Hyperacidity, GERD, and ulcers:
Indications for: NEXIUM IV
Short-term (up to 10 days) alternative to oral therapy for GERD with erosive esophagitis. Risk reduction of rebleeding of gastric or duodenal ulcers following therapeutic endoscopy in adults.
GERD: Inject IV over ≥3 mins or infuse IV over 10–30 mins. ≥18yrs: 20–40mg once daily for ≤10 days; switch to oral form when feasible. Severe hepatic impairment: max 20mg/day. Risk reduction: initially 80mg IV over 30 mins, then 8mg/hr continuous infusion over 71.5 hrs; switch to oral form when feasible. Hepatic impairment (mild to moderate): max continuous infusion at 6mg/hr; (severe): max 4mg/hr.
Infuse IV over 10–30 mins. <1 month: not recommended. 1 month–<1yr: 0.5mg/kg. 1yr–17yrs: <55kg: 10mg; ≥55kg: 20mg.
NEXIUM IV Contraindications:
Concomitant rilpivirine-containing drugs.
NEXIUM IV Warnings/Precautions:
Symptomatic response does not preclude gastric malignancy. Discontinue and evaluate if acute tubulointerstitial nephritis is suspected. Cutaneous and systemic lupus erythematosus. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12. Monitor magnesium levels during prolonged therapy. Increased risk of fundic gland polyps with long-term use (esp. >1yr) or osteoporosis-related fractures (hip, wrist or spine) with long-term (>1yr) and multiple daily dose PPI therapy. Use lowest dose for shortest duration appropriate to condition. Pregnancy. Nursing mothers.
NEXIUM IV Classification:
Proton pump inhibitor.
NEXIUM IV Interactions:
Avoid concomitant St. John's wort, rifampin, nelfinavir. May potentiate saquinavir; monitor for toxicity. May reduce absorption of gastric pH-dependent drugs (eg, iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole, itraconazole). Antagonizes clopidogrel; consider alternative anti-platelets. May affect drugs metabolized by CYP2C19. May potentiate digoxin, tacrolimus, cilostazol (consider reduced dose), citalopram (limit dose to max 20mg/day), high-dose methotrexate (consider temporary withdrawal of PPI). Caution with drugs that may cause hypomagnesemia (eg, digoxin, diuretics); monitor. Monitor INR, PT with warfarin. Potentiated by voriconazole; may need to adjust esomeprazole dose in Zollinger-Ellison syndrome. May give antacids concomitantly. May cause false (+) results in diagnostic investigations for neuroendocrine tumors; discontinue esomeprazole 14 days prior to CgA level assessment; may need repeat test. May cause false (+) results with secretin stimulation test or urine tests for tetrahydrocannabinol.
Headache, diarrhea, abdominal pain, nausea, flatulence, constipation, dry mouth, inj site reactions, dizziness, vertigo; possible C. difficile-associated diarrhea; rare: rash, allergic reactions, hypomagnesemia. Children: Also, somnolence, regurgitation, tachypnea, increased ALT.
See Biaxin for more information on clarithromycin. See Amoxil for more information on amoxicillin.
Generic Drug Availability:
Caps—30, 90, 1000; Susp—30 packets; IV soln (single-use vial)—10