1. Esomeprazole®
The most advanced PPI for acid regulation
IDA

2. Agenda
 Main GIT disorders
 Disorders causes and symptoms.
 Treatment pathways (probe for attendees)
 Why PPI
 Why Esomeprazole (vs. others PPI)
 Indication , side effects and DDI
 Dosage and price

3. Main GIT disorders

4. • Dyspepsia
• Gastroesophageal reflux
disease (GERD)
• Peptic ulcer disease (PUD)
• gastritis

5. Causes and Symptoms

6. Dyspepsia GERD Peptic Ulcer Gastritis
• Abnormal function • Defect in • Inflammation
(dysfunction) of the gastrin of lining of
muscles of the production the stomach
organs of the regulation -> • Caused by:
gastrointestinal induction of Alchol
tract acid Sever
• May be functional production infection
or organic from parietal NSAIDS
(ulcerative)
cells ->
erosion of
mucosa ->
ulcer.
• Caused by :
H.Pylori
NSAIDS

7. Dyspepsia GERD Peptic Ulcer Gastritis
• heart burn • Heartburn • Abdominal • Burbing
• Regurgitation pain
• Early satiety • Dysphagia increased • Bloating
• Odynophagia by food
• Flatulence • Increased • Loss of • Unexplained
salivation appetite weight loss
• Fullness • Nausea • Heart burn
• Chest pain • N&V • Yellow ,
• N&V • Asthma false green or
symptoms • May lead to bloody
• Epigastirc pain perforation vomiting

8. How you deal with that ?

9. Life style Neutralizing Blocking acid Prokinetics
acids production
• Smoking • Antacids • H2 blockers • Promote
downward
• Weight (very temporary emptying of the
loss treatment) • PPI esophagus and
stomach.
• Eating
habits
• Alcohol
• Posture
after
meals

10. Why PPI ?

12. Recent PPI’s:
Lansoprazole
Pantoprazole
Rabeprazole
Omeprazole
Esomeprazole

13. Why Esomeprazole?

14. Esomeprazole vs. Omeprazole
 esomeprazole is the s-enantiomar of omeprazole (racemic
mixture)
 less first pass metabolism -> higher bioavailability -> more
effective and longer lasting acid blockage -> 24 h interval
 Esomeprazole has increased antimicrobial activity
against Helicobacter pylori than omeprazole.
 most of the esomeprazole metabolized by slower acting 3a4
enz, and the remaining metabolized by fast acting 2c19 , also it
binds irreversibly to proton pump inhibiting acid secretion
Journal of Clinical Gastroenterology: July 2004 - Volume 38 - Issue 6 - pp 503-506

16. Comparative Symptoms Relief clinical trial :

19. Indication
• Treatment GERD
• Dyspepsia
• H.Pylori (in combination with clarithromycin or amoxicillin)
• Healing and maintenance of Erosive esophagitis
• Peptic ulcer especially NSAIDS-associated
• Pathological hyper secretory condition e.g. :
Zollinger-Ellison

20. Side effects
 diarrhea,
 Nausea & vomiting
 headaches
 rash and dizziness
 Nervousness
 abnormal heartbeat
 muscle pain, weakness and leg cramps
 water retention :infrequently.

21. Drug – drug interaction:
Increase blood concentration of:
 Diazepam : decrease its hepatic elimination
 Digoxin : increase its gastric absorption
Decrease concentration of:
 Ketoconazole : decrease its gastric absorption

22. Dosage:
 For GERD:
20 or 40 mg of esomeprazole once daily for 4-8 weeks
 For H. pylori:
40 mg once daily + amoxicillin and clarithromycin for 10
days.
 The dose for preventing NSAID-induced ulcers :
20 to 40 mg daily for 6 months.
 Zollinger-Ellison syndrome:
40 mg twice daily.

23. Esomeprazole
14 tablet
70 L.E

24. THANK YOU !