Esomeprazole

Generic Name
Esomeprazole
Brand Names
Nexium, Vimovo, Nexium Control
Drug Type
Small Molecule
Chemical Formula
C17H19N3O3S
CAS Number
119141-88-7
Unique Ingredient Identifier
N3PA6559FT
Background

Esomeprazole, sold under the brand name Nexium, is a proton pump inhibitor (PPI) medication used for the management of gastroesophageal reflux disease (GERD), for gastric protection to prevent recurrence of stomach ulcers or gastric damage from chronic use of NSAIDs, and for the treatment of pathological hypersecretory conditions including Zollinger-Ellison (ZE) Syndrome. It can also be found in quadruple regimens for the treatment of H. pylori infections along with other antibiotics including Amoxicillin, Clarithromycin, and Metronidazole, for example. Its efficacy is considered similar to other medications within the PPI class including Omeprazole, Pantoprazole, Lansoprazole, Dexlansoprazole, and Rabeprazole. Esomeprazole is the s-isomer of Omeprazole, which is a racemate of the S- and R-enantiomer. Esomeprazole has been shown to inhibit acid secretion to a similar extent as Omeprazole, without any significant differences between the two compounds in vitro.

Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of esomeprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, esomeprazole's duration of antisecretory effect persists longer than 24 hours.

PPIs such as esomeprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginie (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary syndromes.

Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as esomeprazole has been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal C. difficile), reduced absorption of micronutrients such as iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life.

Rapid discontinuation of PPIs such as esomeprazole may cause a rebound effect and a short term increase in hypersecretion. Esomeprazole doses should be slowly lowered, or tapered, before discontinuing to prevent this rebound effect.

Indication

Esomeprazole is indicated for the treatment of acid-reflux disorders including healing and maintenance of erosive esophagitis, and symptomatic gastroesophageal reflux disease (GERD), peptic ulcer disease, H. pylori eradication, prevention of gastrointestinal bleeds with NSAID use, and for the long-term treatment of pathological hypersecretory conditions including Zollinger-Ellison Syndrome.

Associated Conditions
Duodenal Ulcer, Erosive Esophagitis, Gastro-esophageal Reflux Disease (GERD), Heartburn, Helicobacter Pylori Infection, Stress Ulcers, Upper Gastrointestinal Hemorrhage, Zollinger-Ellison Syndrome, Acute benign gastric ulcers, Develop NSAID-induced gastric ulcers, Maintenance of healing Erosive esophagitis, Postendoscopy Bleeding
Associated Therapies
-

A Comparison of Efficacy of Intravenous Esomeprazole and Ranitidine Treatment of Dyspeptic Pain

First Posted Date
2014-07-22
Last Posted Date
2014-07-22
Lead Sponsor
Pamukkale University
Target Recruit Count
286
Registration Number
NCT02197143
Locations
🇹🇷

Pamukkale Universty, Denizli, Turkey

Stress Ulcer Prophylaxis of Intravenous Esomeprazole in Chinese Seriously Ill Patients

Phase 3
Completed
Conditions
Interventions
First Posted Date
2014-06-06
Last Posted Date
2017-03-10
Lead Sponsor
AstraZeneca
Target Recruit Count
343
Registration Number
NCT02157376
Locations
🇨🇳

Research Site, Zhanjiang, China

Rebamipide in Combination With Esomeprazole in the Management of Asian Patients With Functional Dyspepsia

First Posted Date
2014-05-09
Last Posted Date
2016-01-05
Lead Sponsor
University of Malaya
Target Recruit Count
200
Registration Number
NCT02134405
Locations
🇲🇾

University Malaya Medical Centre, Kuala Lumpur, Federal Territory, Malaysia

A Study to Evaluate the Effect of Multiple Doses of Esomeprazole on the Pharmacokinetics of Isavuconazole

First Posted Date
2014-05-01
Last Posted Date
2014-05-01
Lead Sponsor
Astellas Pharma Global Development, Inc.
Target Recruit Count
24
Registration Number
NCT02128893
Locations
🇺🇸

Parexel Early Phase Clinical Unit, Baltimore, Maryland, United States

Diagnosis of Acid Reflux Disease Using Novel Imaging: A Prospective Study

Not Applicable
Completed
Conditions
Interventions
First Posted Date
2014-03-07
Last Posted Date
2023-03-16
Lead Sponsor
Midwest Biomedical Research Foundation
Target Recruit Count
98
Registration Number
NCT02081404
Locations
🇺🇸

Department of Veterans Affairs Medical Center, Kansas City, Missouri, United States

🇬🇧

Queen Medical Center, Nottingham, United Kingdom

The Use of Hexacapron in Upper Gastrointestinal Bleeding

First Posted Date
2014-02-25
Last Posted Date
2014-02-25
Lead Sponsor
Shaare Zedek Medical Center
Target Recruit Count
300
Registration Number
NCT02071316
Locations
🇮🇱

Shaare Zedek Medical Center, Jerusalem, Israel

Phase 3 Study to Evaluate the Acid-Inhibitory Effect of Multiple Oral Doses of Vonoprazan (TAK-438)

First Posted Date
2014-01-16
Last Posted Date
2016-10-17
Lead Sponsor
Takeda
Target Recruit Count
20
Registration Number
NCT02037477

Study to Evaluate the Safety and Efficacy of CJ-12420 in Patients With Erosive Esophagitis

Phase 2
Completed
Conditions
Interventions
First Posted Date
2014-01-07
Last Posted Date
2014-08-08
Lead Sponsor
HK inno.N Corporation
Target Recruit Count
206
Registration Number
NCT02028663
Locations
🇰🇷

Seoul National University Hospital and 11 others, Seoul, Korea, Republic of

© Copyright 2024. All Rights Reserved by MedPath