Remmo
Generic Name
Esomeprazole
Manufacturer
Example Pharma Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| remmo 40 mg injection | ৳ 110.00 | N/A |
Description
Overview of the medicine
Remmo 40 mg Injection contains Esomeprazole, a proton pump inhibitor that effectively reduces stomach acid production. It is used for the short-term treatment of conditions like erosive esophagitis due to GERD, healing of gastric ulcers, and managing Zollinger-Ellison syndrome, especially when oral administration is not possible or appropriate.
Uses & Indications
Dosage
Adults
Typical dose is 20-40 mg once daily by intravenous infusion or injection for 7 to 10 days, followed by oral therapy. For Zollinger-Ellison syndrome, doses may be higher.
Elderly
No specific dose adjustment is generally required for elderly patients, but monitoring is advised.
Renal_impairment
No dose adjustment is needed for patients with renal impairment.
How to Take
For intravenous use only. Administer as a slow intravenous injection over at least 3 minutes (for 40 mg) or as an intravenous infusion over 10-30 minutes. The reconstituted solution must be used within 12 hours.
Mechanism of Action
Esomeprazole is the S-isomer of omeprazole. It inhibits the H+/K+-ATPase (proton pump) in the gastric parietal cells, thereby blocking the final step of acid secretion. This leads to a dose-dependent inhibition of both basal and stimulated gastric acid secretion.
Pharmacokinetics
Onset
Acid suppression begins within 30 minutes of intravenous administration.
Excretion
Approximately 80% of metabolites are excreted in the urine and 20% in the feces.
Half life
Plasma elimination half-life is approximately 1 to 1.5 hours.
Absorption
Rapidly absorbed after intravenous administration, achieving peak plasma concentration quickly. Bioavailability is 100% with IV administration.
Metabolism
Extensively metabolized in the liver by the cytochrome P450 (CYP) enzyme system, primarily CYP2C19 and CYP3A4. Metabolites are inactive.
Side Effects
Contraindications
- Hypersensitivity to Esomeprazole, other substituted benzimidazoles, or any component of the formulation.
- Concomitant use with nelfinavir.
Drug Interactions
Digoxin
May increase digoxin levels; monitor digoxin concentrations.
Warfarin
May increase INR and prothrombin time; monitor patients for increased bleeding risk.
Clopidogrel
May reduce the antiplatelet effect of Clopidogrel; monitor closely or consider alternative antiplatelet therapy.
Methotrexate
May increase methotrexate plasma levels; consider temporary PPI withdrawal or lower methotrexate doses.
Nelfinavir/Atazanavir
Reduced plasma concentrations of these antiretrovirals; concomitant use with Nelfinavir is contraindicated and generally not recommended with Atazanavir.
Storage
Store below 30°C in a dry place, protected from light. Do not freeze. Keep out of reach of children. Use reconstituted solution within 12 hours.
Overdose
Limited experience with Esomeprazole overdose. Symptoms reported include drowsiness, tachycardia, nausea, diarrhea, and headache. Treatment is symptomatic and supportive. Esomeprazole is not readily dialyzable.
Pregnancy & Lactation
Pregnancy Category B. Studies in animals have not shown harm, but human data are limited. Use only if clearly needed. Esomeprazole is excreted in human milk; use with caution in nursing mothers.
Side Effects
Contraindications
- Hypersensitivity to Esomeprazole, other substituted benzimidazoles, or any component of the formulation.
- Concomitant use with nelfinavir.
Drug Interactions
Digoxin
May increase digoxin levels; monitor digoxin concentrations.
Warfarin
May increase INR and prothrombin time; monitor patients for increased bleeding risk.
Clopidogrel
May reduce the antiplatelet effect of Clopidogrel; monitor closely or consider alternative antiplatelet therapy.
Methotrexate
May increase methotrexate plasma levels; consider temporary PPI withdrawal or lower methotrexate doses.
Nelfinavir/Atazanavir
Reduced plasma concentrations of these antiretrovirals; concomitant use with Nelfinavir is contraindicated and generally not recommended with Atazanavir.
Storage
Store below 30°C in a dry place, protected from light. Do not freeze. Keep out of reach of children. Use reconstituted solution within 12 hours.
Overdose
Limited experience with Esomeprazole overdose. Symptoms reported include drowsiness, tachycardia, nausea, diarrhea, and headache. Treatment is symptomatic and supportive. Esomeprazole is not readily dialyzable.
Pregnancy & Lactation
Pregnancy Category B. Studies in animals have not shown harm, but human data are limited. Use only if clearly needed. Esomeprazole is excreted in human milk; use with caution in nursing mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 24 to 36 months when stored unopened according to manufacturer's instructions.
Availability
Available in pharmacies and hospitals nationwide
Approval Status
Approved by Regulatory Authorities (e.g., DGDA/FDA)
Patent Status
Off-patent (for generic Esomeprazole)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Esomeprazole in various acid-related disorders. Studies have compared its intravenous and oral formulations, and its use in specific patient populations.
Lab Monitoring
- Electrolyte levels (especially magnesium in long-term therapy or with diuretics)
- Liver function tests (if clinical signs of hepatic dysfunction appear)
- Serum Gastrin levels (in patients with Zollinger-Ellison syndrome)
Doctor Notes
- IV Esomeprazole is indicated for patients unable to take oral therapy; transition to oral as soon as clinically appropriate.
- Consider potential drug interactions, especially with Clopidogrel, Warfarin, and Methotrexate.
- Monitor for adverse effects with long-term use, including bone density, magnesium levels, and symptoms of C. difficile.
- Ensure proper reconstitution and administration technique for intravenous use to avoid complications.
Patient Guidelines
- Inform your healthcare provider about all medical conditions, allergies, and medications you are taking.
- Do not discontinue the injection or treatment prematurely without consulting your doctor.
- Report any unusual or severe side effects, especially persistent diarrhea or severe stomach pain.
- This injection is typically for short-term use when oral medication is not feasible, and you should transition to oral therapy as advised by your doctor.
Missed Dose Advice
If a dose is missed, it should be administered as soon as possible. If it is almost time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not administer a double dose to make up for a missed one.
Driving Precautions
Remmo 40 mg Injection may cause dizziness or visual disturbances in some individuals. If you experience these effects, avoid driving or operating machinery.
Lifestyle Advice
- Avoid trigger foods like spicy, fatty, and acidic foods that can worsen symptoms.
- Elevate the head of your bed during sleep to reduce nighttime reflux.
- Quit smoking and reduce alcohol intake, as both can irritate the esophagus and stomach.
- Eat smaller, more frequent meals instead of large ones.
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