Esomeprazole

SPC §4.2 gives 40 mg once daily for 4 weeks for erosive reflux oesophagitis, with an additional 4 weeks if oesophagitis has not healed or symptoms persist. Other adult regimens: long-term maintenance of healed oesophagitis 20 mg once daily; symptomatic GORD without oesophagitis 20 mg once daily (on-demand 20 mg once daily when needed - not recommended for symptom control in NSAID-treated patients at risk of ulcers); H. pylori eradication 20 mg with amoxicillin 1 g and clarithromycin 500 mg, all twice daily for 7 days; healing of NSAID-associated gastric ulcers 20 mg once daily for 4-8 weeks; prevention of NSAID-associated gastric/duodenal ulcers in at-risk patients 20 mg once daily; continued treatment after i.v.-induced prevention of peptic ulcer rebleeding 40 mg once daily for 4 weeks; Zollinger-Ellison syndrome initially 40 mg twice daily, then individually adjusted (most patients controlled on 80-160 mg daily; divide doses above 80 mg daily into twice-daily administration). Adolescents from 12 years use the same GORD regimens as adults; for H. pylori duodenal ulcer in this group the SPC gives weight-band combination therapy (30-40 kg: esomeprazole 20 mg + amoxicillin 750 mg + clarithromycin 7.5 mg/kg twice daily for one week; >40 kg: esomeprazole 20 mg + amoxicillin 1 g + clarithromycin 500 mg twice daily for one week) - the per-kg component is clarithromycin, not esomeprazole. Esomeprazole should not be used in children under 12 years (no data). Swallow capsules whole with liquid; do not chew or crush - for swallowing difficulty the capsule may be opened and the pellets dispersed in half a glass of non-carbonated water and taken within 5 minutes. Hepatic impairment: no adjustment in mild-moderate; do not exceed 20 mg in severe. Elderly: no adjustment.