Esomeprazole

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient esomeprazole is one of the so-called proton pump inhibitors and is used for heartburn and gastric acid regulation. It does not differ in its mode of action from omeprazole, but its effectiveness is slightly higher. Here you can read everything you need to know about esomeprazole: effect, use and possible side effects.

This is how esomeprazole works

Esomeprazole is taken by mouth. The active ingredient dissolves in the intestine and is absorbed into the blood. Esomeprazole then reaches the gastric mucosa via the blood vessels, which produces gastric acid: The essential component of gastric acid - hydrochloric acid - is released into the stomach in the form of positively charged particles (protons) and negatively charged particles (chloride ions) by certain mucous membrane cells. The mucous membrane cells use a certain protein to “pump” the protons through the cell membrane. Esomeprazole inhibits this protein and thus the proton pump. The active ingredient is one of the proton pump inhibitors.

Esomeprazole can only develop its inhibitory effect as soon as it has reached the gastric mucosa and encounters existing gastric acid - it is activated as a result.

Mirror image of omeprazole

The active ingredient omeprazole, also a proton pump inhibitor, has a chemically uniform structure, but it consists of individual particles that relate to each other like an image and a mirror image. For comparison: A person's hands are also constructed in the same way, only in mirror image. These two different types of a substance are called "enantiomers". Often one of these is more effective, less harmful, or otherwise beneficial than the second enantiomer.

This is also the case with esomeprazole, an enantiomer of omeprazole. The other enantiomer of omeprazole can only be broken down in the body by a specific enzyme in the liver (namely CYP2C19). However, around three percent of the population hardly has this enzyme, which is why the aforementioned omeprazole enantiomer would rapidly accumulate in their blood after repeated ingestion.

Esomeprazole, on the other hand, can also be broken down by a second enzyme (CYP3A4), which ensures reliable elimination. With regard to the effect on the gastric mucosa, however, the two enantiomers of omeprazole do not differ.

Uptake, breakdown and excretion of esomeprazole

Esomeprazole will peak in blood about one to two hours after it is taken by mouth. It binds to the proton pumps in the gastric mucosa and develops its inhibitory effect there. Active substances circulating freely in the blood are completely broken down in the liver by the enzymes mentioned. About an hour and a half after taking esomeprazole, blood levels halved.

When is esomeprazole used?

The active substance esomeprazole is used in the following cases:

• to treat heartburn (GERD - gastroesophageal reflux disease)
• in combination with antibiotics in the treatment of gastric germ infection Helicobacter pylori

Depending on the underlying disease, esomeprazole can be used for a short or long term.

This is how esomeprazole is used

The active ingredient esomeprazole is taken in the form of gastro-resistant tablets or capsules. Due to the gastric juice resistance of the preparations, the active ingredient is only released in the intestine, where it can be absorbed into the blood. The absorption is particularly good if the ingestion of the active ingredient takes place on an empty stomach (usually in the morning). Depending on the severity of the disease, twenty to forty milligrams of esomeprazole are taken per day.

An intravenous preparation of esomeprazole is also available for patients with difficulty swallowing. Alternatively, the tablets labeled with the word “MUPS” (multiple unit pellet system) can be dispersed in water beforehand and then drunk or given by feeding tube.

What are the side effects of esomeprazole?

When taking esomeprazole, the side effects of headache, abdominal pain, constipation, diarrhea, gas, nausea and vomiting are one in ten to one hundred.

Esomeprazole side effects such as water retention in arms and legs, insomnia, dizziness and vertigo, abnormal sensations, tiredness, dry mouth, increased liver enzymes and skin reactions such as itching and reddening appear in one in one hundred to one thousand patients. In addition, the risk of bone fractures can be increased, especially in elderly patients and long-term treatment.

What should be considered when taking esomeprazole?

Since esomeprazole inhibits the production of gastric acid, the absorption of other active substances, which are only absorbed depending on gastric acid, may be changed. This applies to certain drugs against fungal infections (ketoconazole, itraconazole) and cancer (Erlotinib) - their absorption may be reduced if esomeprazole is used at the same time.

Conversely, the absorption of the cardiac drug digoxin and other drugs can be increased by taking esomeprazole.

With simultaneous intake of active substances that are metabolized in the liver by the same enzymes as esomeprazole, the breakdown of either the proton pump inhibitor or the other active substances can be influenced. This can lead to an increase or a decrease in the blood level of esomeprazole or the other active substances.

In the case of protease inhibitors for the treatment of HIV (atazanavir, nelfinavir) the blood levels decrease with simultaneous use of esomeprazole, whereas they increase with other protease inhibitors (saquinavir, ritonavir).

The blood levels of methotrexate (anti-cancer and anti-rheumatic drugs), tacrolimus (used to suppress the immune system), diazepam (sedative) and phenytoin (anticonvulsant) also increase when esomeprazole is taken at the same time.

As a precaution, the combined use of esomeprazole and anticoagulants such as warfarin and clopidogrel should also be monitored.

pregnancy and breast feeding period

The use of esomeprazole during pregnancy has been investigated through studies of omeprazole. There were no side effects whatsoever. Nevertheless, the intake should be clarified by a doctor during pregnancy and should only be carried out with caution.

As it is not known whether esomeprazole is excreted in breast milk, the active substance should not be used in breastfeeding women.

Other notes

Esomeprazole can be used in adolescents aged twelve years and over and also in elderly patients. A lower dose may be required in patients with severe hepatic impairment.

How to get esomeprazole medication

Small packs with a maximum of 14 tablets each containing 20 milligrams of active ingredient for the treatment of heartburn have been exempt from prescription requirements in Germany since August 2014. Esomeprazole still requires a prescription in higher doses, larger packs and in preparations with other indications.

How long has esomeprazole been known?

Esomeprazole has been marketed by the pharmaceutical company AstraZeneca since 2001. It was introduced shortly before the expiry of patent protection for omeprazole, also by AstraZeneca.

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