If you need to take these drugs together, your doctor will decrease your dosage of cilostazol. Esomeprazole magnesium can increase the levels of digoxin in your body. Your doctor may check your digoxin blood levels and adjust your digoxin dosage if needed. Esomeprazole magnesium can increase the levels of methotrexate in your body. This may cause dangerous side effects. These side effects can include nausea, vomiting, headache, fatigue, and liver and kidney damage. If you need to take a high dose of methotrexate, your doctor may have you stop taking esomeprazole for a short time.

Esomeprazole magnesium may increase the levels of saquinavir in your body. This may cause more side effects from saquinavir. These may include fatigue, confusion, stomach and back pain, nausea, vomiting, and liver damage.

Your doctor may watch you more closely and decrease your dosage of saquinavir if needed. Esomeprazole magnesium can increase the levels of tacrolimus in your body. This may cause high blood pressure and kidney damage. Your doctor may check your tacrolimus levels and adjust your dosage if needed. Side effects from esomeprazole magnesium: Taking esomeprazole magnesium with certain medications raises your risk of side effects from esomeprazole. This is because the amount of esomeprazole in your body is increased.

Voriconazole can double the levels of esomeprazole magnesium in your body. Your doctor may decrease your dose of esomeprazole. Interactions that can make your drugs less effective When other drugs are less effective: When certain drugs are used with esomeprazole magnesium, they may not work as well.

Daily doses greater than 80 mg should be divided. This dosage may be increased to 40 mg per day if needed. This dosage may be titrated based on desired clinical response and patient tolerance.

Usual Adult Dose for Systemic Mastocytosis: Usual Adult Dose for Dyspepsia: Prevention of frequent heartburn: Usual Pediatric Dose for Erosive Esophagitis: Higher doses of 1 to 1.

Children 1 to 16 years: The safety and efficacy of omeprazole use in patients less than 1 year of age and for pediatric uses other than the treatment of GERD and maintenance of healing of erosive esophagitis has not been established. Dosage Information in more detail What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose.

Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at The clinical importance and the mechanisms behind these interactions are not always known. Increased gastric pH during omeprazole treatment may change the absorption of the antiretroviral drug.

Other possible interaction mechanisms are via CYP2C Reduced Concentrations Of Atazanavir And Nelfinavir For some antiretroviral drugs, such as atazanavir and nelfinavir, decreased serum levels have been reported when given together with omeprazole. Concomitant administration with omeprazole and drugs such as atazanavir and nelfinavir is therefore not recommended. Therefore, clinical and laboratory monitoring for saquinavir toxicity is recommended during concurrent use with NEXIUM.

Dose reduction of saquinavir should be considered from the safety perspective for individual patients. There are also some antiretroviral drugs of which unchanged serum levels have been reported when given with omeprazole. Drugs For Which Gastric pH Can Affect Bioavailability Due to its effects on gastric acid secretion, esomeprazole can reduce the absorption of drugs where gastric pH is an important determinant of their bioavailability.

Like with other drugs that decrease the intragastric acidity, the absorption of drugs such as ketoconazole, atazanavir, iron salts, erlotinib, and mycophenolate mofetil MMF can decrease, while the absorption of drugs such as digoxin can increase during treatment with esomeprazole.

Esomeprazole is an enantiomer of omeprazole. Co-administration of omeprazole in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the active metabolite, mycophenolic acid MPA , possibly due to a decrease in MMF solubility at an increased gastric pH.

No clinically relevant interactions with drugs metabolized by these CYP enzymes would be expected. Drug interaction studies have shown that esomeprazole does not have any clinically significant interactions with phenytoin, warfarin, quinidine, clarithromycin, or amoxicillin. However, post-marketing reports of changes in prothrombin measures have been received among patients on concomitant warfarin and esomeprazole therapy. Increases in INR and prothrombin time may lead to abnormal bleeding and even death.

Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time. Esomeprazole may potentially interfere with CYP2C19, the major esomeprazole metabolizing enzyme. Concomitant use of esomeprazole 40 mg results in reduced plasma concentrations of the active metabolite of clopidogrel and a reduction in platelet inhibition.

Omeprazole acts as an inhibitor of CYP2C Co-administration of cilostazol with esomeprazole is expected to increase concentrations of cilostazol and its above mentioned active metabolite. Therefore a dose reduction of cilostazol from mg twice daily to 50 mg twice daily should be considered.

Concomitant administration of esomeprazole and a combined inhibitor of CYP2C19 and CYP3A4, such as voriconazole, may result in more than doubling of the esomeprazole exposure. Dose adjustment of esomeprazole is not normally required. Omeprazole, of which esomeprazole is an enantiomer, has been reported to interact with St.

In a cross-over study in 12 healthy male subjects, St. Avoid concomitant use of St. Tacrolimus Concomitant administration of esomeprazole and tacrolimus may increase the serum levels of tacrolimus. Because of these drug interactions, clarithromycin is contraindicated for co-administration with certain drugs [see Contraindications in prescribing information for clarithromycin]. Consider additional follow-up and diagnostic testing in adult patients who have a suboptimal response or an early symptomatic relapse after completing treatment with a PPI.

