Esomeprazole (Nexium) is a proton pump inhibitor. It is one of the most potent of the proton pump inhibitors and is used to suppress gastric acid secretion.

Esomeprazole (Nexium) Uses:

Oral:

• Esomeprazole magnesium and esomeprazole strontium:

  • Gastroesophageal reflux disease (Rx only):

    • Healing of erosive esophagitis:
      • Short-term treatment of 4 to 8 weeks of  erosive esophagitis
    • Maintenance of healing of erosive esophagitis:
      • Maintaining symptom resolution and healing of erosive esophagitis

  • Symptomatic gastroesophageal reflux disease:

    • Short-term  treatment of 4 to 8 weeks of symptomatic gastroesophageal reflux disease (GERD)

  • Helicobacter pylori eradication (Rx only):

    • As part of a multidrug regimen for Helicobacter pylori eradication in patients with duodenal ulcer disease (active or history of within the past 5 years)

  • Risk reduction of nonsteroidal anti-inflammatory drug-associated gastric ulcer (Rx only):

    • Prevention of gastric ulcers associated with continuous NSAID therapy in patients at risk (age ≥60 years and/or history of gastric ulcer)

  • Pathological hypersecretory conditions, including Zollinger-Ellison syndrome (Rx only):

    • Treatment (long-term) of pathological hypersecretory conditions including Zollinger-Ellison syndrome

• Esomeprazole magnesium:

  • Heartburn (OTC labeling):
    • Treatment of frequent heartburn (≥2 days per week).

IV:

• Esomeprazole sodium:

  • Gastroesophageal reflux disease (Rx only):

    • Short-term (≤10 days) treatment of gastroesophageal reflux disease (GERD) with erosive esophagitis in pediatric patients 1 month to 17 years of age and adults when oral therapy is not possible or appropriate

  • Risk reduction of ulcer rebleeding post-procedure (Rx only):

    • Decrease the risk of rebleeding post endoscopy for acute bleeding gastric or duodenal ulcers in adults

• Off Label Use of Esomeprazole in Adults:

  • Used in Barrett esophagus
  • Used in dyspepsia
  • Used in stress ulcer prophylaxis in critically ill patients
  • Used for the treatment of NSAID induced gastric ulcers

Esomeprazole (Nexium) Dose in Adults

Note:

• All dosing is expressed in terms of the esomeprazole base, regardless of the salt associated with the dosing information.
• Esomeprazole strontium 24.65 mg is equivalent to 20 mg of esomeprazole base; esomeprazole strontium 49.3 mg is equivalent to 40 mg of esomeprazole base.

Esomeprazole (Nexium) Dose in the treatment of Barrett esophagus (off-label):

• Oral: Utilize standard doses (20 or 40 mg) once in a day
• poorly controlled reflux symptoms or esophagitis may require twice in a day dosing.
• The use of 40 mg twice in a day (in combination with aspirin) also has been reported.

Esomeprazole (Nexium) Dose in the treatment of Dyspepsia (off-label):

• Oral: 40 mg once in a  day for up to 8 weeks.

Esomeprazole (Nexium) Dose in the treatment of Erosive esophagitis (healing):

• Oral: Esomeprazole magnesium, esomeprazole strontium:
• Initial:
  • 20 to 40 mg once in a day for 4 to 8 weeks;
  • if incomplete healing, may continue for an additional 4 to 8 weeks;
• maintenance:
  • 20 mg once in a day (controlled studies did not extend beyond 6 months)

Esomeprazole (Nexium) Dose in the treatment of Heartburn (OTC labeling):

• 20 mg once in a day for 14 days (maximum: 20 mg/day);
• The treatment may be repeated after 4 months if required.

Esomeprazole (Nexium) Dose in the treatment of Helicobacter pylori eradication: Oral:

• American College of Gastroenterology guidelines:

  • Clarithromycin triple regimen:

    • 20 to 40 mg two times in a day in combination with clarithromycin 500 mg two times in a day and either amoxicillin 1 g two times in a day or metronidazole 500 mg thrice in a day;
    • continue regimen for 2 weeks.
    • Note:
      • Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15 percent, eradication rates with clarithromycin-based regimens ≤85 percent ).

  • Bismuth quadruple regimen:

    • 20 mg twice in a day in combination with tetracycline 500 mg 4 times in a day, metronidazole 250 mg 4 times in a day or 500 mg 3 or 4 times in a day, and either bismuth subcitrate 120 to 300 mg 4 times in a day or bismuth subsalicylate 300 mg 4 times in a day;
    • continue regimen for 10 to 14 days.

  • Concomitant regimen:

    • 20 mg two times daily in combination with amoxicillin 1 g two times in a day, clarithromycin 500 mg two times in a day, and either metronidazole or tinidazole 500 mg two times in a day;
    • continue regimen for 10 to 14 days.

  • Sequential regimen:

    • 20 mg two times daily plus amoxicillin 1 g two times daily for 5 to 7 days;
    • then continue esomeprazole along with clarithromycin 500 mg two times in a  day, and either metronidazole or tinidazole 500 mg two times in a day for 5 to 7 days.

  • Hybrid regimen:

    • 20 mg two times in a day plus amoxicillin 1 g two times in a  day for a weak;
    • then continue esomeprazole and amoxicillin along with clarithromycin 500 mg two times in a  day, and either metronidazole or tinidazole 500 mg two times in a  day for a weak.

  • Levofloxacin triple regimen:

    • 20 mg two times in a day in combination with amoxicillin 1 g two times in a day and levofloxacin 500 mg once in a day;
    • continue regimen for 10 to 14 days.

• Manufacturer's labeling:

  • Dosing in the prescribing information may not reflect current clinical practice. Esomeprazole magnesium, esomeprazole strontium: 40 mg once in a day.

Esomeprazole (Nexium) Dose in the treatment of pathological hypersecretory conditions (Zollinger-Ellison syndrome):

• Oral: Esomeprazole magnesium, esomeprazole strontium:
  • 40 mg two times in a day;
  • adjust regimen to individual patient needs;
  • doses up to 240 mg every day have been administered.

Esomeprazole (Nexium) Dose in the Prevention of NSAID-induced gastric ulcers:

• Oral: Esomeprazole magnesium, esomeprazole strontium:
  • 20 to 40 mg once in a day for up to 6 months;
• Note:
  • 40 mg daily did not show additional benefit over 20 mg daily in clinical trials.

Esomeprazole (Nexium) Dose in the Prevention of recurrent gastric or duodenal ulcer bleeding post endoscopy:

• IV: 80 mg over 30 minutes, followed by 8 mg/hour continuous infusion for a total of 72 hours, then 40 mg orally once in a day for 27 additional days or
• may follow continuous infusion with any single daily-dose oral proton pump inhibitor (PPI) for a duration dictated by the underlying etiology.
• Note:
  • The use of intermittent PPIs was found to be comparable with the use of continuous infusion PPIs in patients with high-risk endoscopic findings and maybe preferred.

Esomeprazole (Nexium) Dose in the treatment of Symptomatic gastroesophageal reflux:

• Oral: Esomeprazole magnesium, esomeprazole strontium:
  • 20 mg once in a day  for 4 weeks; may consider an additional 4 weeks of treatment if symptoms do not resolve

Esomeprazole (Nexium) Dose in the Treatment of GERD (short-term):

• IV: 20 mg or 40 mg once in a day.
• Note:
  • Indicated only in cases where oral therapy is inappropriate or not possible; safety/efficacy ≥10 days has not been established.

