Nexium 20 mg Side Effects: Dangers of Long-Term Use
What are the side effects of Nexium 20 mg? How dangerous is long-term use of Nexium? Discover the risks and potential health concerns associated with prolonged Nexium consumption.
What is Nexium?
Nexium is a proton pump inhibitor (PPI) medication used to treat various stomach acid-related conditions, such as gastroesophageal reflux disease (GERD), ulcers, and Zollinger-Ellison syndrome. It is one of the most widely prescribed drugs in the United States, often referred to as “the purple pill.” Nexium comes in several formulations, including prescription, generic, and over-the-counter (OTC) versions.
Nexium Formulations
The different versions of Nexium include:
- Prescription Nexium: Manufactured by AstraZeneca, this formulation is used to treat more serious acid-related disorders.
- Generic Nexium: Several drugmakers manufacture the generic version, esomeprazole, which is available in both prescription and OTC formulations.
- OTC Nexium 24HR: The FDA-approved over-the-counter version for treating chronic heartburn, manufactured by Pfizer.
- Store Brand Nexium 24HR: Generic versions of the 24HR esomeprazole sold under the in-house brands of certain retailers, such as Walmart and Walgreens.
What is Nexium Used to Treat?
Nexium is approved by the FDA to treat the following conditions in adults and children over one year of age:
- Gastroesophageal reflux disease (GERD)
- Erosive esophagitis
- Zollinger-Ellison syndrome
- Stomach ulcers
- Frequent heartburn (OTC versions only)
The prescription version of Nexium can also help the esophagus heal in adults with severe GERD, prevent stomach ulcers in people taking NSAIDs, and treat and prevent stomach ulcers caused by bacteria.
How Should Nexium Be Taken?
The recommended dosage and instructions for taking Nexium vary depending on the formulation:
- Prescription Nexium: Usually taken once daily, although some may require two doses per day.
- OTC Nexium 24HR: Should be taken once daily for up to 14 days every 4 months.
- Nexium Oral Suspension: Granules must be mixed with water before consumption. The amount of water depends on the dosage strength.
- Nexium can also be administered through an orogastric or nasogastric tube, but specific instructions from a healthcare provider should be followed in this case.
It’s important to take Nexium at least one hour before eating, and to swallow the capsules whole without crushing or splitting them. If you cannot swallow the capsule, you can mix the contents with applesauce.
Nexium Overdose
It is possible to overdose on Nexium if you ingest large quantities at once. The maximum recommended daily dose is 80 mg, and taking more than this amount without a healthcare professional’s guidance can lead to serious complications. If someone you know has overdosed on Nexium or is experiencing symptoms like unconsciousness, seizures, or difficulty breathing, call 911 or the poison helpline at 1-800-222-1222 immediately.
Nexium Side Effects
The most common side effects of Nexium include:
- Headache
- Nausea
- Abdominal pain
- Constipation
- Diarrhea
- Dry mouth or unusual taste
- Flatulence
More serious side effects have also been reported, such as kidney damage and bone fractures. Thousands of people have filed lawsuits against AstraZeneca, the manufacturer of Nexium, alleging that the company failed to adequately warn the public about the potential for kidney problems associated with the drug.
Dangers of Long-Term Nexium Use
Prolonged use of Nexium, as well as other proton pump inhibitors (PPIs), has been linked to several health concerns, including:
- Kidney damage and chronic kidney disease
- Increased risk of bone fractures, especially in the hip, wrist, and spine
- Vitamin and mineral deficiencies, such as vitamin B12, calcium, and magnesium
- Increased risk of infections, such as Clostridium difficile (C. diff) and pneumonia
- Dementia and cognitive impairment
If you have been taking Nexium or other PPIs for an extended period, it is important to discuss the potential risks with your healthcare provider and consider alternative treatment options or ways to minimize your exposure to the medication.
Side Effects & Dangers of Long-Term Use
Nexium (esomeprazole) is a medicine used to treat GERD, ulcers and other stomach acid-related conditions. It belongs to a class of drugs called proton pump inhibitors. Nexium side effects include headaches, constipation and nausea, and it may lead to kidney damage and bone fractures
What Is Nexium?
Nexium is part of a class of drugs called proton pump inhibitors (PPIs). It is one of the most widely used medications in the United States for stomach acid-related conditions. Many people refer to it as “the purple pill.”
Nexium comes in four versions:
- Prescription Nexium: AstraZeneca manufactures this formulation that treats serious acid-related disorders.
-
Generic Nexium: Several drugmakers manufacture esomeprazole, or generic Nexium. It is available in prescription and over the counter formulations. -
OTC Nexium 24HR: The U. S. Food and Drug Administration (FDA) approved this over-the-counter version of Nexium to treat chronic heartburn. Pfizer manufactures it. -
Store Brand Nexium 24HR: This generic version of 24HR esomeprazole is sold under the in-house brands of certain retailers, including Walmart and Walgreens.
Nexium 24HR tablet.
Esomeprazole is the active ingredient in all versions of Nexium. Its chemical composition is almost identical to that of omeprazole, the active ingredient in Prilosec. Some studies show esomeprazole is slightly more effective at controlling stomach acid than omeprazole.
What Is Nexium Used to Treat?
Nexium treats serious stomach acid-related conditions in adults and children older than one year of age. Prescription Nexium also may allow the esophagus to heal in adults with serious GERD, prevent stomach ulcers in people who take NSAIDs and treat, as well as prevent, stomach ulcers that bacteria can cause.
The FDA approved Nexium to treat:
- Gastroesophageal reflux disease (GERD)
-
Erosive esophagitis -
Zollinger-Ellison syndrome -
Stomach ulcers -
Frequent heartburn (OTC versions only)
People who experience heartburn more than two days a week can take OTC Nexium to relieve their symptoms. The medication is not a treatment for sudden heartburn, but it can help control acid problems for up to 24 hours when taken regularly. It may take up to four days for the drug to take effect.
How Should I Take Nexium?
Most people with a Nexium prescription can take it once a day, although some people can take two doses a day. Over-the-counter versions of the drug should be taken once a day for up to 14 days every four months. The best time to take Nexium is at least one hour before eating.
Take Nexium capsules whole. Don’t crush or split pills. If you cannot swallow a whole capsule, you can mix the contents into a tablespoon of applesauce and eat that.
