Ema
Generic Name
Esomeprazole 20 mg
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ema 20 mg capsule | ৳ 7.00 | ৳ 70.00 |
Description
Overview of the medicine
Ema 20 mg Capsule contains Esomeprazole, a proton pump inhibitor used to treat conditions involving excessive stomach acid production such as GERD, erosive esophagitis, and Zollinger-Ellison syndrome.
Uses & Indications
Dosage
Adults
Erosive Esophagitis: 20 or 40 mg once daily for 4-8 weeks. Maintenance: 20 mg once daily. Symptomatic GERD: 20 mg once daily for 4 weeks. H. pylori Eradication: 20 mg twice daily for 10 days (with antibiotics). Zollinger-Ellison Syndrome: Initial 40 mg twice daily, adjust as needed.
Elderly
No specific dose adjustment is generally required based on age.
Renal_impairment
No dose adjustment is generally required for patients with renal impairment. However, caution should be exercised in severe cases.
Hepatic_impairment
For severe hepatic impairment (Child-Pugh Class C), a maximum dose of 20 mg per day should not be exceeded.
How to Take
Take the capsule whole with water at least one hour before a meal. Do not crush or chew. For patients who have difficulty swallowing, the capsule may be opened and the enteric-coated granules mixed with a spoonful of applesauce or yogurt and swallowed immediately.
Mechanism of Action
Esomeprazole is a proton pump inhibitor that specifically inhibits the H+/K+-ATPase enzyme system (proton pump) in the gastric parietal cells, thereby blocking the final step of acid secretion.
Pharmacokinetics
Onset
Within 1 hour; maximal acid suppression typically achieved within 2-4 days of daily dosing.
Excretion
Mainly excreted in urine (approximately 80%) and feces (approximately 20%) as inactive metabolites.
Half life
Approximately 1.5 hours.
Absorption
Rapidly absorbed after oral administration. Bioavailability is approximately 50-68% at 20 mg and increases with repeated dosing.
Metabolism
Extensively metabolized in the liver by the CYP2C19 and CYP3A4 enzyme systems.
Side Effects
Contraindications
- Hypersensitivity to esomeprazole, other benzimidazole substituted proton pump inhibitors, or any components of the formulation
- Concomitant use with nelfinavir
Drug Interactions
Digoxin
May increase digoxin exposure; monitor digoxin levels.
Diazepam
May increase plasma levels of diazepam due to inhibition of its metabolism.
Warfarin
Increased INR/PT reported; monitor for bleeding, especially at initiation or discontinuation.
Clopidogrel
May reduce the antiplatelet effect of clopidogrel. Concomitant use should be approached with caution.
Methotrexate
Increased methotrexate levels. Consider temporary withdrawal of esomeprazole during high-dose methotrexate treatment.
Atazanavir/Nelfinavir
Significant reduction in plasma concentrations of these antivirals. Concomitant use is contraindicated with nelfinavir and generally not recommended with atazanavir.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose are generally minimal and transient, including drowsiness, tachycardia, and abdominal pain. Treatment should be symptomatic and supportive.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies the potential risk to the fetus. Esomeprazole is excreted in breast milk; use with caution in lactating mothers after careful consideration of benefits versus risks.
Side Effects
Contraindications
- Hypersensitivity to esomeprazole, other benzimidazole substituted proton pump inhibitors, or any components of the formulation
- Concomitant use with nelfinavir
Drug Interactions
Digoxin
May increase digoxin exposure; monitor digoxin levels.
Diazepam
May increase plasma levels of diazepam due to inhibition of its metabolism.
Warfarin
Increased INR/PT reported; monitor for bleeding, especially at initiation or discontinuation.
Clopidogrel
May reduce the antiplatelet effect of clopidogrel. Concomitant use should be approached with caution.
Methotrexate
Increased methotrexate levels. Consider temporary withdrawal of esomeprazole during high-dose methotrexate treatment.
Atazanavir/Nelfinavir
Significant reduction in plasma concentrations of these antivirals. Concomitant use is contraindicated with nelfinavir and generally not recommended with atazanavir.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose are generally minimal and transient, including drowsiness, tachycardia, and abdominal pain. Treatment should be symptomatic and supportive.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies the potential risk to the fetus. Esomeprazole is excreted in breast milk; use with caution in lactating mothers after careful consideration of benefits versus risks.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from the date of manufacture
Availability
Available in pharmacies nationwide
Approval Status
Approved by DGDA (Bangladesh), FDA (USA)
Patent Status
Generic available, original patent expired
WHO Essential Medicine
YesClinical Trials
Esomeprazole has been extensively studied in numerous randomized, double-blind, placebo-controlled clinical trials demonstrating its efficacy and safety for various acid-related disorders including GERD, erosive esophagitis, and H. pylori eradication.
Lab Monitoring
- Magnesium levels (especially with long-term use, concomitant diuretics, or other medications that cause hypomagnesemia)
- Liver function tests (if clinically indicated)
- INR/PT (with warfarin co-administration)
- Chromogranin A (CgA) levels (can be increased by PPIs, affecting neuroendocrine tumor diagnosis)
Doctor Notes
- Before initiating therapy, consider ruling out gastric malignancy as PPIs may mask symptoms.
- Monitor patients on long-term therapy for magnesium levels, especially if concomitant diuretics or other hypomagnesemia-inducing drugs are used.
- Inform patients about the potential increased risk of bone fractures with long-term use and counsel on adequate calcium and vitamin D intake.
- Advise caution with concomitant use of clopidogrel and other drugs with narrow therapeutic windows due to potential drug interactions.
Patient Guidelines
- Take Ema exactly as prescribed by your doctor.
- Do not stop taking the medicine without consulting your doctor, even if your symptoms improve.
- Report any new or worsening symptoms, or any severe side effects to your doctor immediately.
- The capsule should be swallowed whole; do not crush, chew, or open it unless specifically instructed by your doctor for administration with soft food.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Ema is generally not expected to affect the ability to drive or operate machinery. However, if you experience side effects like dizziness, visual disturbances, or somnolence, avoid such activities until you are sure you can perform them safely.
Lifestyle Advice
- Avoid trigger foods that worsen heartburn or indigestion (e.g., spicy, fatty, acidic foods, caffeine, alcohol).
- Eat smaller, more frequent meals instead of large ones.
- Avoid lying down immediately after eating; wait at least 2-3 hours.
- Elevate the head of your bed if you experience nighttime reflux.
- Maintain a healthy weight.
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