Esomeprazole (Nexium) Dose in the Treatment of NSAID-induced gastric ulcers (off-label):

• Oral: Esomeprazole magnesium:
  • 20 mg once in a day for 8 weeks.

• Discontinuation of Esomeprazole (Nexium) therapy:

  • Oral: Some experts recommend a step-down approach in order to avoid worsening or rebound symptoms.
  • One recommendation is to decrease the dose by 50% over 2 weeks to 4 weeks.
  • If the patient is already on the lowest possible dose, alternate day therapy may be considered.
  • If symptoms worsen during treatment or after discontinuation, the patient should be re-evaluated.

Esomeprazole (Nexium) Dose in Childrens

Esomeprazole (Nexium) Dose in the treatment of Erosive esophagitis associated with GERD:

Oral:

• Infants:

Note: Safety and efficacy of doses >1.33 mg/kg/day has not been studied.

• • 3 to 5 kg:
    • 5 mg once in a day for up to 6 weeks
  • >5 to 7.5 kg:
    • 5 mg once in a day for up to 6 weeks
  • >7.5 kg:
    • 10 mg once in a day for up to 6 weeks

• Children 1 to 11 years:

Note: Safety and efficacy of doses >1 mg/kg/day has not been studied.

• • <20 kg:
    • 10 mg once in a day for 8 weeks
  • >20 kg:
    • 10 or 20 mg once in a day for 8 weeks

• Children ≥12 years and Adolescents:

  • 20 to 40 mg once in a day for 4 to 8 weeks

IV Esomeprazole (Nexium): Note: Indicated only in cases where oral therapy is inappropriate or not possible; safety and efficacy >10 days have not been established.

• Infants:

  • 5 mg/kg/dose once in a day

• Children and Adolescents ≤17 years:

  • <55 kg:
    • 10 mg once in a day
  • ≥55 kg:
    • 20 mg once in a day

Esomeprazole (Nexium) Dose in the treatment of symptomaticGERD:

• Fixed dosing: Oral:

  • Children 1 to 11 years:
    • 10 mg once in a day for up to 8 weeks.
    • Note: Safety and efficacy of doses >1 mg/kg/day has not been studied.
  • Children ≥12 years and Adolescents:
    • 20 mg once in a day for 4 to 8 weeks

• Weight-directed dosing: Oral:

  • Infants, Children, and Adolescents:
    • 0.7 to 3.3 mg/kg/day

Esomeprazole (Nexium) Pregnancy Risk Category: B

 

• There are many recommendations for treating GERD during pregnancy.
• Lifestyle modifications, followed by medication, are the first treatment for non-pregnant women.
• Based on the available data, PPIs can be used when clinically warranted (preferring an agent with more information during pregnancy).
• Esomeprazole is the s-isomer of omeprazole; refer to the omeprazole monograph for additional information.

Use of Esomeprazole while breastfeeding

• Esomeprazole, also known as omeprazole s-isomer, is the s-isomer for omeprazole. Esomeprazole can be found in breastmilk because it is omeprazole.
• According to the manufacturer of the product, when deciding whether to continue or stop breastfeeding during therapy, it should consider the risks to infant exposure, the benefits to the infant and the benefits to the mother.
• Refer to the omeprazole monograph for additional information.

Esomeprazole (Nexium) Dose in Kidney Disease:

• Oral:

  • Esomeprazole magnesium:

    • Mild-to-severe impairment:
      • No dosage adjustment required.

  • Esomeprazole strontium:

    • Mild-to-moderate impairment:
      • No dosage adjustment required.
    • Severe impairment:
      • Use is not recommended (has not been studied).
• IV:
  • Mild-to-severe impairment:
    • No dosage adjustment required.

Esomeprazole (Nexium) Dose in Liver disease:

• Oral:
  • Mild to moderate impairment (Child-Pugh class A or B):
    • No dosage adjustment required.
  • Severe impairment (Child-Pugh class C):
    • Maximum: 20 mg in a day.
• IV:

  • Treatment of GERD (short-term):

    • Mild to moderate impairment (Child-Pugh class A or B):
      • No dosage adjustment required.
    • Severe impairment (Child-Pugh class C):
      • The dose should not exceed 20 mg each day.

  • Prevention of recurrent gastric or duodenal ulcer bleeding post endoscopy:

    • Mild to moderate impairment (Child-Pugh class A or B):
      • 80 mg over 30 minutes, followed by a maximum continuous infusion of 6 mg/hour for a total of 72 hours
    • Severe impairment (Child-Pugh class C):
      • 80 mg over 30 minutes, followed by a maximum continuous infusion of 4 mg/hour for a total of 72 hour

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Unless otherwise specified, percentages represent adverse reactions identified in clinical trials evaluating the oral formulation.

Common Side Effects of Esomeprazole (Nexium):

• Central nervous system:

  • Headache

Less Common Side Effects of Esomeprazole (Nexium):

• Central Nervous System:

  • Vertigo
  • Drowsiness
  • Irritability
  • Dizziness

• Dermatologic:

  • Pruritus

• Endocrine & Metabolic:

  • Altered Thyroid Hormone Levels
  • Increased Serum Potassium
  • Increased Serum Sodium
  • Increased Thyroid Stimulating Hormone Level
  • Increased Uric Acid
  • Decreased Serum Potassium
  • Decreased Serum Sodium
  • Decreased Thyroid Hormones
  • Increased Gastrin

• Gastrointestinal:

  • Flatulence
  • Diarrhea
  • Constipation
  • Abdominal Pain
  • Nausea
  • Vomiting
  • Xerostomia

• Hematologic & Oncologic:

  • Quantitative Disorders Of Platelets

• Hepatic:

  • Increased Serum Alkaline Phosphatase
  • Increased Serum Alanine Aminotransferase
  • Increased Serum Aspartate Aminotransferase

• Local:

  • Injection Site Reaction

• Renal:

  • Increased Serum Creatinine

• Respiratory:

  • Cough
  • Tachypnea

• Miscellaneous:

  • Fever

Rare Side effects of Esomeprazole (Nexium):

• Cardiovascular:

  • Esophageal Varices

• Gastrointestinal:

  • Barrett Esophagus
  • Duodenitis
  • Mucosal Discoloration
  • Esophageal Stenosis
  • Esophageal Ulcer
  • Esophagitis
  • Gastritis

• Hematologic & Oncologic:

  • Benign Polyp

• Miscellaneous:

  • Benign Nodule

Contraindications to Esomeprazole (Nexium):

 

• Hypersensitivity (eg anaphylaxis and bronchospasms, acute interstitial Nephritis or anaphylactic shock), to esomeprazole or other substituted benzimidazole pron pump inhibitors or any component of formulation

Canadian labeling: Additional contraindications not in US labeling

• Concurrent use with rilpivirine.

