Nexium (Esomeprazole Magnesium Trihydrate)

Nexium is a proton pump inhibitor indicated for several acid‑related gastrointestinal conditions.

• Gastro‑oesophageal reflux disease (GERD): provides symptomatic relief and promotes healing of the oesophageal lining.
• Erosive oesophagitis: accelerates mucosal healing and prevents recurrence.
• NSAID‑induced gastric ulcer: protects the gastric mucosa by suppressing acid secretion.
• Zollinger‑Ellison syndrome: controls excessive gastric acid production.
• Helicobacter pylori eradication (in combination therapy): enhances the effectiveness of antibiotic regimens by maintaining a higher gastric pH.

• Esomeprazole irreversibly binds to the H+/K+ ATPase enzyme (gastric proton pump) located on the secretory surface of gastric parietal cells. By inhibiting this final step of acid secretion, it markedly reduces both basal and stimulated gastric acid output, leading to an increased gastric pH and facilitating healing of acid‑related mucosal damage.

Adverse reactions may occur with any medication and should be monitored by a healthcare professional.

Common Side Effects

• Headache: mild to moderate intensity.
• Diarrhoea: usually transient.
• Nausea or abdominal discomfort.
• Flatulence: excess gas.
• Constipation: occasional.
• Dry mouth: reduced salivation.

Serious or Rare Side Effects

• Severe allergic reaction (anaphylaxis): rash, swelling, difficulty breathing.
• Clostridioides difficile infection: persistent diarrhoea.
• Low magnesium levels (hypomagnesemia): muscle cramps, irregular heartbeat.
• Bone fractures: increased risk with long‑term use.
• Acute interstitial nephritis: kidney inflammation.
• Liver enzyme elevation: signs of hepatic dysfunction.

Before initiating therapy, consider the following safety measures.

• Renal function assessment: adjust use in severe impairment.
• Hepatic impairment: monitor liver enzymes.
• Elderly patients: start with the lowest effective dose.
• Discontinuation: avoid abrupt stop without medical guidance to prevent rebound acid hypersecretion.
• Pregnancy and lactation: discuss risks and benefits with a healthcare professional.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Esomeprazole may affect the pharmacokinetics of several concomitant medicines.

Major Interactions (Avoid)

• Clopidogrel: reduced antiplatelet activity, increasing cardiovascular risk.
• Atazanavir: decreased absorption leading to sub‑therapeutic levels.

Moderate Interactions (Monitor Closely)

• Warfarin: potential alteration of INR, requiring closer monitoring.
• Digoxin: increased serum concentrations, risk of toxicity.
• Methotrexate: elevated levels may enhance toxicity, especially at high doses.