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.

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.

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.