTGA

GORD, erosive esophagitis, Zollinger-Ellison syndrome.

Clinical Place

Used when highly potent acid suppression is required.

Quick reference

Class & Role

Proton Pump Inhibitor — The S-enantiomer of Omeprazole.

Route / Formulation

Enteric-coated tablets/capsules (20 mg, 40 mg). (Nexium)

Usual Dose & Max

PO 20-40 mg OD (30 mins before breakfast). Max 80 mg/day.

Key Indication Doses

GORD / PUD: PO 20-40 mg OD (30 mins before breakfast). Severe Bleeding Ulcer: IV 80 mg STAT, then 8 mg/hr infusion for 72 hours.

Best Uses

Esomeprazole is the most potent PPI with the highest acid suppression, but carries the same long-term risks as all PPIs and should be regularly reviewed for de-prescribing.

Key Risks

Gastrointestinal: C. difficile infection risk, microscopic colitis. Metabolic: Hypomagnesemia (chronic use).

Key Interactions

Moderate-to-strong inhibitor of CYP2C19. Blocks the activation of Clopidogrel, leading to fatal stent thrombosis. Use Pantoprazole instead.

Monitoring

Routine Mg2+ checks for long-term users.

Clinical Pearl

Because it is the purified S-enantiomer, Esomeprazole undergoes less hepatic first-pass metabolism than standard Omeprazole, delivering more active drug to the proton pumps.

Access

Nexium20 mg EC tablet

Brand: Nexium
Formulation: Enteric-coated tablets/capsules (20 mg, 40 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.