Adults

The usual dosage for Esomeprazole is 20 mg or 40 mg once daily. A 200 mg capsule is highly atypical and should only be used under strict medical supervision for very specific, severe hypersecretory conditions like refractory Zollinger-Ellison syndrome, with individual dose titration. Consult a physician for specific dosing instructions.

Elderly

No general dosage adjustment is necessary for elderly patients, but caution is advised, especially with a high strength like 200 mg. Consult a physician for specific guidance.

Renal_impairment

No dosage adjustment is generally required for patients with impaired renal function, but for 200 mg strength, medical consultation is essential.

Onset

Acid inhibitory effect typically begins within 1 hour.

Excretion

Excreted mainly as metabolites; approximately 80% in the urine and 20% in the feces.

Half life

Approximately 1-1.5 hours.

Absorption

Rapidly absorbed after oral administration. Bioavailability is about 64% after a single dose and increases to 89% after repeated once-daily dosing. Peak plasma concentrations are reached within 1-2 hours.

Metabolism

Primarily metabolized in the liver by the cytochrome P450 enzyme system, mainly CYP2C19 (responsible for the majority of metabolism) and CYP3A4. Extensive first-pass metabolism occurs.

Digoxin

Increased absorption of digoxin due to altered gastric pH; monitor digoxin levels and adjust dosage as needed.

Warfarin

Increased INR and prothrombin time; monitor closely. Dosage adjustment of warfarin may be necessary.

Clopidogrel

Esomeprazole may reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Concomitant use should be avoided.

Methotrexate

May increase serum levels of methotrexate; consider temporary PPI withdrawal or close monitoring if high-dose methotrexate is administered.

Atazanavir, Nelfinavir

Reduced absorption of antiretrovirals due to increased gastric pH; concomitant use is generally contraindicated or requires careful monitoring and alternative therapies.