OTC labeling

• Use OTC for self-medication and do not consume if you experience difficulty swallowing or pain.
• You can vomit with blood or bloody stool;
• Heartburn that causes dizziness, lightheadedness or sweating.
• Chest pain, shoulder pain, shortness of breath, sweating or pain spreading to arms or neck, or lightheadedness.
• frequent chest pain

Warnings and precautions

• Carcinoma

  • No reports of enterochromaffin-like (ECL) cell carcinoids, dysplasia, or neoplasia have occurred.

• Clostridium difficile-associated diarrhea (CDAD), formerly Clostridium, is now Clostridioides

  • The best PPI therapy for your condition is the one that has the lowest dosage and longest duration.
  • Proton pump inhibitors (PPIs), especially when used in hospitals, may increase the risk for CDAD. Patients with persistent diarrhea should be diagnosed with CDAD if their condition does not improve.

• Cutaneous and systemic Lupus Erythematosus

  • This condition has been described as a new onset of or an exacerbation autoimmune disease. Most cases were cutaneous lupus erythematosus, but subacute CLE was more common.
  • If you notice any signs or symptoms of CLE/SLE, discontinue treatment and consult a specialist. Most patients feel better within 4 to 12 weeks.
  • Systemic lupus is less common and usually occurs in the early to middle ages.

• Fractures

  • Proton pump inhibitor (PPI), therapy may increase the incidence of osteoporosis-related fractures of bones in the hip, spine and wrist.
  • Patients receiving long-term or high-dose therapy for more than a year must be closely monitored.
  • To reduce fracture risk in patients at high risk, you should use the lowest effective dose for the shortest time.

• Polyps of the fundic gland:

  • A diagnosis of polyps can increase the likelihood of small intestinal obstruction.
  • Proton pump inhibitors (PPIs), especially if used for a long time, can increase the risk of fundic polyps.
  • It can occur without any symptoms, but may include nausea, vomiting, and abdominal pain. Ulcerated polyps may also cause GI bleeding, anemia, and/or anemia.
  • The best PPI therapy for your condition is the one that has the lowest dosage and longest duration.

• Gastrointestinal infection (eg, Salmonella, Campylobacter):

  • These infections can be exacerbated by the use of proton pump inhibitors.

• Hypomagnesemia:

  • Rarely reported, often with prolonged PPI usage of 3 or more months (most cases for more than 1 years).
  • It could be symptomatic, or not. Severe cases can cause seizures, tetany, or cardiac arrhythmias.
  • It is important to obtain serum magnesium levels before you begin long-term treatment, particularly if you are taking digoxin, diuretics or any other drugs that can cause hypomagnesemia. Also, it is important to check your blood regularly thereafter.
  • Magnesium supplementation may be used to correct hypomagnesemia. However, discontinuation of esomeprazole may prove necessary. Magnesium levels usually return to normal within a week.

• Interstitial nephritis:

  • If acute interstitial Nephritis occurs, discontinue use.
  • Patients taking PPIs have been known to experience acute interstitial nephritis. This can occur at any stage of therapy and is usually due to an idiopathic hypersensitivity reaction.

• Vitamin B deficiency:

  • Vitamin B malabsorption may occur if prolonged treatment is continued for more than two years.
  • The severity of the deficiency depends on the dose. It is more common in women than in men, and it is more prevalent in those who are younger than 30 years.

• Gastric cancer:

  • Gastric malignancy can still be present despite symptoms being relieved.

• Hepatic impairment

  • Patients suffering from severe hepatic impairment might need to reduce their dosage.

• Renal impairment

  • In renal impairment, the pharmacokinetics for esomeprazole are not expected to change.
  • For any degree of renal impairment, dosage adjustments are not required for esomeprazole potassium or magnesium.
  • The pharmacokinetics and safety of strontium in mild to moderate renal impairment may be affected.
  • However, it is not recommended that esomeprazole strontium be used in severe impairment. This has not been tested.

Esomeprazole: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy)
Amphetamine	Proton Pump Inhibitors may increase the absorption of Amphetamine.
Bisphosphonate Derivatives	Proton Pump Inhibitors may diminish the therapeutic effect of Bisphosphonate Derivatives.
Capecitabine	Proton Pump Inhibitors may diminish the therapeutic effect of Capecitabine.
Cefpodoxime	Proton Pump Inhibitors may decrease the serum concentration of Cefpodoxime.
Citalopram	Esomeprazole may increase the serum concentration of Citalopram.
CYP2C19 Inducers (Moderate)	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers).
Cysteamine (Systemic)	Proton Pump Inhibitors may diminish the therapeutic effect of Cysteamine (Systemic).
Dexmethylphenidate	Proton Pump Inhibitors may increase the absorption of Dexmethylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption.
Dextroamphetamine	Proton Pump Inhibitors may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing.
Doxycycline	Proton Pump Inhibitors may decrease the bioavailability of Doxycycline.
Fluconazole	May increase the serum concentration of Proton Pump Inhibitors.
Indinavir	Proton Pump Inhibitors may decrease the serum concentration of Indinavir.
Iron Salts	Proton Pump Inhibitors may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose.
Lumacaftor	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers).
Methotrexate	Proton Pump Inhibitors may increase the serum concentration of Methotrexate.
Methylphenidate	Proton Pump Inhibitors may increase the absorption of Methylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Proton Pump Inhibitors may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased.
Mycophenolate	Proton Pump Inhibitors may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced.
Raltegravir	Proton Pump Inhibitors may increase the serum concentration of Raltegravir.
Riociguat	Proton Pump Inhibitors may decrease the serum concentration of Riociguat.
Saquinavir	Proton Pump Inhibitors may increase the serum concentration of Saquinavir.
SORAfenib	Proton Pump Inhibitors may decrease the absorption of SORAfenib.
Tipranavir	May decrease the serum concentration of Proton Pump Inhibitors. These data are derived from studies with Ritonavir-boosted Tipranavir.
Vitamin K Antagonists (eg, warfarin)	Esomeprazole may increase the serum concentration of Vitamin K Antagonists.
Voriconazole	May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may increase the serum concentration of Voriconazole. Management: In patients receiving omeprazole 40 mg/day or greater, reduce omeprazole dose by half when initiating voriconazole.
Risk Factor D (Consider therapy modification)
Atazanavir	Proton Pump Inhibitors may decrease the serum concentration of Atazanavir. Management: See full drug interaction monograph for details.
Bosutinib	Proton Pump Inhibitors may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors, such as antacids or H2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib.
Cefditoren	Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs). Consider alternative methods to minimize/control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of PPIs can not be avoided.
Cilostazol	CYP2C19 Inhibitors may increase the serum concentration of Cilostazol. Management: Consider reducing the cilostazol dose to 50 mg twice daily in patients who are also receiving inhibitors of CYP2C19.
Clopidogrel	Esomeprazole may diminish the antiplatelet effect of Clopidogrel. Esomeprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Clopidogrel prescribing information recommends avoiding concurrent use with esomeprazole. Rabeprazole or pantoprazole may be lower-risk alternatives to esomeprazole.
CYP2C19 Inducers (Strong)	May increase the metabolism of CYP2C19 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Dabrafenib	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C19 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Enzalutamide	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C19. Management: Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C19 substrate should be performed with caution and close monitoring.
Gefitinib	Proton Pump Inhibitors may decrease the serum concentration of Gefitinib. Management: Avoid use of proton pump inhibitors (PPIs) with gefitinib when possible. If required, administer gefitinib 12 hours after administration of the PPI or 12 hours before the next dose of the PPI.
Itraconazole	Proton Pump Inhibitors may increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any proton pump inhibitors (PPIs). Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction.
Ketoconazole (Systemic)	Proton Pump Inhibitors may decrease the serum concentration of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Proton Pump Inhibitors.
Ledipasvir	Proton Pump Inhibitors may decrease the serum concentration of Ledipasvir. Management: PPI doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Administration with higher doses of PPIs, 2 hours after a PPI, or in combination with food and PPIs may reduce ledipasvir bioavailability.
Mesalamine	Proton Pump Inhibitors may diminish the therapeutic effect of Mesalamine. Proton pump inhibitor-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose proton pump inhibitors (PPIs) with sustainedrelease mesalamine products.
Nilotinib	Proton Pump Inhibitors may decrease the serum concentration of Nilotinib. Management: Avoid this combination when possible since separation of doses is not likely to be an adequate method of minimizing the interaction.
Posaconazole	Proton Pump Inhibitors may decrease the serum concentration of Posaconazole.
Secretin	Proton Pump Inhibitors may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details.
Tacrolimus (Systemic)	Proton Pump Inhibitors may increase the serum concentration of Tacrolimus (Systemic). Management: Tacrolimus dose adjustment may be required. Rabeprazole, pantoprazole, or selected H2-receptor antagonists (i.e., ranitidine or famotidine) may be less likely to interact. Genetic testing may predict patients at highest risk.
Risk Factor X (Avoid combination)
Acalabrutinib	Proton Pump Inhibitors may decrease the serum concentration of Acalabrutinib.
Cefuroxime	Proton Pump Inhibitors may decrease the absorption of Cefuroxime.
Dacomitinib	Proton Pump Inhibitors may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with proton pump inhibitors. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA.
Dasatinib	Proton Pump Inhibitors may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of the proton pump inhibitor if some acid-reducing therapy is needed.
Delavirdine	Proton Pump Inhibitors may decrease the serum concentration of Delavirdine. Management: Chronic therapy with proton pump inhibitors (PPIs) should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI therapy with delavirdine is uncertain, but such therapy should be undertaken with caution.
Erlotinib	Proton Pump Inhibitors may decrease the serum concentration of Erlotinib.
Nelfinavir	Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Proton Pump Inhibitors may decrease the serum concentration of Nelfinavir.
Neratinib	Proton Pump Inhibitors may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption.
PAZOPanib	Proton Pump Inhibitors may decrease the serum concentration of PAZOPanib.
RifAMPin	May decrease the serum concentration of Esomeprazole.
Rilpivirine	Proton Pump Inhibitors may decrease the serum concentration of Rilpivirine.
Risedronate	Proton Pump Inhibitors may diminish the therapeutic effect of Risedronate. Proton Pump Inhibitors may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate.
St John's Wort	May decrease the serum concentration of Esomeprazole.
Velpatasvir	Proton Pump Inhibitors may decrease the serum concentration of Velpatasvir.

