How does it work?
This medicine contains the active ingredient esomeprazole, which is a type of medicine called a proton pump inhibitor.

Proton pumps are found on cells that line the stomach and are used by these cells to produce stomach acid. Esomeprazole works by inhibiting the action of the proton pumps, and this reduces the production of stomach acid.

Acid is produced in the stomach as a normal part of the digestive process. However, in the condition known as gastro-oesophageal reflux disease or acid reflux, this acid is allowed to flow back into the food pipe (oesophagus), where it causes pain and a burning sensation known as heartburn. The acid can also irritate and cause inflammation of the lining of the foodpipe (reflux oesophagitis).

Esomeprazole reduces the production of stomach acid and thus reduces acid flowing back into the foodpipe. It is used to relieve the symptoms of gastro-oesophageal reflux disease, such as heartburn. It is also used to treat reflux oesophagitis, because stopping the acid flowing back into the foodpipe allows the lining of the foodpipe to heal. Esomeprazole is also used for the long-term management of people with healed oesophagitis, as suppressing the production of stomach acid helps prevent this condition recurring.

Esomeprazole is also used to treat ulcers in the stomach or upper intestine (peptic ulcers) that are associated with a type of bacteria called Helicobacter pylori. This type of bacteria is the most common cause of peptic ulcers. The bacteria cause the stomach to produce too much acid, which irritates the lining of the stomach and upper intestine and causes ulcers.

Esomeprazole is used in combination with antibiotics to eradicate Helicobacter pylori from the gut. The esomeprazole creates an environment in the gut in which the antibiotics can work effectively against the H pylori bacteria. The reduced acid in the gut allows the ulcer to heal, and both actions help prevent the ulcer from recurring.

Esomeprazole can also be used to prevent and treat peptic ulcers that can occur as a side effect of non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, often used to treat arthritis.

What is it used for?
- Eradicating Helicobacter pylori bacteria from the gut (in combination with antibiotics), which helps peptic ulcers to heal and prevents them from recurring
- Treatment and prevention of peptic ulcers associated with non-steroidal anti-inflammatory drugs (NSAIDs)
- Gastro-oesophageal reflux disease

Warning!
- This medicine can relieve the symptoms of stomach cancer and therefore delay diagnosis of this condition. For this reason, if your doctor suspects you have a stomach ulcer he should exclude the possibility of stomach cancer before you start treatment with this medicine, particularly if you are middle aged or older and have new or recently changed symptoms.
- Swallow the tablets whole, do not chew or crush them. If you have difficulty swallowing the tablets whole they can be dispersed in a glass of still water. Stir until the tablets disintegrate. The mixture will not be clear, as it will contain solid granules from the tablet. These should not be crushed or chewed, as they contain the medicine and are covered with a special coating. Drink the mixture immediately or at least within 30 minutes (stir again before drinking). To ensure you have taken all the medicine rinse the glass with water and drink. Do not use any other liquid to disperse the tablets, as this may affect the medicine.

Use with caution in
- Severely decreased kidney function
- Severely decreased liver function

Not to be used in

- Children
- Breastfeeding
- Inherited deficiency of sucrase and isomaltase in the gut, leading to intolerance to sugars in the diet
- Inherited inability to absorb the sugars glucose and galactose (glucose-galactose malabsorption)
- Inherited intolerance to fructose in the diet

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor.
- There is no information available about the safety of this medicine during breastfeeding. For this reason, the manufacturer states that it should not be used during breastfeeding. Seek medical advice from your doctor.

Label warnings
- This medication is to be swallowed whole, not chewed.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Headache
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- Excess gas in the stomach and intestines (flatulence)
- Dry mouth
- Skin reactions such as rash and itch
- Inflammation of the skin (dermatitis)
- Dizziness
- Pain in the muscles and joints
- Swelling of the legs and ankles due to excess fluid retention (peripheral oedema)
- Pins and needles (paraesthesia)
- Depression
- Agitation
- Confusion
- Difficulty sleeping (insomnia)
- Sleepiness (somnolence)
- Liver or blood disorders
- Taste disturbance

The side effects listed above may not include all of the side effects reported by the drug`s manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Esomeprazole may increase the blood level of the following medicines:
- barbiturates
- citalopram
- clomipramine
- diazepam
- imipramine
- phenytoin (the manufacturer recommends that people taking phenytoin should have their phenytoin blood level monitored when starting or stopping esomerazole)
- proguanil
- propranolol.

Esomeprazole may increase the anti-blood-clotting effect of the anticoagulant medicine warfarin. If you are taking warfarin it is recommended that your blood clotting time (INR) is monitored after starting and stopping this medicine.

Esomeprazole may decrease the absorption of the following medicines from the gut, and thus may make them less effective:
- itraconazole
- ketoconazole.


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