For Nexium in oral suspension form, you must mix it with water before you can take it:
- Mix 2.5 mg or 5 mg packets of granules with one teaspoon of water.
-
Mix 10 mg, 20 mg or 40 mg packets with one tablespoon of water.
Give a mixture two to three minutes to thicken, then drink all the liquid within 30 minutes.
You can also take Nexium through an orogastric or nasogastric tube. If this is how you take it, get specific directions from your healthcare provider and follow them.
Nexium Overdose
You can overdose on Nexium if you ingest large quantities at one time. Don’t take more than 80 mg per day (the maximum recommended dose) unless a healthcare professional directs you to do so.
If someone you know overdoses on Nexium or falls unconscious after taking it, has seizures or has difficulty breathing, call 911 for emergency treatment. You can also call the poison helpline at 1-800-222-1222 or visit https://www.poisonhelp.org/help for more information on how to avoid serious complications.
Side Effects of Nexium
The most common Nexium side effects include headache and nausea. Serious side effects include kidney damage and bone fractures. Thousands of people have filed Nexium lawsuits after they took Nexium and later developed kidney disease. According to lawsuits, AstraZeneca knew the drug could cause kidney problems but failed to warn the public.
Common side effects of Nexium include:
- Abdominal pain
-
Constipation -
Decreased appetite -
Diarrhea -
Dry mouth or an unusual taste in the mouth -
Flatulence -
Headache -
Nausea
Infants who take Nexium may experience abnormal liver enzymes, rapid breathing and regurgitation. Children who take Nexium may get drowsy.
Nexium may cause other side effects beyond those listed here. Contact your doctor if you experience after-effects that interfere with your quality of life or that do not go away.
Serious Side Effects of Nexium
While most people tolerate Nexium well, some people experience severe side effects from the medication.
Less common side effects include:
- Acne
-
Allergic reactions -
Blisters, peeling skin, hives, rashes or polyps -
Changes in urination frequency or bloody urine -
Difficulty breathing or irregular heartbeat -
Dizziness, lightheadedness or excessive tiredness -
Elevated liver enzymes, irregular blood cell count or vitamin B-12 deficiency -
Fever -
Hoarseness or difficulty swallowing -
Jaundice, or yellowing of the skin and eyes -
Severe diarrhea or bloody stool -
Severe nausea or loss of appetite -
Swelling, joint pain, muscle cramps or weakness -
Uncontrollable shaking, jitteriness or seizures
Nexium increases the risk of developing cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). People with either disease may see their condition worsen if they take Nexium.
The drug also increases the likelihood of developing bone fractures.
Some people who took Nexium reported blurred vision, hepatitis and autoimmune issues after taking it. People reported these side effects outside the scope of clinical trials, so scientists can’t verify a link to the drug.
Talk to your doctor immediately if you experience any of these serious side effects after taking Nexium.
Lawsuit Information
Proton pump inhibitors like Nexium have been involved in over 12,000 lawsuits. Learn more about these cases.
View Lawsuits
Precautions Before Taking Nexium
Nexium may not be safe and helpful for everyone. Consult your doctor about Nexium before taking an over-the-counter version of the medication if you have any conditions or take medications that may result in adverse interactions.
Before taking Nexium, tell your doctors:
- If you have allergies to any medications or medication ingredients, especially if they’re in esomeprazole or other PPIs.
-
If you take blood thinners, methotrexate, HIV medications, antifungal drugs or any other medications that may interact with Nexium. -
If you take vitamins or supplements, including St. John’s Wort. -
If you have an autoimmune disease, liver disease, low magnesium or vitamin B-12 levels or osteoporosis. -
If you’re pregnant or if you plan to become pregnant. -
If you took OTC Nexium for more than 14 days and are experiencing bloody stools, severe heartburn, nausea, vomiting or unexplained weight loss. (You may have a more serious condition that Nexium can’t treat.)
Ask about Nexium and other PPIs and about how your medical history might impact their effectiveness for you.
Nexium Drug Interactions
Drug interactions can affect how Nexium and other medications perform. Some studies suggest taking PPIs with aspirin may weaken aspirin’s effectiveness.
A study in the European Journal of Hospital Pharmacy examined medical records of 1,288 elderly people who had multiple drug prescriptions. In that group, 65% of people who had an esomeprazole prescription also had a prescription for at least one of 18 other medications that could cause a severe negative interaction.
A 2022 medical literature review published in Expert Opinion on Drug Metabolism & Toxicology also found that esomeprazole may strongly inhibit the cytochrome CYP2C19. This may reduce your body’s ability to metabolize certain medications, including antidepressants, antifungals, antiplatelet drugs and anticancer compounds.
To avoid problematic drug interactions with Nexium, tell your doctor about all the medications you take before you start a dose of Nexium. You can find a list of potential drug interactions on Nexium’s prescribing information.
When to Stop Taking Nexium
You should not stop taking prescription Nexium without speaking to your medical provider. Stopping your medication suddenly may lead to Nexium withdrawal symptoms and could make your stomach problems worse.
Many Nexium side effects are mild and may go away after your body gets used to the medication. If you experience a serious side effect like an allergic reaction, seek emergency medical help immediately.
If you want to stop taking Nexium, discuss your treatment goals with your doctor. Ask about alternatives to PPIs that might help you, such as h3 blockers, antacids or lifestyle changes. You may need to see your doctor several times to taper your Nexium dose before stopping it entirely.
FDA Warnings About Nexium
The FDA released several warnings about Nexium’s side effects and contraindications, which were added to the warnings and precautions section of Nexium’s drug label.
Among the most recent:
- In November 2021, the FDA sent a letter to AstraZeneca advising that labeling information include risks of hypocalcemia (calcium deficiency) and hypokalemia (low potassium) in patients treated with PPIs for at least three months, severe adverse skin reactions and drug-induced hypersensitivity syndrome (that can impact organs).
-
In October 2021, the FDA issued a warning following reports of erectile dysfunction in people taking PPIs, including Nexium and generic esomeprazole. It took no regulatory action. -
In November 2020, the FDA cautioned people about acute tubulointerstitial nephritis (a type of kidney damage) developing for people who take PPIs. -
In October 2020, drugmakers changed Nexium’s drug label to state that people taking products containing rilpivirine (an HIV antiviral medication) should not take Nexium at the same time.