In older patients, also consider an endoscopy. Acute interstitial nephritis may occur at any point during PPI therapy and is generally attributed to an idiopathic hypersensitivity reaction.

Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.

Clostridium difficile associated diarrhea CDAD has been reported with use of nearly all antibacterial agents. Bone Fracture Several published observational studies suggest that proton pump inhibitor PPI therapy may be associated with an increased risk for osteoporosis -related fractures of the hip, wrist , or spine.

Pediatrics The safety of esomeprazole magnesium delayed-release capsules was evaluated in pediatric and adolescent patients aged 1 to 17 years in four clinical trials for the treatment of symptomatic GERD [see Clinical Studies ].

No new safety concerns were identified in pediatric patients. Postmarketing Experience The following adverse reactions have been identified during post-approval use of esomeprazole magnesium delayed-release capsules. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These reports are listed below by body system: Coadministration of atazanavir with proton pump inhibitors is expected to substantially decrease atazanavir plasma concentrations and may result in a loss of therapeutic effect and the development of drug resistance.

Co-administration of saquinavir with proton pump inhibitors is expected to increase saquinavir concentrations, which may increase toxicity and require dose reduction. Omeprazole, of which esomeprazole is an enantiomer, has been reported to interact with some antiretroviral drugs. The clinical importance and the mechanisms behind these interactions are not always known. Increased gastric pH during omeprazole treatment may change the absorption of the antiretroviral drug.

Other possible interaction mechanisms are via CYP2C Reduced Concentrations Of Atazanavir And Nelfinavir For some antiretroviral drugs, such as atazanavir and nelfinavir, decreased serum levels have been reported when given together with omeprazole.

Concomitant administration with omeprazole and drugs such as atazanavir and nelfinavir is therefore not recommended. Therefore, clinical and laboratory monitoring for saquinavir toxicity is recommended during concurrent use with esomeprazole magnesium delayed-release capsules. Dose reduction of saquinavir should be considered from the safety perspective for individual patients. There are also some antiretroviral drugs of which unchanged serum levels have been reported when given with omeprazole.

Drugs For Which Gastric pH Can Affect Bioavailability Due to its effects on gastric acid secretion, esomeprazole can reduce the absorption of drugs where gastric pH is an important determinant of their bioavailability. Like with other drugs that decrease the intragastric acidity, the absorption of drugs such as ketoconazole, atazanavir, iron salts, erlotinib, and mycophenolate mofetil MMF can decrease, while the absorption of drugs such as digoxin can increase during treatment with esomeprazole.

Esomeprazole is an enantiomer of omeprazole. Co-administration of digoxin with esomeprazole magnesium delayed-release capsules is expected to increase the systemic exposure of digoxin.

Therefore, patients may need to be monitored when digoxin is taken concomitantly with esomeprazole magnesium delayed-release capsules. Co-administration of omeprazole in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the active metabolite, mycophenolic acid MPA , possibly due to a decrease in MMF solubility at an increased gastric pH.

The clinical relevance of reduced MPA exposure on organ rejection has not been established in transplant patients receiving esomeprazole magnesium delayed-release capsules and MMF. No clinically relevant interactions with drugs metabolized by these CYP enzymes would be expected.

Drug interaction studies have shown that esomeprazole does not have any clinically significant interactions with phenytoin, warfarin, quinidine, clarithromycin, or amoxicillin. However, postmarketing reports of changes in prothrombin measures have been received among patients on concomitant warfarin and esomeprazole therapy. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time.

Esomeprazole may potentially interfere with CYP2C19, the major esomeprazole metabolizing enzyme. Concomitant use of esomeprazole 40 mg results in reduced plasma concentrations of the active metabolite of clopidogrel and a reduction in platelet inhibition.

Avoid concomitant administration of esomeprazole magnesium delayed-release capsules with clopidogrel. Omeprazole acts as an inhibitor of CYP2C Co-administration of cilostazol with esomeprazole is expected to increase concentrations of cilostazol and its above mentioned active metabolite.

Therefore a dose reduction of cilostazol from mg twice daily to 50 mg twice daily should be considered. Concomitant administration of esomeprazole and a combined inhibitor of CYP2C19 and CYP3A4, such as voriconazole, may result in more than doubling of the esomeprazole exposure. Dose adjustment of esomeprazole is not normally required.

Omeprazole, of which esomeprazole is an enantiomer, has been reported to interact with St. In a cross-over study in 12 healthy male subjects, St. Avoid concomitant use of St. John's Wort or rifampin with esomeprazole magnesium delayed-release capsules.

Tacrolimus Concomitant administration of esomeprazole and tacrolimus may increase the serum levels of tacrolimus. Consider additional follow-up and diagnostic testing in adult patients who have a suboptimal response or an early symptomatic relapse after completing treatment with a PPI.

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© Copyright 2017 Esomeprazole 80mg per day - In the United States, Canada, Australia and the United Kingdom, medication containing esomeprazole magnesium is available as delayed-release capsules or tablets at strengths of 20 mg or 40 mg. In the United states, delayed-release capsules containing mg esomeprazole strontium are also available, as is injectable esomeprazole sodium for ..