Cautions
Contraindications
Warnings/Precautions
General Precautions
Pending revision, the material in this section should be considered in light of more recently available information in the MEDWATCH notification at the beginning of this monograph.
GI Effects
Response to esomeprazole does not preclude presence of occult gastric neoplasm. Atrophic gastritis reported occasionally with long-term omeprazole use.
Respiratory Effects
Administration of proton-pump inhibitors has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).
Specific Populations
Pregnancy
Category B.
Lactation
Not known whether esomeprazole is distributed into milk, but omeprazole is distributed into milk. Discontinue nursing or the drug.
Pediatric Use
Safety and efficacy of oral esomeprazole for short-term treatment of GERD in adolescents 12–17 years of age is supported by controlled clinical trials in adults and safety and pharmacokinetic studies in adolescents. Adverse effects and pharmacokinetics similar in adolescents and adults.
Safety and efficacy of oral esomeprazole for short-term treatment of GERD in children <12 years of age or for other uses in pediatric patients not established.
Safety and efficacy of IV esomeprazole in pediatric patients not established.
Geriatric Use
No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.
Hepatic Impairment
Use with caution. (See Hepatic Impairment under Dosage and Administration.)
Common Adverse Effects
Headache, dizziness, diarrhea, nausea, flatulence, dyspepsia, abdominal pain, constipation, dry mouth.
Drug Interactions
Extensively metabolized by CYP isoenzymes, principally CYP2C19; also to lesser extent by CYP3A4. May inhibit CYP2C19; unlikely to inhibit CYP3A4, 1A2, 2A6, 2C9, 2D6, or 2E1.
Drugs Metabolized by Hepatic Microsomal Enzymes
Potential to inhibit metabolism of drugs metabolized by CYP2C19. Interaction unlikely with drugs metabolized by other CYP isoenzymes.
Specific Drugs
| Drug |
Interaction |
Comments |
| Amoxicillin |
Pharmacokinetic interaction unlikely |
|
| Atazanavir |
Possibility of substantially decreased plasma atazanavir concentrations and possible loss of therapeutic effect |
Concomitant use not recommended |
| Clarithromycin |
Increased plasma concentrations of esomeprazole and 14-hydroxyclarithromycin |
Not considered clinically important |
| Diazepam |
Decreased diazepam metabolism and increased plasma concentrations |
Not considered clinically important |
| Gastric pH-dependent drugs (e.g., digoxin, iron salts, ketoconazole) |
Esomeprazole may decrease drug absorption |
|
| NSAIAs (naproxen, rofecoxib) |
Pharmacokinetic interaction unlikely |
|
| Oral contraceptives |
No change in esomeprazole pharmacokinetics |
|
| Phenytoin |
Pharmacokinetic interaction unlikely |
|
| Quinidine |
Pharmacokinetic interaction unlikely |
|
| Sucralfate |
Possible delayed proton-pump inhibitor absorption and decreased bioavailability |
Administer proton-pump inhibitor at least 30 minutes before sucralfate |
| Warfarin |
Potential for decreased warfarin metabolism and changes in prothrombin measures |
Monitor PT and INR |