Past warnings about Nexium have included potential increased risks of low magnesium levels, vitamin B12 deficiency, and clostridium difficile-associated diarrhea. Warnings about rare, but serious possible increased risks have included bone fractures, acute interstitial nephritis, new or worsening lupus and potential fetal harm.
Is Nexium Safe?
Most people who take Nexium tolerate it well and experience mild side effects, if any. Like all medications, it carries some risks. For some, the benefits of taking it outweigh these risks.
Talk to your doctors about whether Nexium is safe for you. They can evaluate your pre-existing health conditions and any recent changes to your health and weigh those against your current medications.
Nexium Facts
Please seek the advice of a medical professional before making health care decisions.
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Uses, side effects, and cautions
Nexium (esomeprazole) reduces the production of acid in the stomach. It can treat numerous stomach conditions. A person may wish to discuss Nexium side effects with their doctor before taking the medication.
They are commonly prescribed to treat problems related to excess stomach acid, including gastrointestinal reflux disease (GERD) and peptic ulcers.
This article will look at the uses of Nexium, how it works, and any adverse effects or precautions.
Fast facts about Nexium
- Nexium, or esomeprazole, is a proton pump inhibitor (PPI).
- It reduces the production of stomach acid and relieves the symptoms of gastrointestinal reflux.
- Side effects include headache, nausea and flatulence, and possibly a higher risk of a hip fracture.
- It might reduce the absorption of certain nutrients.
- Some people may be using a PPI without really needing one.
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Share on PinterestNexium and other PPIs are prescribed for gastro-esophageal reflux disease (GERD) and other gastric conditions.
Nexium is a proton pump inhibitor (PPI), one of the most widely sold groups of drugs in the world.
PPIs such as Nexium reduce stomach acid secretion. They affect the parietal cells in the stomach wall. These cells secrete hydrochloric acid and intrinsic factor, an important factor in the absorption of vitamin B 12.
The drug works by inhibiting hydrogen potassium ATPase (H+/K+ ATPase), a transporter that is responsible for acidifying the stomach.
Nexium is most commonly used to treat the following conditions:
Dyspepsia, or indigestion: Symptoms include nausea, heartburn, and upper abdominal fullness and pain.
Peptic ulcer disease: There is a gap in the lining of the stomach, esophagus, or intestine.
Gastroesophageal reflux disease (GERD): A chronic condition where stomach acid comes up from the stomach into the esophagus and damages the mucosa, leading to heartburn.
Zollinger-Ellison syndrome: A pancreatic tumor overstimulates the production of stomach acid.
Nexium may be used by patients who are taking nonsteroidal anti-inflammatory drugs (NSAIDs). This is due to NSAIDs’ propensity to produce stomach ulcers; Nexium helps prevent their formation.
PPIs include Aciphex, Zegerid, Prilosec, Protonix and Prevacid.
The effects of Nexium on mild symptoms are comparable to similar drugs. However, Nexium appears to be more effective than some drugs for more severe symptoms.
It also appears to improve esophageal healing rates, compared with some other leading brands.
Nexium comes as a capsule, which prevents it from being released too quickly. A rapid release would cause the medication to be broken down by the stomach acid.
Other ways of taking it include mixing granules with water, and delivering this solution through a feeding tube.
It is usually taken once a day, at the same time every day, around 1 hour before eating. For some conditions, it is taken twice a day.
It is important to follow the doctor’s instructions and to read the information leaflet carefully.
The most common adverse effects of Nexium are:
- headache
- diarrhea, nausea, and flatulence
- decreased appetite
- constipation
- dry mouth or an unusual taste in the mouth
- abdominal pain
Less commonly, it may lead to:
- allergic reactions
- dark urine
- chest or back pain
- acne
- changes in heart rhythm
- fever
- yellow coloration of the eyes or skin, known as jaundice
- extreme fatigue and muscle weakness
- unusual bleeding or bruising
- paresthesia, a tingling or prickly sensation
- persistent sore throat
- severe stomach pain
- muscle spasms and shaking
- diarrhea and watery stools
- seizures
If anyone has any of these symptoms, they should contact a doctor immediately.
Nexium can give rise to some additional problems.
Hip fracture
There is some evidence that long-term use of esomeprazole can increase the chances of hip fracture.
One theory is that PPIs interfere with calcium absorption, which may weaken bones.
Another is that they impact normal bone recycling by inhibiting proton pumps in the body that are involved in bone creation and remodeling.
One study found no link between intestinal calcium absorption and PPI use in women after menopause. The researchers note that this could be because it was a short-term investigation, lasting only 30 days, or because people who use a PPI may have other risk factors already.
Other studies have found no link between low calcium absorption and PPI use.
Clostridium difficile infection
PPIs have been linked with an initial bout of Clostridium difficile infection (CDI) and recurrence. Some researchers suggest that some people are prescribed a PPI without needing one, and that discontinuing use could reduce the risk of infection.
Pneumonia
One study of data for 63,878 hospital admissions to a hospital in Boston, MA, from January 2004 through December 2007, found that patients using PPIs had a 30-percent higher chance of developing hospital-acquired pneumonia.
Over half of the patients admitted were prescribed a PPI, and 2,219 of them acquired pneumonia in the hospital, or 3.5 percent of all the patients.
A study in the United Kingdom (U.K.) found that outpatients using a PPI had a higher risk of pneumonia than the general population for the first 30 days of using the drug, and especially in the first 2 days.
Polyps
Nexium and other PPIs may be associated with hyperplasia, or a thickening of the stomach lining, which could lead to a benign tumor. However, evidence supporting this is limited.
Kidney damage
Some studies have found a correlation between PPIs and chronic kidney disease, but it is not clear whether the link is causal.
Nutritional
Some evidence suggests that, because gastric acid breaks down food, and because PPIs reduce the levels of acid, nutritional deficits may occur.
Some researchers have suggested that PPIs might interfere with the absorption of calcium, iron, and vitamin B 12, but more studies are needed to confirm this.
There are many confounding variables, however, and how these factors interact is not yet fully understood. The strongest evidence for nutritional shortfalls is in regard to magnesium.
Nexium is a competitive inhibitor of the enzyme CYP2C19, so it might affect drugs that rely on this enzyme.
Diazepam and warfarin are broken down by CYP2C19. If these are used alongside a PPI, level of active ingredients in the body might rise.
Clopidogrel (Plavix) needs CYP2C19 to be converted into its active form. Using this type of drug alongside Nexium will reduce its effect.
Changes in stomach acidity can also affect the way certain drugs are absorbed.
Ketoconazole and atazanavir are best absorbed in an acidic environment. Ketoconazole is an antifungal treatment, and atazanavir is used in HIV therapy,
Erythromycin is degraded by stomach acid. A more alkaline situation will increase absorption.
An overdose can lead to:
- confusion
- drowsiness
- vision problems
- nausea
- sweating and flushing
- headache
- dry mouth
- rapid heartbeat
In the case of an overdose, contact the local poison control center or seek medical attention.
Research published in 2016 found that people using a PPI had an 11.8-percent risk of chronic kidney disease (CKD) over 10 years, compared with an expected risk of 8.5 percent if they had not used a PPI.
However, it is possible that people who are prescribed a PPI may already be at higher risk of CKD.
In 2013, over 15 million Americans were using a prescription PPI.
Statistics suggest that between 40 and 70 percent of patients are given some kind of PPI during a stay in the hospital.
Studies suggest that up to 70 percent of PPI use may not be necessary, and that in 25 percent of cases, the person could stop use it without the risk of developing symptoms.
People who use a PPI and who feel they may not be at risk of symptoms should speak to their doctor about the possibility of discontinuing its use.
Always follow the physician’s advice when using any medication, and read the patient information leaflet before use.
Analogues, side effects, composition, contraindications
Date of publication: 08/03/2022 POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED. number 31944
All authors
Contents of the article
- Nexium: active substance
- Nexium: composition
- Nexium: dosage
- Nexium taken before meals or after meals
- Nexium: side effects
- Nexium and alcohol: compatibility
- Nexium: analogues
- Nexium or Omeprazole: which is better
- Rabeprazole or Nexium: which is better
- Ask an expert on the topic of the article
9001 5 Nexium or Omez: which is better
Every day, customers come to the pharmacy with complaints of pain in the upper abdomen, bouts of sour belching, heartburn, gas formation and constipation. These symptoms are characteristic of a disease of the stomach with high acidity.
Improper diet, stress, drugs, infections, alcohol abuse and smoking are causes that increase the production of hydrochloric acid in the stomach
Excess hydrochloric acid leads to inflammation of the gastric mucosa, damage and ulceration. Acid enters the esophagus and duodenum (duodenum), which are not adapted to the effects of such an aggressive environment. To prevent the development of diseases such as gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), an integrated approach is needed. It includes lifestyle changes, diet and medication.
Pharmacist Natalia Dolgikh talks about Nexium, which reduces the amount of acid in the stomach. We will learn the composition, why it is prescribed and how to take the medicine. We list the possible side effects and analogues of the drug.
All products Nexium
21 review
Nexium: active substance
The active substance of Nexium medicine is esomeprazole magnesium trihydrate. It belongs to the so-called proton pump inhibitors (PPIs). It is an enzyme that releases hydrochloric acid in the stomach. Esomeprazole blocks it, reduces acid secretion and reduces its irritating effect on the walls of organs.
In addition to this property, esomeprazole inhibits the vital activity of the bacterium Helicobacter pylori, which provokes the occurrence of stomach ulcers.
Why Nexium is prescribed:
- treatment and prevention of erosive reflux esophagitis
- treatment of symptoms of gastroesophageal reflux disease (GERD)
- treatment of duodenal ulcer associated with Helicobacter pylori
- prevention of recurrence of stomach ulcers caused by Helicobacter pylori
- prevention and healing of gastric ulcers with long-term use of non-steroidal anti-inflammatory drugs (NSAIDs)
- hypersecretion of gastric glands
Nexium: composition
Nexium is produced in the form of tablets and pellets for the preparation of a suspension in an enteric coating. In addition to esomeprazole, the composition of the drug includes excipients and sucrose. Their content should be taken into account when prescribing to diabetics and allergy sufferers.
Tablets contain 20 mg and 40 mg of esomeprazole and a 10 mg pellet suspension in one sachet. The latter is intended for children and patients with difficulty in swallowing.
Nexium: dosage
Dosage and regimen of Nexium depends on the nature and severity of the disease. Dosage adjustment is required for long-term therapy in patients with severe liver and kidney disease.
- GERD: The dosage depends on the weight of the child and is 10-20 mg once a day for 8 weeks. For adults and children over 12 years: 40 mg once a day for 4 weeks, if necessary, repeat the course. Relapse prevention and symptom management: 20 mg once a day.
- Peptic ulcer of the stomach and duodenum: as part of complex treatment for 20 mg
- Healing and prevention of gastric ulcers with long-term use of NSAIDs: 20-40 mg once a day for 4-8 weeks.
- Hypersecretion of the gastric glands: the initial dose is 40 mg 2 times a day, then the dose and duration are selected by the doctor individually.
Nexium taken before meals or after meals
Eating slows down the absorption of esomeprazole in the stomach, but this does not affect its effectiveness. Doctors recommend taking Nexium in the morning 30 minutes before meals. So the drug will begin to work at the moment when food stimulates the secretion of gastric juice.
Nexium tablets and pellets are taken orally without chewing, washed down with water. You can dissolve the tablet in half a glass of water and drink as a suspension.
Nexium side effects
The most common side effects of Nexium are:
- headache, dizziness
- abdominal pain, diarrhoea, constipation, bloating
- nausea, vomiting
- dermatitis, pruritus, rash, urticaria
- sleep disorders
- goosebumps
- dry mouth
- blurred vision
- edema
- increased activity of liver enzymes
Nexium and alcohol: compatibility
There is no information on the compatibility of Nexium with alcohol in the instructions for the drug. Ethyl alcohol and its decay products exacerbate the manifestations of gastritis, ulcers, increase the risk of bleeding and are toxic to the kidneys and liver. If you drink alcohol during treatment with Nexium, then the effectiveness of the treatment decreases, and the side effects increase.
