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Proton Pump Inhibitor — Stress Ulcer Prophylaxis Pregnancy: Use with caution — limited data; omeprazole preferred (more safety data)

Esomeprazole (Burns — Curling's Ulcer Prophylaxis)

Brand names: Nexium

Adult dose

Dose: 40 mg IV or oral once daily
Route: IV or Oral
Frequency: Once daily
Max: 80 mg/day
Stress ulcer (Curling's ulcer) prophylaxis in major burns (>30% TBSA). Continue until tolerating enteral nutrition and clinical condition stabilises. IV for acute phase; switch to oral when GI tract functioning. Curling's ulcer is a specific complication of major thermal injury.

Paediatric dose

Route: Oral / IV
Frequency: Once daily
Max: 40 mg/day
Children 1–11 years: 10 mg once daily (under 20 kg) or 10–20 mg once daily (over 20 kg). Children ≥12 years: 20–40 mg once daily.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Max 20 mg/day in severe hepatic impairment.

Clinical pearls

  • Curling's ulcer — first described by Thomas Blizard Curling in 1842; occurs within first 72 hours of major burns due to splanchnic hypoperfusion and stress response
  • NICE: PPI prophylaxis recommended when ≥2 of: ICU admission, coagulopathy, mechanical ventilation >48h, previous GI ulcer — all present in major burns
  • Early enteral nutrition (within 6–12h of burns) is the most effective Curling's ulcer prevention strategy — reduces mucosal ischaemia

Contraindications

  • Concomitant atazanavir or nelfinavir (reduces antiretroviral absorption)

Side effects

  • Headache
  • Diarrhoea
  • Nausea
  • Hypomagnesaemia (long-term)
  • C. difficile risk (long-term)
  • Increased pneumonia risk (ICU — controversial)

Interactions

  • Clopidogrel (less interaction than omeprazole — esomeprazole preferred when antiplatelet needed)
  • Methotrexate (PPIs may increase toxicity)
  • Atazanavir (avoid concomitant use)

Monitoring

  • Serum magnesium (long-term use)
  • Signs of GI bleeding (malaena, haematemesis)
  • Review indication and step down when clinical condition allows

Reference: BNFc; BNF 90; NICE NG17 (Acutely ill adults — GI bleeding prevention); BBA Major Burns Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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