Classifications: proton pump inhibitor;
Therapeutic: antiulcer
; proton pump inhibitor
Prototype: Omeprazole
Pregnancy Category: B


20 mg, 40 mg capsules; 20 mg, 40 mg powder for injection


Isomer of omeprazole. A weak base that is converted to the active form in the highly acidic environment of the gastric parietal cells. Inhibits the enzyme H+K+-ATPase (the acid pump), thus suppressing gastric acid secretion.

Therapeutic Effect

Due to inhibition of the H+K+-ATPase, esomeprazole substantially decreases both basal and stimulated acid secretion through inhibition of the acid pump in parietal cells.


Erosive esophagitis, gastrointestinal reflux disease (GERD), duodenal ulcer associated with H. pylori in combination with antibiotics.


Hypersensitivity to esomeprazole magnesium, omeprazole, or other proton pump inhibitors; gastric malignancy; lactation.

Cautious Use

Severe renal insufficiency; severe hepatic impairment; treatment for more than a year; gastric ulcers; pregnancy (category B). Safety and efficacy in children are not established.

Route & Dosage

Healing of Erosive Esophagitis
Adult: PO/IV 20–40 mg q.d. at least 1 h before meals times 4–8 wk

GERD, Erosive Esophagitis Maintenance
Adult: PO 20 mg q.d.

Duodenal Ulcer
Adult: PO 40 mg q.d. times 10 d

Hepatic Impairment
Child-Pugh Class C: Do not exceed 20 mg/d


  • Give at least 1 h before eating.
  • Do not crush or chew capsule. Must be swallowed whole.
  • Open capsule and mix pellets with applesauce (cold or room temperature) if patient cannot swallow capsules. Do NOT crush pellets. Applesauce should be swallowed immediately after mixing without chewing.
  • May take with antacids.
  • Store in the original blister package 15°–30° C (59°–86° F).

PREPARE: Direct: Reconstitute powder with 5 mL of NS.  IV Infusion: Further dilute reconstituted solution in 50 mL of NS, LR, or D5W.  

ADMINISTER: Direct: Withdraw 5 mL of reconstituted solution and give over no less than 3 min.  IV Infusion: Give IV solution over 10–30 min.  

INCOMPATIBILITIES Do not give simultaneously with any other medication through the same IV site or line. Flush IV line with NS, LR, or D5W before/after infusion.

  • Store reconstituted solution at room temperature up to 30° C (86° F); give within 12 h of reconstitution with NS or LR and within 6 h of reconstitution with D5W.

Adverse Effects (≥1%)

CNS: Headache. GI: Nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dry mouth.


Drug: May increase diazepam, phenytoin, warfarin levels. Food: Food decreases absorption by up to 35%.


Absorption: Destroyed in acidic environment, therefore capsules are designed for delayed absorption in the small intestine. 70% reaches systemic circulation. Metabolism: In liver by CYP2C19. Elimination: Inactive metabolites excreted in both urine and feces. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of adverse CNS effects (vertigo, agitation, depression) especially in severely ill patients.
  • Monitor phenytoin levels with concurrent use.
  • Monitor INR/PT with concurrent warfarin use.
  • Lab tests: Periodic liver function tests, CBC, Hct & Hbg, urinalysis for hematuria and proteinuria.

Patient & Family Education

  • Report any changes in urinary elimination such as pain or discomfort associated with urination to physician.
  • Report severe diarrhea. Drug may need to be discontinued.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2023 Last Updated On: 02/02/2023 (0)
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