Nexium: analogues
Nexium analogues include all drugs from the PPI group. These are medicines containing:
- esomeprazole: Emanera
- omeprazole: Losek, Omez, Gastrozol, Ultop
- rabeprazole: Pariet, Razo, Rabelok, Hairabezol
- lansoprazole: Lancid
- pantoprazole: Controloc, Nolpaza
- dexlansoprazole: Dexilant
All analogues, like Nexium, have proven effectiveness. It is supported by clinical and post-marketing studies. You can only replace Nexium on your own with Emanera. Check with your pharmacist first to find the right dosage.
Nexium or Esomeprazole: which is better?
Preparations are complete analogues, with the same active ingredient. They differ in manufacturers, forms of release and place of production of substances.
All products Emaner
20 reviews
Nexium or Omeprazole: which is better
Omeprazole is approved for use by women during pregnancy and breastfeeding as prescribed by a doctor. It has indications of dyspepsia associated with high acidity. Omeprazole is prescribed for children from the age of 2 for GERD, and from the age of 4 for a duodenal ulcer caused by Helicobacter pylori. The bactericidal effect of omeprazole on the bacterium Helicobacter pylori 9 has been confirmed0082 in vitro .
Nexium penetrates the stomach tissue better than omeprazole. Prohibited for pregnant and lactating women. The drug in the form of pellet-granules with a dosage of 10 mg is prescribed for children from 1 year old only with GERD. Nexium is not used for dyspepsia.
Nexium or Omez: which is better
Omez contains the active ingredient omeprazole, the left isomer of which is Nexium. They have the same chemical formula of the molecule. Indications and side effects are similar.
Read more about the drug in the article: Omez: instructions for use
Omez is a drug that is available in dosages of 10, 20 and 40 mg. The 10mg capsules are available over-the-counter and are used to relieve symptoms of dyspepsia, maintenance therapy against relapses of GERD and duodenal ulcers. The dosage of 10 mg is prohibited for children under 18 years of age.
Omez in other dosages, unlike Nexium, is used to treat duodenal ulcers in children from 4 years of age. Other contraindications for drugs overlap.
Rabeprazole or Nexium: which is better
According to the instructions, Rabeprazole has less indications for use than Nexium. It is prescribed for symptoms of dyspepsia and GERD. Eating does not affect its absorption. Contraindicated in children under 18, pregnant and lactating women. Compatible with antacids.
Nexium is suitable for the treatment of a wider range of diseases, including during pregnancy, when the expected benefit to the woman outweighs the possible risk to the fetus. Nexium is indicated for the treatment of children. Released by prescription.
Rabeprazole is best used to relieve the symptoms of dyspepsia, heartburn, belching with increased acidity. It is not recommended to take it for more than 14 days without a doctor’s prescription.
All products Omez
20 reviews
All products Omeprazole-Teva
15 reviews
All products Omeprazole
11 reviews
- Nexium is a drug with the active substance esomeprazole magnesium trihydrate.
- The drug inhibits the secretion of hydrochloric acid in the stomach and is active against Helicobacter pylori.
- The doses of the drug are adjusted according to the age of the patient and the condition to be treated.
- Nexium is taken once a day, preferably in the morning, 30 minutes before meals.
- This product may cause side effects – please read them before starting treatment. If they appear or other conditions that are not described in the instructions, contact a specialist.
- It is not recommended to drink alcohol during treatment with the drug
- The drug has 100 analogues, but you can only replace Nexium on your own with Emanera. Check with your pharmacist first to find the right dosage.
Ask an expert about the topic of the article
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Nexium, tbl p / o 20mg №28
The appearance of the product may differ from that shown in the photo
Characteristic: COMPOSITION
Each Nexium tablet contains :
– esomeprazole magnesium trihydrate 22.3 mg or 44.5 mg, respectively. 20 mg and 40 mg esomeprazole.
excipients: glyceryl monostearate 40-55, hyprolose, hypromellose, iron dye red oxide E172, iron dye yellow oxide E172 (for a dosage of 20 mg), magnesium stearate, methacrylic and ethacrylic acid copolymer (1:1), microcrystalline cellulose, paraffin , macrogol, polysorbate 80, crospovidone, sodium stearyl fumarate, sucrose spherical granules, titanium dioxide E171, talc, triethyl citrate.
Farmgroup: agent that lowers the secretion of gastric glands – a proton pump inhibitor.
Pharmacological action: Esomeprazole is the S-isomer of omeprazole and reduces the secretion of hydrochloric acid in the stomach by specific inhibition of the proton pump in the parietal cells of the stomach. The S- and R-isomers of omeprazole have similar pharmacodynamic activity.
Mechanism of action
Esomeprazole is a weak base that becomes active in the highly acidic environment of the secretory tubules of the parietal cells of the gastric mucosa and inhibits the proton pump – the enzyme H + / K + – ATPase, while inhibiting both basal and stimulated secretion of hydrochloric acid.
Influence on the secretion of acid in the stomach.
The action of esomeprazole develops within 1 hour after oral administration of 20 mg or 40 mg. With daily administration of the drug for 5 days at a dose of 20 mg once a day, the average maximum concentration of hydrochloric acid after stimulation with pentagastrin is reduced by 90% (when measuring the acid concentration 6-7 hours after taking the drug on the 5th day of therapy).
In symptomatic patients with gastroesophageal reflux disease (GERD) after 5 days of daily oral administration of esomeprazole 20 mg or 40 mg, intragastric pH above 4 was maintained for an average of 13 and 17 hours out of 24 hours. While taking esomeprazole at a dose of 20 mg per day, intragastric pH above 4 was maintained for at least 8, 12 and 16 hours in 76%, 54% and 24% of patients, respectively. For 40 mg esomeprazole, this ratio is 97%, 92% and 56%, respectively.
A correlation was found between the plasma concentration of the drug and inhibition of hydrochloric acid secretion (the AUC parameter (area under the concentration-time curve) was used to assess the concentration).
The therapeutic effect achieved as a result of inhibition of hydrochloric acid secretion. healing of reflux esophagitis occurs in approximately 78% of patients after 4 weeks of therapy and in 93% after 8 weeks of therapy.
Treatment with Nexium 20 mg twice daily in combination with appropriate antibiotics for one week leads to successful eradication of Helicobacter pylori about 90% of patients.
Patients with uncomplicated peptic ulcer after a week of eradication do not require subsequent monotherapy with drugs that reduce the secretion of the gastric glands to heal the ulcer and eliminate symptoms.
The efficacy of Nexium in peptic ulcer bleeding was shown in a study of patients with endoscopically confirmed peptic ulcer bleeding.
Other effects associated with inhibition of hydrochloric acid secretion. During treatment with drugs that reduce the secretion of the gastric glands, the concentration of gastrin in plasma increases as a result of a decrease in acid secretion.
In patients who have received esomeprazole for a long time, there is an increase in the number of enterochromaffin-like cells, probably associated with an increase in plasma gastrin concentration.
In patients taking drugs that reduce the secretion of the gastric glands for a long period of time, the formation of glandular cysts in the stomach is more common. These phenomena are due to physiological changes as a result of a pronounced inhibition of the secretion of hydrochloric acid. The cysts are benign and regress.
The use of drugs that suppress the secretion of hydrochloric acid in the stomach, including proton pump inhibitors, is accompanied by an increase in the content of microbial flora in the stomach, which is normally present in the gastrointestinal tract. The use of proton pump inhibitors may lead to a slight increase in the risk of infectious diseases of the gastrointestinal tract caused by bacteria of the genus Salmonella spp. and Campylobacter spp.
In two comparative studies conducted with ranitidine, Nexium showed better efficacy in healing gastric ulcers in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 (COX-2) inhibitors.
In two studies, Nexium showed high efficacy in the prevention of gastric and duodenal ulcers in patients treated with NSAIDs (age group over 60 years and / or with a history of peptic ulcer), including selective COX-2 inhibitors.
Pharmacokinetics: Absorption and distribution. Esomeprazole is unstable in an acidic environment, therefore, tablets containing granules of the drug, the shell of which is resistant to the action of gastric juice, are used for oral administration. Under in vivo conditions, only a small part of esomeprazole is converted to the R-isomer. The drug is rapidly absorbed: the maximum plasma concentration is reached 1-2 hours after ingestion. The absolute bioavailability of esomeprazole after a single dose of 40 mg is 64% and increases to 89% against the background of daily intake once a day. For a dose of 20 mg of esomeprazole, these figures are 50% and 68%, respectively. The volume of distribution at steady state concentration in healthy people is approximately 0.22 l/kg of body weight. Esomeprazole binds to plasma proteins by 97%.
Eating slows down and reduces the absorption of esomeprazole in the stomach, but this does not significantly affect the effectiveness of inhibition of hydrochloric acid secretion.
Metabolism and excretion. Esomeprazole is metabolized with the participation of the cytochrome P450 system. The main part is metabolized with the participation of a specific polymorphic isoenzyme CYP2C19, with the formation of hydroxylated and desmethylated metabolites of esomeprazole. The metabolism of the remaining part is carried out by the CYP3A4 isoenzyme; in this case, a sulfo derivative of esomeprazole is formed, which is the main metabolite determined in plasma.
The parameters below mainly reflect the nature of the pharmacokinetics in patients with increased activity of the CYP2C19 isoenzyme.
The total clearance is approximately 17 l / h after a single dose of the drug and 9 l / h after multiple doses. The elimination half-life is 1.3 hours when taken systematically once a day. The area under the concentration-time curve (AUC) increases with repeated administration of esomeprazole. The dose-dependent increase in AUC with repeated administration of esomeprazole is non-linear, which is a consequence of a decrease in first-pass metabolism through the liver, as well as a decrease in systemic clearance, probably caused by inhibition of the CYP2C19 isoenzymeesomeprazole and/or its sulfonic derivative. With daily intake once a day, esomeprazole is completely eliminated from the blood plasma between doses and does not accumulate.
Major metabolites of esomeprazole do not affect gastric acid secretion. When administered orally, up to 80% of the dose is excreted as metabolites in the urine, the rest is excreted in the faeces. Less than 1% of unchanged esomeprazole is found in the urine.
Features of pharmacokinetics in some groups of patients. Approximately 2.9±1.5% of the population reduced activity of the CYP2C19 isoenzyme. In such patients, the metabolism of esomeprazole is mainly carried out as a result of the action of CYP3A4. With the systematic administration of 40 mg of esomeprazole once a day, the average AUC value is 100% higher than the value of this parameter in patients with increased activity of the CYP2C19 isoenzyme. The average values of the maximum plasma concentrations in patients with reduced activity of the isoenzyme are increased by approximately 60%. These features do not affect the dose and route of administration of esomeprazole.
In elderly patients (71-80 years), the metabolism of esomeprazole does not undergo significant changes.
After a single dose of 40 mg of esomeprazole, the mean AUC in women is 30% higher than that in men. With daily administration of the drug once a day, there are no differences in pharmacokinetics in men and women. These features do not affect the dose and route of administration of esomeprazole.
In patients with mild to moderate hepatic insufficiency, the metabolism of esomeprazole may be impaired. In patients with severe hepatic insufficiency, the metabolic rate is reduced, which leads to an increase in the AUC value for esomeprazole by 2 times.
Pharmacokinetics have not been studied in patients with renal insufficiency. Since not esomeprazole itself is excreted through the kidneys, but its metabolites, it can be assumed that the metabolism of esomeprazole in patients with renal insufficiency does not change.
In children aged 12-18 years, after repeated administration of 20 mg and 40 mg of esomeprazole, the AUC value and the time to reach maximum plasma concentration (tmax) were similar to AUC and tmax values in adults.
Readings: Gastroesophageal reflux disease:
– Treatment of erosive reflux esophagitis
– Long-term maintenance treatment after healing of erosive reflux esophagitis to prevent recurrence
– Symptomatic treatment of gastroesophageal reflux disease
Gastric and duodenal ulcer
As part of combination therapy :
– ulcer treatment duodenal ulcer associated with Helicobacter pylori
– prevention of recurrence of peptic ulcer associated with Helicobacter pylori
Long-term acid-suppressing therapy in patients who have had bleeding from a peptic ulcer (after intravenous use of drugs that reduce the secretion of the gastric glands to prevent relapse).
Patients on long-term use of NSAIDs:
– healing of gastric ulcers associated with taking NSAIDs
– prevention of gastric and duodenal ulcers associated with taking NSAIDs in patients at risk
Zollinger-Ellison syndrome or other conditions characterized by pathological hypersecretion of glands stomach, including idiopathic hypersecretion.
Category of action on the fetus: Currently, there is not enough data on the use of Nexium during pregnancy. The results of epidemiological studies of omeprazole, which is a racemic mixture, showed no fetotoxic effect or impaired fetal development.
When esomeprazole is administered to animals, no direct or indirect adverse effects on embryonic or fetal development have been identified. The introduction of the racemic mixture of the drug also did not have any negative effect on animals during pregnancy, childbirth, and also during postnatal development.
The drug should be prescribed to pregnant women only if the expected benefit to the mother outweighs the possible risk to the fetus.
It is not known whether esomeprazole is excreted in breast milk, so Nexium should not be administered during breastfeeding.
Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or other ingredients of the formulation.
Hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency.
Children under 12 years of age (due to the lack of data on the efficacy and safety of the drug in this group of patients) and children over 12 years of age for indications other than gastroesophageal reflux disease.
Esomeprazole should not be co-administered with atazanavir and nelfinavir (see Drug Interactions and Other Drug Interactions).
Precautions – severe renal impairment (experience is limited).
Dosage: I.D. The tablet should be swallowed whole with liquid. Tablets should not be chewed or crushed.
For patients with difficulty in swallowing, the tablets can be dissolved in half a glass of still water (other liquids should not be used as the protective coating of the microgranules may dissolve), stirring until the tablet disintegrates, after which the suspension of microgranules should be drunk immediately or within 30 minutes, after which Fill the glass halfway with water again, stir the rest and drink. Microgranules should not be chewed or crushed.
For patients who cannot swallow, the tablets should be dissolved in still water and administered via a nasogastric tube. It is important that the selected syringe and probe are suitable for this procedure. Instructions for the preparation and administration of the drug through a nasogastric tube are given in the section “Administration of the drug through a nasogastric tube”.
Adults and children over 12 years old
Gastroesophageal reflux disease
Treatment of erosive reflux esophagitis: 40 mg once a day for 4 weeks.
An additional 4-week course of treatment is recommended in cases where, after the first course, healing of esophagitis does not occur or symptoms persist.
Long-term maintenance treatment after healing of erosive reflux esophagitis to prevent recurrence: 20 mg once daily.
Symptomatic treatment of gastroesophageal reflux disease: 20 mg once daily for patients without esophagitis. If after 4 weeks of treatment the symptoms do not disappear, an additional examination of the patient should be carried out. After the symptoms have been eliminated, you can switch to the regimen of taking the drug “as needed”, i.e. take Nexium 20 mg once daily when symptoms recur. For patients taking NSAIDs and at risk of developing gastric or duodenal ulcers, treatment on an “as needed” basis is not recommended.
Adults
Gastric and duodenal ulcer
As part of combination therapy for eradication with Helicobacter pylori:
– treatment of duodenal ulcer associated with Helicobacter pylori: Nexium 20 mg, amoxicillin 1 g and clarithromycin 500 mg. All drugs are taken twice a day for 1 week.
– prevention of recurrence of peptic ulcers associated with Helicobacter pylori: Nexium 20 mg, amoxicillin 1 g and clarithromycin 500 mg. All drugs are taken twice a day for 1 week.
Long-term acid-suppressing therapy in patients who have had bleeding from a peptic ulcer (after intravenous use of drugs that reduce the secretion of the gastric glands to prevent relapse)
Nexium 40 mg 1 time per day for 4 weeks after the end of intravenous
therapy with drugs that reduce the secretion of the gastric glands .
Patients on long-term use of NSAIDs:
– healing of gastric ulcer associated with taking NSAIDs: Nexium 20 mg or 40 mg once a day. The duration of treatment is 4-8 weeks.
– prevention of gastric and duodenal ulcers associated with taking NSAIDs: Nexium 20 mg or 40 mg once a day.
Conditions associated with pathological hypersecretion of the gastric glands, including Zollinger-Ellison syndrome and idiopathic hypersecretion: The recommended initial dose is Nexium 40 mg twice a day. In the future, the dose is selected individually, the duration of treatment is determined by the clinical picture of the disease. There is experience with the use of the drug in doses up to 120 mg 2 times a day.
Renal insufficiency: dose adjustment of the drug is not required. However, experience with Nexium in patients with severe renal impairment is limited; in this regard, when prescribing the drug to such patients, care should be taken (see the section “Pharmacokinetics”).
Hepatic insufficiency: with mild and moderate hepatic insufficiency, dose adjustment of the drug is not required. For patients with severe hepatic insufficiency, the maximum daily dose should not exceed 20 mg.
Elderly patients: dose adjustment of the drug is not required.
Nasogastric tube administration
When nasogastric tube administration:
1. Insert a tablet into the syringe and fill the syringe with 25 ml of water and approximately 5 ml of air. For some probes, it may be necessary to dilute the drug in 50 ml of drinking water in order to prevent clogging of the probe with tablet granules.
2. Shake the syringe immediately for about two minutes to dissolve the tablet.
3. Hold the syringe with the tip up and check that the tip is not clogged.
4. Insert the tip of the syringe into the probe while continuing to hold it pointing upwards.
5. Shake the syringe and turn it upside down. Inject 5-10 ml of the dissolved drug into the tube immediately. After injection, return the syringe to its original position and shake (the syringe must be held with the tip up to avoid clogging the tip).
6. Turn the syringe upside down and inject another 5-10 ml of the drug into the tube. Repeat this operation until the syringe is empty.
7. In the case of the remainder of the drug in the form of sediment in the syringe, fill the syringe with 25 ml of water and 5 ml of air and repeat the operations described in paragraph 5.6. Some probes may require 50 ml of drinking water for this purpose.
Side effects: The following are the side effects that do not depend on the dosing regimen of the drug, noted with the use of Nexium, both in clinical trials and in post-marketing studies.
