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Esomeprazole Dosage

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Usual Adult Dose for Gastroesophageal Reflux Disease

Esomeprazole Magnesium: 20 mg orally once a day for 4 weeks. If symptoms do not resolve after 4 weeks, an additional 4 weeks may be considered.
Esomeprazole Strontium: 24.65 mg orally once a day for 4 to 8 weeks. If symptoms do not resolve after 4 weeks, an additional 4 weeks may be considered.

Comment: Esomeprazole Sodium injection may be used if unable to use oral route.

Usual Adult Dose for Erosive Esophagitis

Healing:
Esomeprazole Magnesium: 20 to 40 mg orally once a day for 4 to 8 weeks. An additional 4 to 8 week course of therapy may be considered in patients not healed after initial treatment.
Esomeprazole Strontium: 24.65 to 49.3 mg orally once a day for 4 to 8 weeks. An additional 4 to 8 week course of therapy may be considered in patients not healed after initial treatment.

Maintenance of healing:
Esomeprazole Magnesium: 20 mg orally once daily, for up to 6 months
Esomeprazole Strontium: 24.65 mg orally once daily, for up to 6 months

Comment: Esomeprazole Sodium injection may be used if unable to use oral route.

Usual Adult Dose for Helicobacter pylori Infection

Esomeprazole Magnesium: 40 mg orally once a day for 10 days along with amoxicillin 1000 mg and clarithromycin 500 mg orally twice a day for 10 days
Esomeprazole Strontium: 49.3 mg orally once a day for 10 days along with amoxicillin 1000 mg and clarithromycin 500 mg orally twice a day for 10 days

Usual Adult Dose for NSAID-Induced Gastric Ulcer

Esomeprazole Magnesium: 20 to 40 mg orally once daily for up to 6 months
Esomeprazole Strontium: 24.65 to 49.3 mg orally once a day for up to 6 months

Usual Adult Dose for Zollinger-Ellison Syndrome

Esomeprazole Magnesium: 40 mg orally twice daily. Doses up to 240 mg daily have been used.
Esomeprazole Strontium: 49.3 mg orally twice daily. Doses up to 240 mg daily have been used.

Usual Adult Dose for Pathological Hypersecretory Conditions

Esomeprazole Magnesium: 40 mg orally twice daily. Doses up to 240 mg daily have been used.
Esomeprazole Strontium: 49.3 mg orally twice daily. Doses up to 240 mg daily have been used.

Usual Pediatric Dose for Gastroesophageal Reflux Disease

12 to 17 year olds: 20 mg once daily
Duration of therapy: 4 weeks

1 to 11 year olds: 10 mg once daily
Duration of therapy: For up to 8 weeks
Comments: Doses over 1 mg/kg/day have not been studied.

Usual Pediatric Dose for Erosive Esophagitis

Healing:
12 to 17 year olds: 20 or 40 mg once daily
Duration of therapy: 4 to 8 weeks
1 to 11 year olds:
-weight less than 20 kg: 10 mg once daily
-weight greater than or equal to 20 kg: 10 or 20 mg once daily
Duration of therapy: 8 weeks
Comments: Doses over 1 mg/kg/day have not been studied.

Due to acid-mediated GERD:
1 month to less than 1 year old:
-weight 3 kg to 5 kg: 2.5 mg once daily
-weight greater than 5 kg to 7.5 kg: 5 mg once daily
-weight greater than 7.5 kg to 12 kg: 10 mg once daily
Duration of therapy: For up to 6 weeks
Comments: Doses over 1.33 mg/kg/day have not been studied.

When oral therapy is not possible or appropriate (GERD with Erosive Esophagitis):
1 month to less than 1 year of age: 0.5 mg/kg once daily IV infusion over 10 minutes to 30 minutes
1 year to 17 years:
-weight less than 55 kg: 10 mg once daily IV infusion over 10 minutes to 30 minutes
-weight 55 kg or greater: 20 mg once daily IV infusion over 10 minutes to 30 minutes

Renal Dose Adjustments

Esomeprazole Magnesium: No adjustment recommended

Esomeprazole Strontium:
-Mild to moderate renal dysfunction: No adjustment recommended
-Severe renal dysfunction: Not recommended

Liver Dose Adjustments

Esomeprazole Magnesium:
- Mild to moderate hepatic insufficiency (Child-Pugh class A and B): No adjustment recommended
- Severe hepatic insufficiency (Child-Pugh class C): Maximum daily dose should not exceed 20 mg

Esomeprazole Strontium:
- Mild to moderate hepatic insufficiency (Child-Pugh class A and B): No adjustment recommended
- Severe hepatic insufficiency (Child-Pugh class C): Maximum daily dose should not exceed 24.65 mg

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Hemodialysis: No adjustment recommended
Peritoneal dialysis: Data not available

- Esomeprazole is highly protein bound and not expected to be removed by dialysis.

Other Comments

Administration advice:
Oral Capsules:
-Take at least one hour before meals.
-Delayed-release capsule can be opened and mixed with 1 tablespoon of applesauce and swallowed immediately. Any unused mixture should be discarded. Mixing with other foods has not been evaluated and is not recommended.
Intravenous:
-The intravenous injection of esomeprazole should be administered over no less than 3 minutes. The intravenous infusion should be administered over 10 to 30 minutes.
-Treatment with esomeprazole injection is intended for short-term treatment (up to 10 days).

Storage requirements: Keep the delayed-release capsules in a tightly closed container.

Reconstitution/preparation techniques:
Delayed-release capsule:
-For patients with a nasogastric tube (NG), the delayed-release capsule can be opened, emptied into a 60 mL catheter tipped syringe, and mixed with 50 mL of water. Shake for 15 seconds, check for granules remaining in the tip, deliver contents through the NG tube, and flush the NG tube with water. Use mixture immediately after preparing. Rinse syringe with water after each use.
Oral suspension:
-Oral administration: Empty contents of 2.5 mg or 5 mg packet into 5 mL of water. Use 15 mL of water for the 10 mg, 20 mg and 40 mg packets. Stir, let thicken for 2 to 3 minutes, stir again, and drink within 30 minutes. Mix any remaining medicine with more water, stir, and drink.
-Nasogastric (NG) or gastric tube: Add 5 mL water to a catheter tipped syringe and add contents of a 2.5 mg or 5 mg packet. Use 10 mL water for the 10 mg, 20 mg and 40 mg packets. Shake the syringe and let thicken for 2 to 3 minutes. Shake syringe prior to injecting through the NG or gastric tube using a French size 6 or larger. Use mixture within 30 minutes. Refill the syringe with equal amount of water originally used, shake, and flush any remaining contents from NG or gastric tube.

Patient advice:
-Do not chew or crush capsules.
-Antacids can be used during treatment.

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