NEXIUM I.V. 40MG POWDER FOR SOLUTION FOR INJECTION/INFUSION

Active substance: ESOMEPRAZOLE SODIUM

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PS03633

Package leaflet: Information for the user

Nexium IV 40 mg
Powder for solution for injection/infusion
esomeprazole

Read all of this leaflet carefully before you are given 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, pharmacist or nurse.
• If you get any side effects, talk to your doctor, pharmacist or nurse. 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 Nexium is given to you
3. How Nexium is given to you
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 for the short‑term treatment of certain conditions, when you are unable
to have treatment by mouth. It 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.
• 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.
• Prevention of rebleeding following therapeutic endoscopy for acute bleeding gastric
or duodenal ulcers.
Children and adolescents aged 1-18 years
• ‘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.
2. What you need to know before Nexium is given to you
You must not be given Nexium:
• If you are allergic (hypersensitive) to esomeprazole or any of the other ingredients
of this medicine (listed in section 6: Contents of the pack and other information).
• 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).
You must not be given Nexium if any of the above apply to you. If you are not sure,
talk to your doctor or nurse before you are given this medicine.
Warnings and precautions
Check with your doctor or nurse before you are given Nexium if:
• You have severe liver problems.
• You have severe kidney problems.
Nexium may hide the symptoms of other diseases. Therefore, if any of the following
happen to you before you are given Nexium or after you are given 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).
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).
Other medicines and Nexium
Tell your doctor or nurse 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.
You must not be given Nexium if you are taking a medicine containing nelfinavir (used
to treat HIV infection).
Tell your doctor or nurse 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 having Nexium.
• Medicines that are used to thin your blood, such as warfarin. Your doctor may need
to monitor you when you start or stop having 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).
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 you are given 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 be given
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 occur
(see section 4). If affected, you should not drive or use machines.
3. How Nexium is given to you
Nexium can be given to children and adolescents aged 1-18 years and adults, including
the elderly.
Being given Nexium
Adults
• Nexium will be given to you by your doctor who will decide how much you need.
• The recommended dose is 20 mg or 40 mg once a day.
• If you have severe liver problems, the maximum dose is 20 mg a day (GERD).
• The medicine will be given to you as an injection or infusion into one of your veins.
This will last for up to 30 minutes.
• The recommended dose for prevention of re-bleeding of gastric or duodenal ulcer,
is 80 mg administered as intravenous infusion over 30 minutes followed by a
continuous infusion of 8 mg/hr given over 3 days. If you have severe liver problems,
a continuous infusion of 4 mg/hr given over 3 days may be sufficient.
Children aged 1-18 years
• Nexium will be given by your doctor who will decide how much you need.
• For children 1-11 years, the recommended dose is 10 or 20 mg given once a day.
• For children 12-18 years, the recommended dose is 20 or 40 mg given once a day.
• The medicine will be given as an injection or infusion into a vein. This will last up to
30 minutes.
If you are given too much Nexium
If you think you have been given too much Nexium, talk to your doctor straight away.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
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.
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).
• Injection site reaction.
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).
• Eyesight problems such as blurred vision.
• 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).

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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.
• 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
• The doctor and hospital pharmacist are responsible for storing, using and disposing
of Nexium correctly.
• Do not use this medicine after the expiry date which is stated on the carton and vial
after EXP. The expiry date refers to the last day of that month.
• Keep this medicine out of the sight and reach of children.
• Do not store above 30°C.
• Keep the vial in the outer carton in order to protect from light. Vials can, however,
be stored exposed to normal indoor light outside the box for up to 24 hours.
6. Contents of the pack and other information
What Nexium contains
The active substance is esomeprazole sodium. Each vial of powder for solution for
injection/infusion contains 42.5 mg of esomeprazole sodium, equivalent to 40 mg of
esomeprazole.
The other ingredients are disodium edetate and sodium hydroxide. Each vial contains
less than 1 mmol sodium (23 mg) i.e. essentially ‘sodium-free’.
What Nexium looks like and contents of the pack
Nexium is a white to off-white ‘cake’ or powder. This is made into a solution before it is
given to you.
Pack sizes: 1 vial, 10 vials. Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
The Marketing Authorisation for Nexium is held by AstraZeneca UK Limited,
600 Capability Green, Luton, LU1 3LU, United Kingdom.
Nexium is released by AstraZeneca AB, S-151 85, Södertälje, Sweden;
AstraZeneca UK Ltd, Macclesfield, UK; AstraZeneca GmbH, Wedel,
Germany and Corden Pharma GmbH, Plankstadt, Germany.

To listen to or request a copy of this leaflet in Braille,
large print or audio please call, free of charge:
0800 198 5000 (UK only)
Please be ready to give the following information:
Product name
Reference number
Nexium IV 40 mg
17901/0221
This is a service provided by the Royal National
Institute of Blind People.
This medicine is authorised in the Member States of the EEA under the following names:
Member States
Name of the medicinal product
Austria, Denmark, Finland, Greece, Iceland,
Nexium
Ireland, Italy, The Netherlands, Norway, Poland,
Spain, Sweden, United Kingdom
Belgium, Luxembourg
Nexiam
France
Inexium
Portugal
Nexium I.V.
This leaflet was last revised in August 2014.
© AstraZeneca 2014
Nexium is a trade mark of the AstraZeneca group of companies.
GI 13 0071b
----------------------------------------------------------------------------------------------------------------The following information is intended for healthcare professionals only:
Nexium IV 40 mg contains 40 mg of esomeprazole, as a sodium salt. Each vial also
contains disodium edetate and sodium hydroxide (<1 mmol sodium).
Vials are for single use only. If the entire reconstituted content of the vial is not required
for a single dose, any unused solution should be discarded.
For further information on dose recommendations and storage conditions, see
sections 3 and 5, respectively.
Preparation and Administration of Reconstituted Solution:
For the reconstitution of solution, withdraw the plastic cap of colour at the top of the vial
of Nexium, and pierce the stopper in the centre of the designed circle, by maintaining
the needle vertically, in order to be able to cross the stopper correctly.
The reconstituted solution for injection or infusion should be clear and colourless
to very slightly yellow. It should be inspected visually for particulate matter and
discolouration before administration and only clear solution should be used.
The shelf life after reconstitution in terms of chemical and physical stability has been
demonstrated for 12 hours at 30°C. However, from a microbiological point of view, the
product should be used immediately.
Nexium Injection
To prepare a solution for injection:
Injection 40 mg
For 8 mg/ml esomeprazole reconstituted solution: Prepare the solution by adding 5 ml
of 0.9% sodium chloride for intravenous use to the esomeprazole 40 mg vial.
The reconstituted solution for injection should be administered intravenously over a
period of at least 3 minutes.
For further information on dose administration, please see SmPC section 4.2.
Nexium Infusion
To prepare a solution for infusion:
Infusion 40 mg
Dissolve the content of one esomeprazole 40 mg vial in up to 100 ml of 0.9% sodium
chloride for intravenous use.
Infusion 80 mg
Dissolve the contents of two esomeprazole 40 mg vials in up to 100 ml of 0.9% sodium
chloride for intravenous use.
For further information on dose administration, please see SmPC section 4.2.
Disposal
Any unused product or waste material should be disposed of in accordance with local
requirements.
Marketing Authorisation Holder
AstraZeneca UK Limited, 600 Capability Green, Luton, LU1 3LU, United Kingdom.
This leaflet was last revised in: August 2014
© AstraZeneca 2014
Nexium is a trademark of the AstraZeneca group of companies.
GI 13 0071b

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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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