Vonomax Duo
Generic Name
Esomeprazole + Domperidone
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| vonomax duo 40 mg tablet | ৳ 55.00 | N/A |
Description
Overview of the medicine
Vonomax Duo is a combination medication used to treat conditions like gastroesophageal reflux disease (GERD), dyspepsia, and other acid-related disorders where improved gastric motility and acid suppression are required. Esomeprazole reduces stomach acid, while domperidone helps with nausea, vomiting, and promotes faster emptying of the stomach.
Uses & Indications
Dosage
Adults
One capsule once daily, preferably 30-60 minutes before breakfast.
Elderly
No specific dose adjustment is required in elderly patients, but caution is advised.
Renal_impairment
For patients with severe renal impairment (creatinine clearance < 30 mL/min), the frequency of domperidone administration should be reduced to once or twice daily.
How to Take
Take orally with a glass of water. The capsule should be swallowed whole and not chewed or crushed. It is best taken before a meal, preferably in the morning.
Mechanism of Action
Esomeprazole is a proton pump inhibitor that irreversibly blocks the H+/K+-ATPase enzyme system (the proton pump) in gastric parietal cells, thereby reducing gastric acid secretion. Domperidone is a peripheral dopamine D2 receptor antagonist that increases gastrointestinal motility and acts as an antiemetic by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ).
Pharmacokinetics
Onset
Esomeprazole: 1 hour for acid suppression. Domperidone: 15-30 minutes for prokinetic effect.
Excretion
Esomeprazole and its metabolites are primarily excreted via the urine (approx. 80%) and faeces. Domperidone is excreted via urine (approx. 31%) and faeces (approx. 66%), mainly as metabolites.
Half life
Esomeprazole: Approximately 1-1.5 hours. Domperidone: Approximately 7-9 hours.
Absorption
Esomeprazole is rapidly absorbed after oral administration, with a bioavailability of about 90% after repeated dosing. Domperidone is rapidly absorbed from the GI tract after oral administration, but its absolute bioavailability is low (around 15%) due to extensive first-pass metabolism.
Metabolism
Esomeprazole is extensively metabolized in the liver by the cytochrome P450 enzyme system, mainly CYP2C19 and CYP3A4. Domperidone is extensively metabolized in the liver via CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to Esomeprazole, Domperidone, or any components of the formulation
- Patients with known prolongation of cardiac conduction intervals, particularly QTc
- Patients with significant electrolyte disturbances
- Patients with moderate to severe hepatic impairment
- Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors)
- Patients with prolactinoma
- Patients with gastrointestinal haemorrhage, mechanical obstruction, or perforation
Drug Interactions
Digoxin
Esomeprazole may increase digoxin absorption.
Warfarin
Esomeprazole may increase INR, requiring monitoring.
Phenytoin
Esomeprazole may increase phenytoin levels.
Methotrexate
PPIs may increase methotrexate levels, especially at high doses.
Ketoconazole, Erythromycin, Clarithromycin, HIV protease inhibitors
May increase plasma levels of domperidone, increasing risk of QTc prolongation.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose for Esomeprazole are generally mild and reversible. Domperidone overdose may lead to drowsiness, disorientation, and extrapyramidal reactions. Management is symptomatic and supportive; there is no specific antidote.
Pregnancy & Lactation
Pregnancy Category B for Esomeprazole, Category C for Domperidone. Use during pregnancy only if clearly needed. Domperidone is excreted in breast milk; therefore, it is not recommended during lactation.
Side Effects
Contraindications
- Hypersensitivity to Esomeprazole, Domperidone, or any components of the formulation
- Patients with known prolongation of cardiac conduction intervals, particularly QTc
- Patients with significant electrolyte disturbances
- Patients with moderate to severe hepatic impairment
- Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors)
- Patients with prolactinoma
- Patients with gastrointestinal haemorrhage, mechanical obstruction, or perforation
Drug Interactions
Digoxin
Esomeprazole may increase digoxin absorption.
Warfarin
Esomeprazole may increase INR, requiring monitoring.
Phenytoin
Esomeprazole may increase phenytoin levels.
Methotrexate
PPIs may increase methotrexate levels, especially at high doses.
Ketoconazole, Erythromycin, Clarithromycin, HIV protease inhibitors
May increase plasma levels of domperidone, increasing risk of QTc prolongation.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose for Esomeprazole are generally mild and reversible. Domperidone overdose may lead to drowsiness, disorientation, and extrapyramidal reactions. Management is symptomatic and supportive; there is no specific antidote.
Pregnancy & Lactation
Pregnancy Category B for Esomeprazole, Category C for Domperidone. Use during pregnancy only if clearly needed. Domperidone is excreted in breast milk; therefore, it is not recommended during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from manufacturing date
Availability
Available in pharmacies and hospitals
Approval Status
DGDA approved
Patent Status
Off-patent (Generic available)
Clinical Trials
Clinical trials have demonstrated the efficacy and safety of the combination of Esomeprazole and Domperidone for their approved indications.
Lab Monitoring
- Monitor serum magnesium levels in patients on long-term PPI therapy.
- Periodically monitor liver function tests in patients with hepatic impairment.
Doctor Notes
- Consider alternative therapy if patient has known cardiac conduction abnormalities or takes concomitant strong CYP3A4 inhibitors.
- Advise patients on lifestyle modifications to optimize treatment outcomes.
- Monitor for hypomagnesemia in patients on prolonged PPI therapy.
Patient Guidelines
- Take the capsule whole, do not chew or crush it.
- Take it 30-60 minutes before breakfast.
- Inform your doctor about all other medications you are taking.
- Report any unusual heart symptoms (palpitations, dizziness) immediately.
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 resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine may cause dizziness or drowsiness in some individuals. If you experience these symptoms, avoid driving or operating machinery.
Lifestyle Advice
- Avoid spicy, fatty foods, caffeine, and alcohol to reduce reflux symptoms.
- Eat smaller, more frequent meals.
- Avoid lying down immediately after eating.
- Elevate the head of your bed while sleeping.
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