Monitoring parameters:

• Susceptibility testing  recommended in patients who fail H. pylori eradication regimen.
• Monitor for rebleeding in patients with peptic ulcer bleed.
• For patients expected to be on prolonged therapy or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (eg, diuretics), consider monitoring magnesium levels prior to initiation of treatment and periodically thereafter.

How to administer Esomeprazole (Nexium)?

Oral Esomeprazole, (Nexium),:

• Capsule:
  • Take the whole thing in your mouth and wait at least one hour before you eat. It is best to take it before breakfast.
  • You can open the capsule and mix 1 tablespoon of applesauce with it.
  • Take the mixture immediately and swallow it.
  • Granules might be more suitable for patients who have difficulty swallowing.
• Granules:
  • Mix the 2.5 mg and 5 mg packets in a container with 5mL water. The 10 mg, 20mg, and 40 mg packets can be put into a container with 15mL water. Stir the mixture for 2 to 3 minutes.
  • Mix and drink within 30 minutes.
  • Drink more water if any medicine is left after drinking.
• Tablet
  • Take it whole, don't chew or crush.
  • Take a glass of water with you before you start your morning.
• Tablet [Canadian Product]:
  • Drink the whole thing with water, or perhaps a half-a-glass of noncarbonated water.
  • Mix until the tablets are broken down. You can then drink the liquid with pellets right away or within 30 minutes.
  • Avoid crushing or chewing pellets.
  • Drink after you have finished drinking. Rinse the glass with water.

IV Esomeprazole, (Nexium).

• Before and after administration of LR, D5W, or NS, flush the line.
• Treatment for GERD
  • You can administer injections (>=3 min) or infusions intermittently (10–30 minutes).
• Endoscopy can prevent recurrent bleeding from the gastric and duodenal stomach.
  • Infuse the loading dose for 30 minutes. Then, continue the continuous infusion at 8 mg/hour for 71.5 hours. (Adjust the rate of continuous injection in patients with hepatic impairment).

Nasogastric tube

• Capsule
  • Place intact granules in a 60mL catheter-tip Syringe. Mix with 50mL water.
  • Turn the plunger upside down and shake vigorously for fifteen seconds.
  • Make sure that there are no granules in the tip of your syringe.
  • Do not give pellets that dissolve or are disintegrated.
  • Apply immediately following preparation. After administering, flush the tube with extra water.
• Granules
  • You can also give delayed-release oral suspensiongranules by gastric tube or nasogastric.
  • Use a packet containing 2.5 mg or 5 mg. First, add 5 mL water to a catheter-tipped needle, then add the packet's granules.
  • Use a packet containing 10 mg, 20mg, or 40mg. First, add 15 mL water to a catheter-tipped needle, and then add the granules from your packet.
  • Give the syringe a shake and allow it to thicken for 2 to 3 minutes.
  • In 30 minutes, shake the syringe before using it to administer the medication through a nasogastric tube or gastric tube (6 French or greater).
  • Fill the syringe again with equal amounts (5 mL or 15, mL) water. Shake and flush the tube.
• Tablet [Canadian Product]:
  • You can also give dispersed tablets by nasogastric tubes (sizes 8 to 20 French), using a disposable 25 to 60 mL syringe.
  • Use 50 mL water to disperse the tablet.
  • To flush the tube and syringe after administration, add 25-50 mL more water.
  • The dispersion volume can be reduced to 25 milliliters in larger nasogastric feeding tube sizes (e.g. size 14 French or higher).

Mechanism of action of Esomeprazole (Nexium):

A proton pump inhibitor reduces gastric acid secretion through inhibition of H+/K+-ATPase within the gastric parietal cells. Esomeprazole is the S-isomer of omeprazole.

