Esomeprazole – S-isomer PPI for superior acid suppression and healing.
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What is Esomeprazole?
Esomeprazole is an advanced proton pump inhibitor that offers superior and more consistent acid suppression compared to earlier PPIs. As the S-isomer of omeprazole, it provides enhanced pharmacokinetics and may offer better healing rates for severe acid-related conditions.
Book an online consultation if you’re experiencing persistent heartburn, acid reflux, or stomach ulcers that may benefit from advanced acid suppression therapy. Our GPs can assess your digestive symptoms and determine if Esomeprazole or other PPI treatments are appropriate for your specific condition.
What is Esomeprazole used for?
- Gastro-oesophageal reflux disease (GORD)
- Stomach and duodenal ulcers
- Helicobacter pylori eradication (with antibiotics)
- Prevention of NSAID-induced ulcers
- Zollinger-Ellison syndrome
- Barrett's oesophagus management
- Severe erosive oesophagitis
How does Esomeprazole work?
The S-isomer of omeprazole that provides more consistent and potent acid suppression by irreversibly blocking the hydrogen-potassium pump in gastric parietal cells, with improved pharmacokinetics.
Dosage and Administration
Adults
20-40mg once daily, usually taken before breakfast. Can be increased to 80mg daily for severe conditions.
Children
Weight-based dosing: 10-20mg daily—specialist supervision usually required.
Important Notes
- Take 30-60 minutes before food for optimal effectiveness.
- Swallow tablets whole—do not crush or chew.
- If swallowing difficult, tablets can be dispersed in water and drunk immediately.
- May take 1-4 days to reach full acid-suppressing effect.
Side Effects
Common Side Effects
- Headache
- Nausea and stomach upset
- Diarrhoea or constipation
- Flatulence and abdominal pain
- Dizziness
- Skin rash
Serious Side Effects
Seek immediate medical attention if you experience:
- Severe diarrhoea (C. difficile infection)
- Bone fractures (with long-term use)
- Low magnesium, calcium, or vitamin B12 levels
- Kidney problems (acute interstitial nephritis)
- Severe allergic reactions
- Liver problems (rare)
Important Warnings
- Long-term use may increase risk of hip, wrist, and spine fractures.
- May mask symptoms of stomach cancer—persistent symptoms need investigation.
- Can reduce absorption of vitamin B12, iron, calcium, and magnesium with prolonged use.
- Tell your GP if you have severe liver problems—dose adjustment may be needed.
- May increase risk of infections and pneumonia.
Drug Interactions
Tell your GP if you're taking any of the following medications:
- Warfarin—may increase bleeding risk.
- Clopidogrel—may reduce effectiveness of clopidogrel.
- Digoxin—may increase digoxin levels.
- Ketoconazole and itraconazole—reduced absorption of these antifungals.
- HIV medications (atazanavir, nelfinavir)—may reduce their effectiveness.
- Iron supplements—may reduce iron absorption.
Frequently Asked Questions
How is Esomeprazole different from Omeprazole?
Esomeprazole is the S-isomer of omeprazole, providing more consistent acid suppression with potentially fewer drug interactions and better healing rates for erosive oesophagitis.
Is Esomeprazole more effective than other PPIs?
Esomeprazole may provide slightly superior acid suppression and healing rates compared to some other PPIs, particularly for severe erosive oesophagitis.
Can I take Esomeprazole long-term?
It can be used long-term under medical supervision, but your GP will regularly review the need and may recommend monitoring for long-term effects like bone health.
What's the difference between prescription and over-the-counter versions?
Prescription Esomeprazole is available in higher doses (40mg) and for longer treatment courses, while OTC versions are typically 20mg for short-term use.
Medically Reviewed by: Mohammed Hassan - Independent Prescriber
Last Updated: 2025-01-14