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, severe cutaneous adverse reactions, or cutaneous/systemic lupus erythematosus occurs. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12. Monitor magnesium levels during prolonged therapy. Consider monitoring magnesium, calcium levels in those with preexisting risk of hypocalcemia (eg, hypoparathyroidism). 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 and mineral metabolism. 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