Proton Pump Inhibitor (PPI) Pregnancy: Compatible — esomeprazole/omeprazole data reassuring throughout pregnancy.

Esomeprazole

Brand names: Nexium

Adult dose

Dose: GORD: 20–40mg OD for 4–8 weeks. Maintenance: 20mg OD. Peptic ulcer: 20–40mg OD. H. pylori eradication: 20mg BD (with antibiotics) × 7 days. Peptic ulcer bleeding (post-endoscopy): 80mg IV bolus then 8mg/hour infusion for 72 hours.

Route: Oral or IV

Frequency: Once daily (30 min before food)

Max: 40mg OD (standard); higher doses in Zollinger-Ellison syndrome under specialist care

S-isomer of omeprazole. IV preparation used post-endoscopic haemostasis for peptic ulcer bleeding (80mg bolus + 8mg/h × 72h). Oral absorption improved on empty stomach.

Paediatric dose

Route: Oral

Frequency: Once daily

Max: 40mg OD

BNF for Children: 1–11 years (≥10kg): body weight 10–<20kg: 10mg OD; ≥20kg: 10–20mg OD. 12–17 years: 20–40mg OD. Not licensed <1 year. Source: BNF for Children 2024.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Max 20mg OD in severe hepatic impairment (Child-Pugh C).

Clinical pearls

IV esomeprazole post-endoscopy: 80mg bolus followed by 8mg/hour infusion for 72h significantly reduces re-bleeding after endoscopic haemostasis (HEAT study).
S-isomer of omeprazole — marginally more potent acid suppression but clinically similar. Not preferred over pantoprazole with clopidogrel.
Hypomagnesaemia: particularly relevant in patients on digoxin, diuretics, or at risk of QT prolongation — check Mg²⁺.
Annual review of long-term PPI prescriptions — step down or stop when clinically appropriate.

Contraindications

Concomitant atazanavir, nelfinavir, or rilpivirine
Known hypersensitivity to proton pump inhibitors

Side effects

Headache, abdominal pain, nausea, diarrhoea
Hypomagnesaemia (long-term)
C. difficile risk (long-term)
Interstitial nephritis (rare)
Osteoporosis / fracture risk (long-term high-dose use)

Interactions

Clopidogrel: significant CYP2C19 inhibition — prefer pantoprazole
Methotrexate: increased methotrexate levels — monitor
Antiretrovirals (atazanavir, rilpivirine): significantly reduced absorption — avoid
Warfarin: may increase INR

Monitoring

Symptoms
Mg²⁺ and B12 (long-term)
INR if on warfarin

Reference: BNFc; BNF 90; NICE CG141 Peptic Ulcer; HEAT Study (Lancet 2016). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways