NEXIUM 20MG TABLETS

Active substance: ESOMEPRAZOLE MAGNESIUM TRIHYDRATE

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Var #16: To amend leaflet to include detachable information for healthcare professionals
Previously assessed against UK PIL datednot take Nexium Tablets if you are taking a medicine containing nelfinavir (used to treat
August 2014
PACKAGE LEAFLET: INFORMATION FOR THE PATIENT
Do

Nexium® 20mg Tablets /
Esomeprazole 20mg Tablets
(esomeprazole magnesium trihydrate)
This product is available as any of the above names but will be referred to as Nexium
throughout the remainder of this leaflet. Please note that the leaflet also contains
information about other strengths (Nexium 40mg Tablets).
Read all of this leaflet carefully before you start taking this medicine because it
contains important information for you.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm
them, even if their signs of illness are the same as yours.
If you get any side effects talk to your doctor or pharmacist. This includes any possible side
effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What Nexium is and what it is used for
2. What you need to know before you take Nexium
3. How to take Nexium
4. Possible side effects
5. How to store Nexium
6. Contents of the pack and other information
1. What Nexium is and what it is used for
Nexium contains a medicine called esomeprazole. This belongs to a group of medicines
called ‘proton pump inhibitors’. They work by reducing the amount of acid that your
stomach produces.
Nexium is used to treat the following conditions:
Adults

‘Gastroesophageal reflux disease’ (GERD). This is where acid from the stomach
escapes into the gullet (the tube which connects your throat to your stomach) causing
pain, inflammation and heartburn.

Ulcers in the stomach or upper part of the gut (intestine) that are infected with bacteria
called ‘Helicobacter pylori’. If you have this condition, your doctor may also prescribe
antibiotics to treat the infection and allow the ulcer to heal.

Stomach ulcers caused by medicines called NSAIDs (Non-Steroidal Anti-Inflammatory
Drugs). Nexium can also be used to stop stomach ulcers from forming if you are taking
NSAIDs.

Too much acid in the stomach caused by a growth in the pancreas (Zollinger-Ellison
syndrome).

Prolonged treatment after prevention of rebleeding of ulcers with intravenous Nexium.
Adolescents aged 12 years and above

‘Gastroesophageal reflux disease’ (GERD). This is where acid from the stomach
escapes into the gullet (the tube which connects your throat to your stomach) causing
pain, inflammation and heartburn.

Ulcers in the stomach or upper part of the gut (intestine) that are infected with bacteria
called ‘Helicobacter pylori’. If you have this condition, your doctor may also prescribe
antibiotics to treat the infection and allow the ulcer to heal.
2. What you need to know before you take Nexium
Do not take Nexium:

If you are allergic to esomeprazole or any of the other ingredients of this medicine
(listed in Section 6).

If you are allergic to other proton pump inhibitor medicines (e.g. pantoprazole,
lansoprazole, rabeprazole, omeprazole).

If you are taking a medicine containing nelfinavir (used to treat HIV infection).
Do not take Nexium if any of the above apply to you. If you are not sure, talk to your doctor
or pharmacist before taking Nexium.
Warnings and precautions
Talk to your doctor or pharmacist before taking Nexium:

If you have severe liver problems.

If you have severe kidney problems.
Nexium may hide the symptoms of other diseases. Therefore, if any of the following
happen to you before you start taking Nexium or while you are taking it, talk to your
doctor straight away:

You lose a lot of weight for no reason and have problems swallowing.

You get stomach pain or indigestion.

You begin to vomit food or blood.

You pass black stools (blood-stained faeces).

HIV infection).
Tell your doctor or pharmacist if you are taking any of the following medicines:

Atazanavir (used to treat HIV infection).

Clopidogrel (used to prevent blood clots).

Ketoconazole, itraconazole or voriconazole (used to treat infections caused by a
fungus).

Erlotinib (used to treat cancer).

Citalopram, imipramine or clomipramine (used to treat depression).

Diazepam (used to treat anxiety, relax muscles or in epilepsy).

Phenytoin (used in epilepsy). If you are taking phenytoin, your doctor will need to
monitor you when you start or stop taking Nexium.

Medicines that are used to thin your blood, such as warfarin. Your doctor may need to
monitor you when you start or stop taking Nexium.

Cilostazol (used to treat intermittent claudication – a pain in your legs when you walk
which is caused by an insufficient blood supply).

Cisapride (used for indigestion and heartburn).

Digoxin (used for heart problems).

Methotrexate (a chemotherapy medicine used in high doses to treat cancer) – if you are
taking a high dose of methotrexate, your doctor may temporarily stop your Nexium
treatment.

Tacrolimus (organ transplantation).

Rifampicin (used for treatment of tuberculosis).

St. John’s wort (Hypericum perforatum) (used to treat depression).
If your doctor has prescribed the antibiotics amoxicillin and clarithromycin as well as
Nexium to treat ulcers caused by Helicobacter pylori infection, it is very important that you
tell your doctor about any other medicines you are taking.
Nexium with food and drink
You can take your tablets with food or on an empty stomach.
Pregnancy, breast-feeding and fertility
If you are pregnant, think you may be pregnant or are planning to have a baby, ask your
doctor or pharmacist for advice before taking this medicine. Your doctor will decide whether
you can take Nexium during this time. It is not known if Nexium passes into breast milk.
Therefore, you should not take Nexium if you are breastfeeding.
Driving and using machines
Nexium is not likely to affect you being able to drive or use any tools or machines.
However, side effects such as dizziness and blurred vision may uncommonly or rarely
occur (see section 4). If affected, you should not drive or use machines.
Nexium contains sucrose
Nexium contains sugar spheres which contain sucrose, a type of sugar. If you have been
told by your doctor that you have an intolerance to some sugars, talk to your doctor before
taking this medicine.
3. How to take Nexium
Always take this medicine exactly as your doctor or pharmacist has told you. Check with
your doctor or pharmacist if you are not sure.

If you are taking this medicine for a long time, your doctor will want to monitor you
(particularly if you are taking it for more than a year).

If your doctor has told you to take this medicine as and when you need it, tell your
doctor if your symptoms change.
How much to take

Your doctor will tell you how many tablets to take and how long to take them for. This
will depend on your condition, how old you are and how well your liver works.

The recommended doses are given below.
Adults aged 18 and above
To treat heartburn caused by gastroesophageal reflux disease (GERD):

If your doctor has found that your food pipe (gullet) has been slightly damaged, the
recommended dose is one Nexium 40 mg gastro-resistant tablet once a day for 4
weeks. Your doctor may tell you to take the same dose for a further 4 weeks if your
gullet has not yet healed.

The recommended dose once the gullet has healed is one Nexium 20 mg gastroresistant tablet once a day

If your gullet has not been damaged, the recommended dose is one Nexium 20 mg
gastro-resistant tablet each day. Once the condition has been controlled, your doctor
may tell you to take your medicine as and when you need it, up to a maximum of one
Nexium 20 mg gastro-resistant tablet each day.

If you have severe liver problems, your doctor may give you a lower dose.
To treat ulcers caused by Helicobacter pylori infection and to stop them coming back:

The recommended dose is one Nexium 20 mg gastro-resistant tablet twice a day for
one week.

Your doctor will also tell you to take antibiotics for example amoxicillin and
clarithromycin.

If you have been prescribed Nexium “on demand” you should contact your doctor if your
symptoms continue or change in character.

To treat stomach ulcers caused by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

The recommended dose is one Nexium 20 mg gastro-resistant tablet once a day for 4
to 8 weeks.

Taking a proton pump inhibitor like Nexium, especially over a period of more than one year,
may slightly increase your risk of fracture in the hip, wrist or spine. Tell your doctor if you
have osteoporosis or if you are taking corticosteroids (which can increase the risk of
osteoporosis).

To prevent stomach ulcers if you are taking NSAIDs (Non-Steroidal AntiInflammatory Drugs):

The recommended dose is one Nexium 20 mg gastro-resistant tablet once a day.

Children under the age of 12 years
Information on dosing for children aged 1 to 11 years is provided in Nexium sachet product
information (ask your doctor or pharmacist if you require further information).
Other medicines and Nexium
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other
medicines. This includes medicines that you buy without a prescription. This is because
Nexium can affect the way some medicines work and some medicines can have an effect
on Nexium.

To treat too much acid in the stomach caused by a growth in the pancreas (ZollingerEllison syndrome):

The recommended dose is Nexium 40 mg twice a day.

Your doctor will adjust the dose depending on your needs and will also decide how long
you need to take the medicine for. The maximum dose is 80 mg twice a day.
Prolonged treatment after prevention of re-bleeding of ulcers with intravenous
Nexium:

The recommended dose is one Nexium 40 mg tablet once a day for 4 weeks.

Adolescents aged 12 or above
To treat heartburn caused by gastroesophageal reflux disease (GERD):

If your doctor has found that your food pipe (gullet) has been slightly damaged, the
recommended dose is one Nexium 40 mg gastro-resistant tablet once a day for 4
weeks. Your doctor may tell you to take the same dose for a further 4 weeks if your
gullet has not yet healed.

The recommended dose once the gullet has healed is one Nexium 20 mg gastroresistant tablet once a day.

If your gullet has not been damaged, the recommended dose is one Nexium 20 mg
gastro-resistant tablet each day.

If you have severe liver problems, your doctor may give you a lower dose.
To treat ulcers caused by Helicobacter pylori infection and to stop them coming back:

The recommended dose is one Nexium 20 mg gastro-resistant tablet twice a day for
one week.

Your doctor will also tell you to take antibiotics for example amoxicillin and
clarithromycin.
Taking this medicine

You can take your tablets at any time of the day.

You can take your tablets with food or on an empty stomach.

Swallow your tablets whole with a drink of water.
Do not chew or crush the tablets. This is because the tablets contain coated pellets
which stop the medicine from being broken down by the acid in your stomach. It is
important not to damage the pellets.
What to do if you have trouble swallowing the tablets

If you have trouble swallowing the tablets:
- Put them into a glass of still (non-fizzy) water. Do not use any other liquids.
- Stir until the tablets break up (the mixture will not be clear). Then drink the mixture
straight away or within 30 minutes. Always stir the mixture just before drinking it.
- To make sure that you have drunk all of the medicine, rinse the glass very well with
half a glass of water and drink it. The solid pieces contain the medicine - do not chew
or crush them.

If you cannot swallow at all, the tablet can be mixed with some water and put into a
syringe. It can then be given to you through a tube directly into your stomach (‘gastric
tube’).
Children under the age of 12 years
Nexium gastro-resistant tablets are not recommended for children less than 12 years old.
Information on dosing for children aged 1 to 11 years is provided in Nexium sachet product
information (ask your doctor or pharmacist if you require further information).
Older people
Dose adjustment is not required in the elderly.
If you take more Nexium than you should
If you take more Nexium than prescribed by your doctor, talk to your doctor or pharmacist
straight away.
If you forget to take Nexium

If you forget to take a dose, take it as soon as you remember it. However, if it is almost
time for your next dose, skip the missed dose.

Do not take a double dose (two doses at the same time) to make up for a forgotten
dose.
If you have any further questions on the use of this medicine, ask your doctor or
pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.

Rare (may affect up to 1 in 1,000 people)

Blood problems such as a reduced number of white cells or platelets. This can cause
weakness, bruising or make infections more likely.

Low levels of sodium in the blood. This may cause weakness, being sick (vomiting) and
cramps.

Feeling agitated, confused or depressed.

Taste changes.

Eyesight problems such as blurred vision.

Suddenly feeling wheezy or short of breath (bronchospasm).

An inflammation of the inside of the mouth.

An infection called “thrush” which can affect the gut and is caused by a fungus.

Liver problems, including jaundice which can cause yellow skin, dark urine, and
tiredness.

Hair loss (alopecia).

Skin rash on exposure to sunshine.

Joint pains (arthralgia) or muscle pains (myalgia).

Generally feeling unwell and lacking energy.

Increased sweating.
Very rare (may affect up to 1 in 10,000 people)

Changes in blood count including agranulocytosis (lack of white blood cells)

Aggression.

Seeing, feeling or hearing things that are not there (hallucinations).

Severe liver problems leading to liver failure and inflammation of the brain.

Sudden onset of a severe rash or blistering or peeling skin. This may be associated
with a high fever and joint pains (Erythema multiforme, Stevens-Johnson syndrome,
toxic epidermal necrolysis).

Muscle weakness.

Severe kidney problems.

Enlarged breasts in men.
Not known (frequency cannot be estimated from the available data)

If you are on Nexium for more than three months it is possible that the levels of
magnesium in your blood may fall. Low levels of magnesium can be seen as fatigue,
involuntary muscle contractions, disorientation, convulsions, dizziness or increased
heart rate. If you get any of these symptoms, please tell your doctor promptly. Low
levels of magnesium can also lead to a reduction in potassium or calcium levels in the
blood. Your doctor may decide to perform regular blood tests to monitor your levels of
magnesium.

Inflammation in the gut (leading to diarrhoea).
Nexium may in very rare cases affect the white blood cells leading to immune deficiency. If
you have an infection with symptoms such as fever with a severely reduced general
condition or fever with symptoms of a local infection such as pain in the neck, throat or
mouth or difficulties in urinating, you must consult your doctor as soon as possible so that a
lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important
for you to give information about your medication at this time.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. You can also report side effects directly via the
Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects, you can help provide more information on the safety of this
medicine.
5. How to store Nexium



Do not store above 30°C.
Do not take your tablets after the expiry date shown on the carton or blister foil. The
expiry date refers to the last day of that month.
Keep your medicine in a safe place where children cannot see or reach it.
Keep this medicine in the original container.
Medicines should not be disposed of via wastewater or household waste. Ask your
pharmacist how to dispose of medicines no longer required. These measures will help
to protect the environment.
If the tablets have become discoloured or show any other signs of deterioration, you
should seek the advice of your pharmacist who will tell you what to do.

If you notice any of the following serious side effects, stop taking Nexium and
contact a doctor immediately:

Sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or
difficulties in swallowing (severe allergic reaction).

Reddening of the skin with blisters or peeling. There may also be severe blisters and
bleeding in the lips, eyes, mouth, nose and genitals. This could be ‘Stevens-Johnson
syndrome’ or ‘toxic epidermal necrolysis’.

Yellow skin, dark urine and tiredness which can be symptoms of liver problems.





These effects are rare, and may affect up to 1 in 1,000 people.

What Nexium contains
Nexium 20mg tablets are gastro-resistant. This means that the coated pellets in your tablet
are resistant to the acid in your stomach.
Each gastro resistant tablet contains esomeprazole magnesium trihydrate equivalent to
20mg of esomeprazole. Nexium 20mg tablets contains 20 mg of esomeprazole.

Other side effects include:
Common (may affect up to 1 in 10 people)

Headache.

Effects on your stomach or gut: diarrhoea, stomach pain, constipation, wind (flatulence).

Feeling sick (nausea) or being sick (vomiting).
Uncommon (may affect up to 1 in 100 people)

Swelling of the feet and ankles.

Disturbed sleep (insomnia).

Dizziness, tingling feelings such as “pins and needles”, feeling sleepy.

Spinning feeling (vertigo).

Dry mouth.

Changes in blood tests that check how the liver is working.

Skin rash, lumpy rash (hives) and itchy skin.

Fracture of the hip, wrist or spine (if Nexium is used in high doses and over long
duration).



6. Contents of the pack and other information

Each tablet also contains: Glyceryl monostearate 40-55, hydroxypropylcellulose,
hypromellose, iron oxide reddish-brown (E172), magnesium stearate, methacrylic acid ethyl
acrylate copolymer (1:1), microcrystalline cellulose, synthetic paraffin, yellow iron oxide
(E172), macrogol 6000, polysorbate 80, crospovidone, sodium stearyl fumarate, sugar
spheres (sucrose and maize starch), talc, titanium dioxide (E 171), triethyl citrate.
What Nexium looks like and contents of the pack
Nexium is pink capsule shaped tablets marked A EH on one side and 20 mg other side.
Your tablets will come in a blister pack in cartons containing either 14 or 28 tablets.
PL No: 15814/0730

Nexium 20mg Tablets / Esomeprazole 20mg Tablets

POM

Nexium is manufactured by AstraZeneca AB, S151-85, Sodertälje, Sweden and is procured
from within the EU and repackaged by the Product Licence Holder: OPD Laboratories Ltd.,
Unit 6 Colonial Way, Watford, Herts WD24 4PR.
Leaflet revision and issue date (Ref.) 30.01.2015.
Nexium is a registered Trade Mark of AstraZeneca AB, Sweden.
To request a copy of this leaflet in Braille, large print or audio please call 01923 332 796.

The following information is intended for healthcare professionals only:
Administration through gastric tube
1. Put the tablet into an appropriate syringe and fill the syringe with approximately 25 ml water and approximately 5 ml air. For some tubes, dispersion in 50 ml water is needed to prevent the
pellets from clogging the tube.
2. Immediately shake the syringe for approximately 2 minutes to disperse the tablet.
3. Hold the syringe with the tip up and check that the tip has not clogged.
4. Attach the syringe to the tube whilst maintaining the above position.
5. Shake the syringe and position it with the tip pointing down. Immediately inject 5 – 10 ml into the tube. Invert the syringe after injection and shake (the syringe must be held with the tip
pointing up to avoid clogging of the tip)
6. Turn the syringe with the tip down and immediately inject another 5 – 10 ml into the tube. Repeat this procedure until the syringe is empty.
7. Fill the syringe with 25 ml of water and 5 ml of air and repeat step 5 if necessary to wash down any sediment left in the syringe. For some tubes, 50 ml water is needed.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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