Esomeprazole

Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

GORD, erosive esophagitis, Zollinger-Ellison syndrome

PBSPPINexium20 mg EC tabletS4+1

Max Dose

80 mg/day

Half-life

1-1.5 h

Plavix Interaction

AVOID

C. Diff Risk

MODERATE

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.

Maximum Dose

Max 80 mg/day.

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.

Avoid / Cautions

Co-administration with Clopidogrel. Pregnancy Category B3.

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)

Esomeprazole

Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

GORD, erosive esophagitis, Zollinger-Ellison syndrome

PBSPPINexium20 mg EC tabletS4+1

Max Dose

80 mg/day

Half-life

1-1.5 h

Plavix Interaction

AVOID

C. Diff Risk

MODERATE

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.

Maximum Dose

Max 80 mg/day.

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.

Avoid / Cautions

Co-administration with Clopidogrel. Pregnancy Category B3.

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)