Protein binding:

• 97 Percent

Metabolism:

• Hepatic via CYP2C19 primarily and (to a lesser extent) via 3A4 to hydroxy, desmethyl, and sulfone metabolites (all inactive)

Bioavailability: Oral:

• 64 after a single dose; 90 percent with repeat dosing

Half-life elimination:

• Infants:
  • 0.93 hours
• Children 1 to 5 years:
  • 0.42 to 0.74 hours
• Children 6 to 11 years:
  • 0.73 to 0.88 hours
• Children ≥12 years and Adolescents ≤17 years:
  • 0.82 to 1.22 hours
• Adults:
  • ~1 to 1.5 hours

Time to peak: Oral:

• Infants: Median:
  • 3 hours
• Children 1 to 5 years:
  • 1.33 to 1.44 hours
• Children 6 to 11 years:
  • 1.75 to 1.79 hours
• Children ≥12 years and Adolescents ≤17 years:
  • 1.96 to 2.04 hours
• Adults:
  • 1.5 to 2 hours

Excretion:

• Urine (80 percent , primarily as inactive metabolites; <1 percent as active drug);
• feces (20 percent )
• Clearance (with repeated dosing):
  • Children 1 to 5 years: 6 to 19.44 L/hour
  • Children 6 to 11 years: 7.84 to 9.22 L/hour
  • Children ≥12 years and Adolescents ≤17 years: 8.36 to 15.88 L/hour

International Brand Names of Esomeprazole:

• NexIUM
• PMS-Esomeprazole DR
• RAN-Esomeprazole
• SANDOZ Esomeprazole
• Aesopra
• Almiprazole
• Alton
• Axiago
• Carbum
• Ceso
• Emanera
• Emazole
• Emep
• Emess
• Emozul
• Empel
• Escadra
• Esmopump
• Esofag
• Esofax
• Esoflux
• Exozole
• Exzium
• Haxium
• Ignis
• Inexium
• Jubium-20
• Jubium-40
• Lanxium
• Maxima
• Nedox
• Neksium
• Nemeol
• Neopral
• Nepramel
• Nexazol
• Nexazole
• Nexiam
• Esoget DRT
• Esola
• Esomax
• Esomep
• Esonexa
• Esopra
• Esorest
• Esoroxen
• Esotec
• Esoxium
• Esoz-20
• Esoz-40
• Esozid
• Esural
• Exmezol
• Exocid
• Neximash
• Nexipra
• Nexird
• Nexium
• Nexium IV
• NexiumMUPS
• Nexmezol
• Nexpa
• Nexpro
• Ulcium
• Xsom
• Zoleric
• Zutura
• Nexpro-20
• Nexpro-40
• Nexum
• Pamezone
• Peprazom
• Prazia
• Proxium
• Raciper
• S-Omipin
• Solezol
• Sompraz
• Sompraz IV
• Stadnex

Esomeprazole Brand Names in Pakistan:

Esomeprazole Injection 20 Mg in Pakistan
Es-Loprot	Nabiqasim Industries (Pvt) Ltd.
Pep-Ease	Safe Pharmaceutical (Pvt) Ltd.

 

Esomeprazole Injection 40 Mg in Pakistan
Es-Loprot	Nabiqasim Industries (Pvt) Ltd.
Eso Mine	English Pharmaceuticals Industries
Esoborn	Wellborne Pharmachem And Biologicals
Esopep	Global Pharmaceuticals
Esoproto	Wilshire Laboratories (Pvt) Ltd.
Esowel	Welwrd Pharmaceuticals
Essofass	Fassgen Pharmaceuticals
Meprium-L	Friends Pharma (Pvt) Ltd
Pep-Ease	Safe Pharmaceutical (Pvt) Ltd.
Purpal	Dyson Research Laboratories
Somezol	Bosch Pharmaceuticals (Pvt) Ltd.

 

Esomeprazole Injection 40 Mg (IV) in Pakistan
Esso-40	Shaigan Pharmaceuticals (Pvt) Ltd

 

Esomeprazole Infusion 40 Mg in Pakistan
Esold	Pharma Edge
Koncept	Mcolson Research Laboratories
Nexum	Getz Pharma Pakistan (Pvt) Ltd.
Novoteph	Sami Pharmaceuticals (Pvt) Ltd.
X-Prazole	Mediate Pharmaceuticals (Pvt) Ltd

 

Esomeprazole Tablets 5 Mg in Pakistan
Zopril	Valor Pharmaceuticals

 

Esomeprazole Tablets 10 Mg in Pakistan
Zopril	Valor Pharmaceuticals

 

Esomeprazole Tablets 20 Mg in Pakistan
Arlec	Fassgen Pharmaceuticals
Artek	Noa Hemis Pharmaceuticals
Caramep	Caraway Pharmaceuticals
Digesso	Alfalah Pharma (Pvt) Ltd.
Epim	Alliance Pharmaceuticals (Pvt) Ltd.
Esmazole	Global Pharmaceuticals
Esocare	Navegal Laboratories
Esogip	Glitz Pharma
Esolone	Neophar Health-Care
Esopra	Acme Laboratories Pakistan (Pvt) Ltd.
Esoproto	Wilshire Laboratories (Pvt) Ltd.
Esorant	Amarant Pharmaceuticals (Pvt)
Esozil	Shrooq Pharmaceuticals
Eszole Tablet	Miracle Pharmaceuticals(Pvt) Ltd
Exzium	Medisure Laboratories Pakistan (Pvt.) Ltd.
Ezipep	Batala Pharmaceuticals.
Ezo	Bio Labs (Pvt) Ltd.
Eztomac	Kobec Pharmacals
Fasteso	Pharmevo (Pvt) Ltd.
Gutsy	Pulse Pharmaceuticals
Intezole	Pharmethics
Legrace	Ambrosia Pharmaceuticals
Medirium	Medicraft Pharmaceuticals (Pvt) Ltd.
Ottozole-T	Ottoman Pharma
Pepnor	Shaheen Agencies
Pepso	Astarl Pvt Ltd.
Protohib	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Protonic	Pharmark (Pvt) Ltd
Qupra	Unimark Pharmaceuticals
Relaxul	Maple Pharmaceuticals (Pvt) Ltd
S Om	Rogen Pharmaceuticals
S-Om	Valor Pharmaceuticals
S-Prazole	Crest Pharmaceuticals
Saphire	Neutro Pharma (Pvt) Ltd.
Solaze	Meditech Pharmaceuticals
Somicid	Goodman International,
Sompraz	Semos Pharmaceuticals (Pvt) Ltd.
Somrit	Semos Pharmaceuticals (Pvt) Ltd.
Stomwell	Weather Folds Pharmaceuticals
X-Prazole	Mediate Pharmaceuticals (Pvt) Ltd

 

