Indications

Eprazol (Esomeprazole) is a proton pump inhibitor (PPI) used to treat various acid-related conditions:

• GERD (Gastroesophageal Reflux Disease): To relieve chronic heartburn symptoms, heal erosive esophagitis, and maintain healing.
• Peptic Ulcers: For the treatment of duodenal and gastric ulcers, and in combination therapy with amoxicillin and clarithromycin to eradicate Helicobacter pylori infection, which helps prevent duodenal ulcer recurrence.
• Zollinger-Ellison Syndrome: A condition involving high levels of stomach acid.
• Acid-related Dyspepsia.

Pharmacology

Esomeprazole, the S-isomer of omeprazole, works by specifically inhibiting the H+/K+-ATPase enzyme (the proton pump) in the parietal cells of the stomach. This action effectively suppresses gastric acid secretion. Its single-isomer composition provides better acid control than racemic PPIs.

Dosage & Administration

• Oral:
  • Healing of Erosive Esophagitis: 20 mg or 40 mg once daily for 4-8 weeks.
  • Maintenance of Healing: 20 mg once daily.
  • Symptomatic GERD: 20 mg once daily for 4 weeks.
  • H. pylori Eradication: 40 mg once daily for 10 days, with amoxicillin and clarithromycin.
  • Zollinger-Ellison Syndrome: 20-80 mg once daily, adjusted as needed.
• Intravenous (IV):
  • GERD with Erosive Esophagitis: 20 mg or 40 mg once daily (for adults).
  • Risk reduction of rebleeding: 80 mg IV infusion over 30 minutes, followed by a continuous infusion for 72 hours.
• Administration: Oral capsules should be swallowed whole, one hour before a meal. For those with difficulty, pellets can be mixed with applesauce.

Interaction

• CYP2C19 Substrates (e.g., Diazepam): Esomeprazole may inhibit this enzyme, leading to a decrease in the clearance of these drugs.
• Gastric pH-Dependent Drugs (e.g., Ketoconazole, Digoxin, Iron Salts): Esomeprazole's acid-suppressing effect may interfere with the absorption of these drugs.
• Clarithromycin/Amoxicillin: Co-administration results in increased plasma levels of Esomeprazole and 14-hydroxyclarithromycin.

Contraindications

Esomeprazole is contraindicated in patients with a known hypersensitivity to any of its components.

Side Effects

Common side effects include headache, diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth.

Pregnancy & Lactation

There are no adequate studies in pregnant women. Animal studies show no teratogenic effects. As it is unknown if esomeprazole is excreted in human milk, breastfeeding should be discontinued if use is considered essential.

Precautions & Warnings

Symptomatic improvement with Eprazol does not rule out the possibility of gastric malignancy. Patients with severe hepatic insufficiency should not exceed a 20 mg daily dose.

Overdose Effects

There have been no reports of overdose with Eprazol. Treatment should be symptomatic and supportive. Esomeprazole is highly protein-bound and cannot be removed by dialysis.

Storage Conditions

Store at a temperature not exceeding 30°C in a dry place. Protect from light and moisture. Keep out of reach of children.