Esomeprazole

What is esomeprazole?

Esomeprazole is a proton pump inhibitor (PPI), a type of medication that reduces the amount of acid your stomach produces. It is used to treat various acid-related conditions like heartburn, indigestion, gastro-oesophageal reflux disease (GORD) and to prevent stomach ulcers. Esomeprazole is available on prescription and is also available over the counter at a strength of 20mg, for short term relief of heartburn and reflux[1]. 

What is esomeprazole used for?

Esomeprazole is commonly prescribed for conditions featuring excess stomach acid. These include heartburn and acid reflux, gastro-oesophageal reflux disease (GORD), and stomach ulcers. It’s also used to limit the damage to the oesophagus caused by acid reflux, and for preventing ulcers in people taking non-steroidal anti-inflammatory drugs (NSAIDs) long term. The symptoms of Zollinger-Ellison syndrome, a rare condition where the stomach produces too much acid, may also be treated using esomeprazole[1]. 

How does esomeprazole work?

Esomeprazole works by blocking the proton pumps in the lining of the stomach. These pumps are responsible for producing stomach acid, but by reducing the amount of acid, esomeprazole helps relieve symptoms such as heartburn. This allows damaged tissue in the stomach and oesophagus to heal[1]. 

Who can take esomeprazole?

Esomeprazole can be taken by most adults and children aged 1 year and over. When bought over the counter, it is only for use in adults aged 18 plus. However, it may not be suitable for some people. You should speak to your doctor before taking esomeprazole if you are pregnant or breastfeeding, you have liver problems, you have ever had an allergic reaction to esomeprazole or another PPI or if you are due to have an endoscopy in the next few week[1]. 

Please tell your doctor or pharmacist about any conditions you may have before you start treatment and always follow the instructions in the Patient Information Leaflet[2]. 

How do you take esomeprazole?

Esomeprazole is usually taken once a day – ideally in the morning. If it has been prescribed twice a day, take one dose in the morning and one dose in the evening. You’ll usually swallow a capsule whole with water, with or without food. It’s important not to crush or chew tablets. If you have difficulty swallowing, some capsules can be opened and the contents mixed with water or soft food. Always check the leaflet or ask your pharmacist for guidance before doing so as incorrectly taking esomeprazole can limit its effectiveness[1]. 

What is the typical dosage of esomeprazole?

For adults, the typical dose of esomeprazole is between 20mg and 40mg once a day for heartburn, indigestion, stomach ulcers or GORD. The doses of Zollinger-Ellison syndrome are typically much higher, between 80mg-160mg daily. Doses can vary depending on the age, weight and the condition being treated. Over-the-counter products such as Nexium Control are typically taken at a dose of 20mg once daily for up to 14 days. If your condition has not improved after 14 days of use over the counter, you must consult a doctor before continuing to take esomeprazole. Regardless of the type of esomeprazole, you should always follow the dosage instructions given by your doctor or on the medicine leaflet[1]. 

Can you stop taking esomeprazole suddenly?

If you have been prescribed esomeprazole for a short-term condition, you can usually stop taking it when your symptoms improve. If taking it long term, speak to your doctor before stopping, as doing so suddenly may cause your symptoms to return. Your doctor may recommend reducing the dose gradually instead. Your doctor may also suggest taking esomeprazole only when you experience symptoms, meaning you would not be taking it every day[1]. 

What should you do if you take too much esomeprazole?

Taking too much esomeprazole is unlikely to cause severe harm. However, it’s important to be aware that it can cause potential side effects. Some of the side effects might include stomach pain, diarrhoea, headache, and drowsiness. If you take too much esomeprazole and are concerned or feel unwell, contact your doctor or call NHS 111 for advice[1]. 

What should you do if you forget a dose of esomeprazole?

If you forget to take a dose of esomeprazole, take it as soon as you remember. If you take it once daily and it is less than 12 hours till your next dose, skip the dose and take the next dose at the usual time. If you take it twice daily and it is less than 4 hours till your next dose, skip the dose and take the next one at the usual time. Do not take two doses to make up for a missed one[1]. 

What medicines should you avoid while taking esomeprazole?

Esomeprazole can interact with some medicines and supplements, including[1]: 

• Medicines for blood clots, such as clopidogrel and warfarin 

• Methotrexate, used to treat cancer and autoimmune diseases 

• Certain HIV medicines such as atazanavir 

• Antifungal medicines such as ketoconazole, itraconazole, posaconazole, and voriconazole 

• Digoxin, cilostazol, phenytoin and rifampicin 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of esomeprazole?

There are some possible common yet mild side effects when taking esomeprazole. These can include headaches, diarrhoea, stomach pain, constipation, nausea, vomiting, and wind (flatulence)[1]. 

In rare cases, there may also be more serious side effects, including[1]: 

• Joint pain and a red skin rash on areas of the body exposed to the sun, which may be a sign of subacute cutaneous lupus erythematosus (SCLE) a very rare condition 

• Yellowing of the skin or eyes, dark pee or pale poo, which may indicate liver problems 

• Severe stomach pain or ongoing diarrhoea, which may indicate an inflamed bowel 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about esomeprazole

How long does it take for esomeprazole to work? 

When you start taking esomeprazole, you may start to feel better within a few hours. It can take up to 4 weeks for the full effects to appear. If bought over the counter it is important to speak to a doctor if symptoms have not improved after 2 weeks[1]. 

Can I drink alcohol while taking esomeprazole? 

Yes, you can usually drink alcohol in moderation when taking esomeprazole. However, alcohol can increase stomach acid and may irritate the stomach lining and worsen symptoms[1]. 

Can I take esomeprazole long term? 

Esomeprazole can be taken long term but only under medical supervision. If used for over 3 months it can cause a decrease in magnesium levels which may cause symptoms such as fatigue, confusion, dizziness, muscle twitching and an irregular heartbeat. If any of these symptoms occur you should speak with your doctor. If used for over a year if may increase the chance of certain side effects such as bone fractures, gut infections and vitamin B12 deficiency so it important to be monitored regularly when prescribed this medication[1]. 

Is esomeprazole safe during pregnancy? 

Esomeprazole is not recommended during pregnancy as there is limited information about its use during this time. A similar medication called omeprazole may be suggested instead as there is more safety information about the use of this in pregnancy[1]. 

Can I drive whilst taking esomeprazole?  

Esomeprazole can cause side effects such as dizziness and blurred vision. If this does occur it is important not to drive or operate machinery until these have subsided. It's an offence to drive a car if your ability to drive safely is affected and it is your responsibility to make this decision[1]. 

Can lifestyle changes help with increased stomach acid? 

Lifestyle changes can help to reduce the symptoms of increased stomach acid. Things to try include: maintaining a healthy weight, avoiding triggers such as fatty, spicy or acidic foods, reduce caffeinated drinks, alcohol and smoking, do not eat too close to bedtime (your last meal should be at least 3 hours before bedtime), elevate the head of the bed if you find you wake in the night with symptoms[1].

For the official NHS guide to esomeprazole, visit their website.