Esomeprazole Tablets 40 Mg in Pakistan
Arlec	Fassgen Pharmaceuticals
Artek	Noa Hemis Pharmaceuticals
Caramep	Caraway Pharmaceuticals
Digesso	Alfalah Pharma (Pvt) Ltd.
Eesofac	Healers Laboratories
Epim	Alliance Pharmaceuticals (Pvt) Ltd.
Esmazole	Global Pharmaceuticals
Esogip	Glitz Pharma
Esolone	Neophar Health-Care
Esopra	Acme Laboratories Pakistan (Pvt) Ltd.
Esoproto	Wilshire Laboratories (Pvt) Ltd.
Esorant	Amarant Pharmaceuticals (Pvt)
Esot	Aries Pharmaceuticals (Pvt) Ltd
Esozil	Shrooq Pharmaceuticals
Eszole Tablet	Miracle Pharmaceuticals(Pvt) Ltd
Evereso	Everest Pharmaceuticals
Exzium	Medisure Laboratories Pakistan (Pvt.) Ltd.
Ezipep	Batala Pharmaceuticals.
Ezo	Bio Labs (Pvt) Ltd.
Eztomac	Kobec Pharmacals
Fasteso	Pharmevo (Pvt) Ltd.
Gastizol	Qintar Pharmacuticals
Gutsy	Pulse Pharmaceuticals
Legrace	Ambrosia Pharmaceuticals
Linso	Linear Pharma
Medirium	Medicraft Pharmaceuticals (Pvt) Ltd.
Navix	Wns Field Pharmaceuticals
Opa	Caylex Pharmaceuticals (Pvt) Ltd.
Ottozole-T	Ottoman Pharma
Pepnor	Shaheen Agencies
Protohib	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Qupra	Unimark Pharmaceuticals
Relaxul	Maple Pharmaceuticals (Pvt) Ltd
S Om	Rogen Pharmaceuticals
S-Mepra	Nimrall Laboratories
S-Om	Valor Pharmaceuticals
S-Prazole	Crest Pharmaceuticals
Saphire	Neutro Pharma (Pvt) Ltd.
Sogo	Pulse Pharmaceuticals
Somicid	Goodman International,
Sompraz	Semos Pharmaceuticals (Pvt) Ltd.
Somrit	Semos Pharmaceuticals (Pvt) Ltd.
Stomwell	Weather Folds Pharmaceuticals
Unizole	Unison Chemical Works
X-Prazole	Mediate Pharmaceuticals (Pvt) Ltd

 

Esomeprazole Capsules 10 Mg in Pakistan
Esofil	Saffron Pharmaceutical Company

 

Esomeprazole Capsules 20 Mg in Pakistan
Acifre	Noa Hemis Pharmaceuticals
Aciloc	Medipak Limited
Acireg	Barrett Hodgson Pakistan (Pvt) Ltd.
Actif	Webros Pharmaceuticals
Ames	Lexicon Pharmaceuticals (Pvt) Ltd.
Arysa	Helix Pharma (Private) Limited
Awa-Block	Usawa Pharmaceuticals
Axesom	Highnoon Laboratories Ltd.
Axid Neo	Agp (Private) Ltd.
Benprol	Benson Pharamceuticals.
Bioprazole	Biorex Pharmaceuticals
C-Eso	Crown Pharmaceuticals
E Cap	Brookes Pharmaceutical Laboratories (Pak.) Ltd.
E Zole	Bio Labs (Pvt) Ltd.
E-Mepra	Akson Pharmaceuticals (Pvt) Ltd.
E-Prazole	Fynk Pharmaceuticals
E-Z	English Pharmaceuticals Industries
Ecorox	Atco Laboratories Limited
Efrozole	Efroze Chemical Industries (Pvt) Ltd.
Eger	Glitz Pharma
Eleph	Evergreen Pharmaceuticals Pvt Limited
Emage	Envoy Pharma
Emess	Amarant Pharmaceuticals (Pvt)
Empel	Well & Well Pharma (Pvt) Ltd
Emprazole	Umersons
Epi-20	Paramount Pharmaceuticals
Eprazid	Derma Techno Pakistan
Eprazin	Medisave Pharmaceuticals
Es-Amazole	Medera Pharmaceuticals (Pvt) Ltd.
Es-Amazole	Medera Pharmaceuticals (Pvt) Ltd.
Es-Cay	Caylex Pharmaceuticals (Pvt) Ltd.
Es-Loprot	Nabiqasim Industries (Pvt) Ltd.
Es-P	Leads Pharma (Pvt) Ltd
Esante	Macter International (Pvt) Ltd.
Esaprol	Bloom Pharmaceuticals (Pvt) Ltd.
Esasia	Medera Pharmaceuticals (Pvt) Ltd.
Esgerd	Biogenics Pakistan (Pvt) Ltd.
Esho	Prays Pharmaceuticals
Esiam	Siam Pharmaceuticals
Esim	Genome Pharmaceuticals (Pvt) Ltd
Esim	Genome Pharmaceuticals (Pvt) Ltd
Esma	Eros Pharmaceuticals
Esmep	Amarant Pharmaceuticals (Pvt)
Esmitec	Pfizer Laboratories Ltd.
Esmolec	Medimarkers Pharmaceuticals
Eso-One	Medicon Pharmaceuticals Industries (Pvt) Ltd
Esoborn	Wellborne Pharmachem And Biologicals
Esocap	Innvotek Pharmaceuticals
Esocool	Sante (Pvt) Limited
Esocue	Novartis Pharma (Pak) Ltd
Esodin	Danas Pharmaceuticals (Pvt) Ltd
Esofag	Life Pharmaceutical Company
Esofast	Candid Pharmaceuticals
Esofil	Saffron Pharmaceutical Company
Esofine	Medifine Laboratories
Esogent	Regent Laboratories Ltd.
Esoglit	Glitz Pharma
Esogood	Goodman Laboratories
Esole	Basel Pharmaceuticals
Esolive	Olive Pharmaceuticals
Esomalt	Shrooq Pharmaceuticals