– Common (>1/100, <1/10) - Headache, abdominal pain, diarrhoea, flatulence, nausea/vomiting, constipation
– Uncommon (>1/1000, <1/100) - Dermatitis, pruritus, rash, urticaria, drowsiness, insomnia, dizziness, paresthesia, dry mouth, blurred vision, peripheral edema, elevated liver enzymes
– Rare (>1/10000, <1/1000) Hypersensitivity reactions (eg, fever, angioedema, anaphylactic reaction/anaphylactic shock), bronchospasm, hepatitis (with or without jaundice), arthralgia, myalgia, leukopenia, thrombocytopenia, depression, hyponatremia , agitation, confusion, taste disturbance, stomatitis, gastrointestinal candidiasis, alopecia, photosensitivity, malaise, sweating
– Very rare (<1/10000) - Agranulocytosis, pancytopenia, hallucinations, aggressive behavior, liver failure, encephalopathy in patients with liver disease, muscle weakness, interstitial nephritis, gynecomastia, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme
Overdose: Extremely rare cases of intentional overdose have been described to date. Oral administration of esomeprazole at a dose of 280 mg was accompanied by general weakness and symptoms from the gastrointestinal tract. A single dose of 80 mg of Nexium did not cause any negative consequences. There is no known antidote for esomeprazole. Esomeprazole binds well to plasma proteins, so dialysis is ineffective. In case of overdose, symptomatic and general supportive treatment should be carried out.
Interaction: Effect of esomeprazole on the pharmacokinetics of other drugs. A decrease in the acidity of gastric juice during treatment with esomeprazole can lead to a change in the absorption of drugs, the absorption of which depends on the acidity of the environment. Esomeprazole, like antacids and other drugs that reduce the secretion of hydrochloric acid in the stomach, can lead to a decrease in the absorption of ketoconazole and itraconazole.
Omeprazole has been shown to interact with some antiretroviral drugs. The mechanisms and clinical significance of these interactions are not always known. An increase in pH during therapy with omeprazole may affect the absorption of antiretroviral drugs. Interaction at the level of CYP2C19 is also possible. With the joint appointment of omeprazole and some antiretroviral drugs, such as atazanavir and nelfinavir, during therapy with omeprazole, there is a decrease in their serum concentration. Therefore, their simultaneous use is not recommended. Co-administration of omeprazole (40 mg once daily) with atazanavir 300 mg/ritonavir 100 mg to healthy volunteers resulted in a significant decrease in the bioavailability of atazanavir (area under the concentration-time curve, maximum (Cmax) and minimum (Cmin) concentrations decreased by approximately 75%). Increasing the dose of atazanavir to 400 mg did not compensate for the effect of omeprazole on the bioavailability of atazanavir.
With the simultaneous appointment of omeprazole and saquinavir, an increase in the concentration of saquinavir in serum was noted, when administered with some other antiretroviral drugs, their concentration did not change. Given the similar pharmacokinetic and pharmacodynamic properties of omeprazole and esomeprazole, co-administration of esomeprazole with antiretrovirals such as atazanavir and nelfinavir is not recommended.
Esomeprazole inhibits CYP2C19, the main isoenzyme involved in its metabolism. Accordingly, the combined use of esomeprazole with other drugs in the metabolism of which CYP2C19 is involved, such as diazepam, citalopram, imipramine, clomipramine, phenytoin, etc., can lead to an increase in plasma concentrations of these drugs, which, in turn, may require a dose reduction. This interaction is especially important to remember when appointing Nexium in the “as needed” mode. When co-administered with 30 mg of esomeprazole and diazepam, which is a substrate of cytochrome CYP2C19, there is a decrease in the clearance of diazepam by 45%.
Esomeprazole 40 mg resulted in a 13% increase in residual phenytoin levels in patients with epilepsy. In this regard, it is recommended to control plasma concentrations of phenytoin at the beginning of treatment with esomeprazole and when it is canceled.
The administration of omeprazole at a dose of 40 mg once a day led to an increase in the area under the concentration-time curve and Cmax of voriconazole (CYP2C19 substrate) by 15% and 41%, respectively.
The co-administration of warfarin with 40 mg of esomeprazole does not lead to a change in coagulation time in patients taking warfarin for a long time. However, several cases of a clinically significant increase in the INR index (international normalized ratio) have been reported with the combined use of warfarin and esomeprazole. It is recommended to control INR at the beginning and at the end of the combined use of esomeprazole and warfarin or other coumarin derivatives.
Co-administration of cisapride with 40 mg of esomeprazole leads to an increase in the pharmacokinetic parameters of cisapride in healthy volunteers: AUC – by 32% and half-life by 31%, however, the maximum concentration of cisapride in plasma does not change significantly. A slight prolongation of the QT interval, which was observed with cisapride monotherapy, did not increase with the addition of Nexium (see the section “Special Instructions”).
Nexium does not cause clinically significant changes in the pharmacokinetics of amoxicillin and quinidine.
Studies evaluating the short-term co-administration of esomeprazole and naproxen or rofecoxib did not reveal a clinically significant pharmacokinetic interaction.
Effect of drugs on the pharmacokinetics of esomeprazole.
CYP2C19 and CYP3A4 are involved in the metabolism of esomeprazole. The combined use of esomeprazole with clarithromycin (500 mg 2 times a day), which inhibits CYP3A4, leads to a 2-fold increase in the AUC of esomeprazole. Co-administration of esomeprazole and a combined inhibitor of CYP3A4 and CYP2C19, for example, voriconazole, can lead to more than a 2-fold increase in the AUC value for esomeprazole. As a rule, in such cases, no dose adjustment of esomeprazole is required. Dose adjustment of esomeprazole may be required in patients with severe hepatic impairment and long-term use.
Special instructions: If you have any alarming symptoms (such as significant spontaneous weight loss, repeated vomiting, dysphagia, vomiting with blood or melena), and if you have a stomach ulcer (or if a stomach ulcer is suspected), you should exclude the presence of a malignant neoplasm, since treatment with Nexium can lead to a smoothing of symptoms and delay the diagnosis.
In rare cases, in patients who have taken omeprazole for a long time, a histological examination of biopsy specimens of the gastric mucosa of the body of the stomach revealed atrophic gastritis.
Patients taking the drug for a long period (especially more than a year) should be under regular medical supervision.
Patients taking Nexium “as needed” should be instructed to contact their physician if symptoms change. Taking into account fluctuations in the concentration of esomeprazole in plasma when prescribing therapy “as needed”, the interaction of the drug with other drugs should be taken into account (see the section “Interaction with other drugs and other types of drug interactions”). When appointing Nexium for the eradication of Helicobacter pylori, the possibility of drug interactions for all components of triple therapy should be taken into account. Clarithromycin is a potent inhibitor of CYP3A4, therefore, when prescribing eradication therapy to patients receiving other drugs that are metabolized with the participation of CYP3A4 (for example, cisapride), possible contraindications and interactions of clarithromycin with these drugs should be considered.