Adults

For GERD: 20 mg or 40 mg once daily for 4-8 weeks. For maintenance of healing of erosive esophagitis: 20 mg once daily. For symptomatic non-erosive GERD: 20 mg once daily for 4 weeks. For H. pylori eradication: 20 mg twice daily with antibiotics for 7-14 days. For Zollinger-Ellison syndrome: Initial dose 40 mg twice daily, adjusted as needed.

Elderly

No specific dose adjustment is generally required for elderly patients based on age alone, but caution is advised in patients with severe hepatic impairment.

Renal_impairment

No dose adjustment is necessary for patients with impaired renal function.

Onset

Acid suppression occurs within 1 hour of administration.

Excretion

Metabolites are primarily excreted in the urine (about 80%) and feces (about 20%).

Half life

Approximately 1-1.5 hours.

Absorption

Rapidly absorbed after oral administration, with peak plasma concentrations reached in 1-2 hours. Bioavailability is approximately 64% after a single 20 mg dose, increasing to 89% with repeated daily dosing.

Metabolism

Extensively metabolized in the liver by the cytochrome P450 (CYP) enzyme system, primarily by CYP2C19 and CYP3A4.

Diazepam

Increased plasma levels of diazepam due to inhibition of CYP2C19.

Warfarin

Increased INR/prothrombin time; monitor coagulation parameters closely.

Tacrolimus

Increased serum concentrations of tacrolimus; monitor tacrolimus levels and kidney function.

Clopidogrel

Reduced antiplatelet effect of clopidogrel; consider alternative antiplatelet therapy or monitor.

Methotrexate

Increased and prolonged serum levels of methotrexate, potentially leading to toxicity. Consider temporary withdrawal of PPI therapy.

St. John's Wort

May decrease plasma concentrations of esomeprazole.