Esomap	Maple Pharmaceuticals (Pvt) Ltd
Esomax	Martin Dow Pharmaceuticals (Pak) Ltd.
Esomega	Rehmat Pharma
Esomep	Accurate Medical Suppliers
Esomepral	Amson Vaccines & Pharma (Pvt) Ltd.
Esomeprin	Swan Pharmaceuticals(Pvt) Ltd
Esonen	Nenza Pharmaceuticals (Pvt) Limited
Esonil	Lotus Pharmaceuticals (Pvt) Ltd
Esonorm	Csh Pharmaceuticals-North (Pvt) Ltd
Esopase	Cirin Pharmaceuticals (Pvt) Ltd.
Esopep	Global Pharmaceuticals
Esophag	Bryon Pharmaceuticals (Pvt) Ltd.
Esoprazol	Werrick Pharmaceuticals
Esoprime	Pearl Pharmaceuticals
Esor	Rock Pharmaceuticals
Esorid	Hilton Pharma (Pvt) Limited
Esorok	Rakaposhi Pharmaceutical (Pvt) Ltd.
Esorol	Genome Pharmaceuticals (Pvt) Ltd
Esoscot	Scotmann Pharmaceuticals
Esosive	Max Pharmaceuticals
Esotone	Advanced Pharmaceuticals
Esox	Aries Pharmaceuticals (Pvt) Ltd
Esoyan	Roryan Pharmaceutical Industries (Pvt) Ltd
Esozole	Navegal Laboratories
Esozole	Nexus Pharma (Pvt) Ltd
Espra	Consolidated Chemical Laboratories (Pvt) Ltd.
Espraz	Himont Pharmaceuticals (Pvt) Ltd.
Esprazole	Everest Pharmaceuticals
Esprazole	Everest Pharmaceuticals
Esprazole	Everest Pharmaceuticals
Esprol	Surge Laboratories (Pvt) Ltd.
Esro	Focus & Rulz Pharmaceuticals
Esso-20	Shaigan Pharmaceuticals (Pvt) Ltd
Essocam	Chas. A. Mendoza
Essom	Phar-Man Laboratories
Estro	Alina Combine Pharmaceuticals (Pvt) Ltd.
Esvin	Merck Private Ltd.
Eupazole	Raazee Theraputics (Pvt) Ltd.
Ezium	Searle Pakistan (Pvt.) Ltd.
Ezma	Medicure Laboratories
Ezomol	Pharmatec Pakistan (Pvt) Ltd.
Ezumac	Siza International (Pvt) Ltd.
Ezzo	Nimrall Laboratories
F-Eso	Farm Aid Group Pak Ltd.
Gastrolux	Rotex Medica Pakistan (Pvt) Ltd
Gastromeprazole	Tg Pharma
Gastrozole	Hansel Pharmacueutical Pvt (Ltd)
Genzole	Genera Pharmaceuticals
Gerdpill	Platinum Pharmaceuticals (Pvt.) Ltd.
Gocid	Wilsons Pharmaceuticals
Gudu 20	Evergreen Pharmaceuticals Pvt Limited
Huleric	Linear Pharma
Indazole	Indus Pharma (Pvt) Ltd.
Jits	Unimark Pharmaceuticals
Koncept	Mcolson Research Laboratories
Lomac	Hiranis Pharmaceuticals Pvt Ltd
Maxpro	Eg Pharmaceuticals
Meldere	Sanofi Aventis (Pakistan) Ltd.
Meprex	Aptcure Private Limited
Napzol	Lowitt Pharmaceuticals (Pvt) Ltd
Neso	Medisure Laboratories Pakistan (Pvt.) Ltd.
Nexaprazole	Navegal Laboratories
Nexprazole	Obs
Nexpro	Healers Laboratories
Nexum	Getz Pharma Pakistan (Pvt) Ltd.
Novoteph	Sami Pharmaceuticals (Pvt) Ltd.
Nyloz	Zephyr Pharmatec (Pvt) Ltd.
Obpra	Obsons Pharmaceuticals
Omeplus	Standpharm Pakistan (Pvt) Ltd.
Ottozole	Ottoman Pharma
Oxilant	Valor Pharmaceuticals
Parazole	Karachi Chemical Industries
Pep-Eez	Karachi Chemical Industries
Pesso	Drug Pharm (Pvt) Ltd.
Prabest	Beste Pharma (Pvt) Ltd.
Procap	Medicineco Pharmaceuticals
Protx	Allmed Labs
Purpal	Dyson Research Laboratories
Raynex	Ray Pharma (Pvt) Ltd
Rayprazole	Ray Pharma (Pvt) Ltd
Regulax	Novartis Pharma (Pak) Ltd
Rexium	Libra Pharmaceuticals (Pvt) Ltd
Rocid-E	Rogen Pharmaceuticals
Romezole	Medisynth Pharmaceuticals
S-Zole	Nova Med Pharmaceuticals
Saf-Eso	Saaaf Pharmaceuticals
Shaez	Shawan Pharmaceuticals
Simeso	Simz Pharmaceuticals
Somelinz	Linz Pharmaceuticals (Pvt) Ltd.
Somepra	Xenon Pharmaceuticals (Pvt) Ltd.
Somezol	Bosch Pharmaceuticals (Pvt) Ltd.
Sozo	Reliance Pharma
T-Xium	Tagma Pharma (Pvt) Ltd.
Trutil	Pharmix Laboratories (Private) Limited.
Ul-Some	Saydon Pharmaceutical Industries (Pvt) Ltd.
Ulcicare	Jawa Pharmaceuticals(Pvt) Ltd.
Ultech	Wise Pharmaceuticals (Pvt) Ltd
Util	Ambrosia Pharmaceuticals
Vogue	Caraway Pharmaceuticals
Wesoprazol	Warafana Pharmaceuticals
X-Prazole	Mediate Pharmaceuticals (Pvt) Ltd
Xocrel	Z-Jans Pharmaceutical (Pvt) Ltd.
Zexum	Schazoo Zaka
Zimes	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Zoleric	Genix Pharma (Pvt) Ltd
Zoliss	Welwrd Pharmaceuticals
Zoom	Scilife Pharma (Private) Ltd
Zumin	Semos Pharmaceuticals (Pvt) Ltd.

 

Esomeprazole Capsules 40 Mg in Pakistan
Acifre D	Noa Hemis Pharmaceuticals
Aciloc	Medipak Limited
Acireg	Barrett Hodgson Pakistan (Pvt) Ltd.
Actif	Webros Pharmaceuticals
Ames	Lexicon Pharmaceuticals (Pvt) Ltd.
Arysa	Helix Pharma (Private) Limited
Avinza	Mass Pharma (Private) Limited
Awa-Block	Usawa Pharmaceuticals
Axesom	Highnoon Laboratories Ltd.
Axid Neo	Agp (Private) Ltd.
Benprol	Benson Pharamceuticals.
Bioprazole	Biorex Pharmaceuticals
C-Eso	Crown Pharmaceuticals
Contour	S.J. & G. Fazul Ellahie (Pvt) Ltd.
E Cap	Brookes Pharmaceutical Laboratories (Pak.) Ltd.
E Zole	Bio Labs (Pvt) Ltd.
E-Mepra	Akson Pharmaceuticals (Pvt) Ltd.
E-Prazole	Fynk Pharmaceuticals
E-Z	English Pharmaceuticals Industries
Ecorox	Atco Laboratories Limited
Efrozole	Efroze Chemical Industries (Pvt) Ltd.
Eger	Glitz Pharma
Eleph	Evergreen Pharmaceuticals Pvt Limited
Emage	Envoy Pharma
Emess	Amarant Pharmaceuticals (Pvt)
Empel	Well & Well Pharma (Pvt) Ltd
Epi-40	Paramount Pharmaceuticals
Eprazin	Medisave Pharmaceuticals
Es-Amazole	Medera Pharmaceuticals (Pvt) Ltd.
Es-Amazole	Medera Pharmaceuticals (Pvt) Ltd.
Es-Basole	Basel Pharmaceuticals
Es-Cay	Caylex Pharmaceuticals (Pvt) Ltd.
Es-Loprot	Nabiqasim Industries (Pvt) Ltd.
Es-Myzole	Karachi Pharmaceutical Laboratory
Es-P	Leads Pharma (Pvt) Ltd
Esante	Macter International (Pvt) Ltd.
Esasia	Medera Pharmaceuticals (Pvt) Ltd.
Esgerd	Biogenics Pakistan (Pvt) Ltd.
Esho	Prays Pharmaceuticals
Esiam	Siam Pharmaceuticals
Esim	Genome Pharmaceuticals (Pvt) Ltd
Esim	Genome Pharmaceuticals (Pvt) Ltd
Eskem	High - Q International
Esma	Eros Pharmaceuticals
Esmed	Medicaids Pakistan (Pvt) Ltd.
Esmep	Amarant Pharmaceuticals (Pvt)
Esmitec	Pfizer Laboratories Ltd.
Esmolec	Medimarkers Pharmaceuticals
Eso-One Plus	Medicon Pharmaceuticals Industries (Pvt) Ltd
Esoborn	Wellborne Pharmachem And Biologicals
Esobrain	Winbrain Research Laboratories
Esocap	Innvotek Pharmaceuticals
Esocare	Navegal Laboratories
Esocool	Sante (Pvt) Limited
Esocue	Novartis Pharma (Pak) Ltd
Esodin	Danas Pharmaceuticals (Pvt) Ltd
Esofag	Life Pharmaceutical Company
Esofast	Candid Pharmaceuticals
Esofine	Medifine Laboratories
Esogent	Regent Laboratories Ltd.
Esogood	Goodman Laboratories
Esold	Pharma Edge
Esolive	Olive Pharmaceuticals
Esomalt	Shrooq Pharmaceuticals
Esomap	Maple Pharmaceuticals (Pvt) Ltd
Esomax	Martin Dow Pharmaceuticals (Pak) Ltd.
Esomega	Rehmat Pharma
Esomep	Accurate Medical Suppliers
Esomepral	Amson Vaccines & Pharma (Pvt) Ltd.
Esomeprin	Swan Pharmaceuticals(Pvt) Ltd
Esonen	Nenza Pharmaceuticals (Pvt) Limited
Esonil	Lotus Pharmaceuticals (Pvt) Ltd
Esonorm	Csh Pharmaceuticals-North (Pvt) Ltd
Esopase	Cirin Pharmaceuticals (Pvt) Ltd.
Esopep	Global Pharmaceuticals
Esophag	Bryon Pharmaceuticals (Pvt) Ltd.
Esopral	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Esoprazol	Werrick Pharmaceuticals
Esoprime	Pearl Pharmaceuticals
Esopulse	Pulse Pharmaceuticals
Esor	Rock Pharmaceuticals
Esorid	Hilton Pharma (Pvt) Limited
Esorok	Rakaposhi Pharmaceutical (Pvt) Ltd.
Esorol	Genome Pharmaceuticals (Pvt) Ltd
Esoscot	Scotmann Pharmaceuticals
Esosive	Max Pharmaceuticals
Esotone	Advanced Pharmaceuticals
Esox	Aries Pharmaceuticals (Pvt) Ltd
Esoyan	Roryan Pharmaceutical Industries (Pvt) Ltd
Esozeb	Zeb Laboratories
Esozef	Florence Farmaceuticals (Pvt) Ltd
Esozole	Navegal Laboratories
Esozole	Nexus Pharma (Pvt) Ltd
Espra	Consolidated Chemical Laboratories (Pvt) Ltd.
Esprazole	Everest Pharmaceuticals
Esprazole	Everest Pharmaceuticals
Esprazole	Everest Pharmaceuticals
Esprol	Surge Laboratories (Pvt) Ltd.
Esro	Focus & Rulz Pharmaceuticals
Esso-40	Shaigan Pharmaceuticals (Pvt) Ltd
Essocam	Chas. A. Mendoza
Essom	Phar-Man Laboratories
Estone	Advanced Pharmaceuticals
Estro	Alina Combine Pharmaceuticals (Pvt) Ltd.
Esvin	Merck Private Ltd.
Eszole Capsule	Convell Laboratories
Eupazole	Raazee Theraputics (Pvt) Ltd.
Ezium	Searle Pakistan (Pvt.) Ltd.
Ezma	Medicure Laboratories
Ezomol	Pharmatec Pakistan (Pvt) Ltd.
Ezumac	Siza International (Pvt) Ltd.
Ezzo	Nimrall Laboratories
F-Eso	Farm Aid Group Pak Ltd.
Gastrolux	Rotex Medica Pakistan (Pvt) Ltd
Gastrozole	Hansel Pharmacueutical Pvt (Ltd)
Genzole	Genera Pharmaceuticals
Gerdpill	Platinum Pharmaceuticals (Pvt.) Ltd.
Gocid	Wilsons Pharmaceuticals
H2	Imco Pharmaceuticals Laboratories
Healso	Heal Pharmaceuticals Pvt Ltd
Huleric	Linear Pharma
Indazole	Indus Pharma (Pvt) Ltd.
Jits	Unimark Pharmaceuticals
Koncept	Mcolson Research Laboratories
Lesomep	Lawari International
Lomac	Hiranis Pharmaceuticals Pvt Ltd
Maxpro	Eg Pharmaceuticals
Meldere	Sanofi Aventis (Pakistan) Ltd.
Mepraz	Spl Pharmaceuticals (Pvt) Ltd
Meprex	Aptcure Private Limited
Meprium	Friends Pharma (Pvt) Ltd
Meprium	Friends Pharma (Pvt) Ltd
Napzol	Lowitt Pharmaceuticals (Pvt) Ltd
Neso	Medisure Laboratories Pakistan (Pvt.) Ltd.
Nexaprazole	Navegal Laboratories
Nexom	Ferroza International Pharmaceuticals (Pvt) Ltd.
Nexprazole	Obs
Nexpro	Healers Laboratories
Nexum	Getz Pharma Pakistan (Pvt) Ltd.
Novoteph	Sami Pharmaceuticals (Pvt) Ltd.
Nyloz	Zephyr Pharmatec (Pvt) Ltd.
Obpra	Obsons Pharmaceuticals
Omegast	Tg Pharma
Omeplus	Standpharm Pakistan (Pvt) Ltd.
Ottozole	Ottoman Pharma
Oxilant	Valor Pharmaceuticals
Prabest	Beste Pharma (Pvt) Ltd.
Procap	Medicineco Pharmaceuticals
Protx	Allmed Labs
Purpal	Dyson Research Laboratories
Raynex	Ray Pharma (Pvt) Ltd
Rayprazole	Ray Pharma (Pvt) Ltd
Reciper	Arsons Pharmaceuticals Industries (Pvt) Ltd
Regulax	Novartis Pharma (Pak) Ltd
Rexium	Libra Pharmaceuticals (Pvt) Ltd
Romezole	Medisynth Pharmaceuticals
S-Mark	Welmark Pharmaceuticals
S-Zole	Nova Med Pharmaceuticals
Sabizole	Crest Pharmaceuticals
Saf-Eso	Saaaf Pharmaceuticals
Shaez	Shawan Pharmaceuticals
Simeso	Simz Pharmaceuticals
Somelinz	Linz Pharmaceuticals (Pvt) Ltd.
Somepra	Xenon Pharmaceuticals (Pvt) Ltd.
Somezol	Bosch Pharmaceuticals (Pvt) Ltd.
Sompra	Macquins International
Sozo	Reliance Pharma
Syzazole	Sayyed Pharmaceuticals
T-Xium	Tagma Pharma (Pvt) Ltd.
Trutil	Pharmix Laboratories (Private) Limited.
Ul-Some	Saydon Pharmaceutical Industries (Pvt) Ltd.
Ulcicare	Jawa Pharmaceuticals(Pvt) Ltd.
Ultech	Wise Pharmaceuticals (Pvt) Ltd
Util	Ambrosia Pharmaceuticals
Vogue	Caraway Pharmaceuticals
Wesoprazol	Warafana Pharmaceuticals
Wincid	Winilton Pharmaceuticals (Pvt) Ltd
X-Prazole	Mediate Pharmaceuticals (Pvt) Ltd
Xestra	The Schazoo Laboratories Ltd.
Xocrel	Z-Jans Pharmaceutical (Pvt) Ltd.
Zespra	Schazoo Zaka
Zexum	Schazoo Zaka
Zimes	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Zoleric	Genix Pharma (Pvt) Ltd
Zolsure	Medisure Laboratories Pakistan (Pvt.) Ltd.
Zoom	Scilife Pharma (Private) Ltd
Zumin	Semos Pharmaceuticals (Pvt) Ltd.