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Nexpro-20/Nexpro-40: In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with Esomeprazole may alleviate symptoms and delay diagnosis.
Patients on long-term treatment (particularly those treated for more than a year) should be kept under regular surveillance.
Patients on on-demand treatment should be instructed to contact their physician if their symptoms change in character. When prescribing esomeprazole for on-demand therapy, the implications for interactions with other pharmaceuticals, due to fluctuating plasma concentrations of esomeprazole should be considered.
When prescribing esomeprazole for eradication of Helicobacter pylori possible drug interactions for all components in the triple therapy should be considered. Clarithromycin is a potent inhibitor of CYP3A4 and hence contraindications and interactions for clarithromycin should be considered when the triple therapy is used in patients concurrently taking other drugs metabolized via CYP3A4 such as cisapride.
Treatment with proton pump inhibitors may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter.
Co-administration of esomeprazole with atazanavir is not recommended. If the combination of atazanavir with a proton pump inhibitor is judged unavoidable, close clinical monitoring is recommended. Esomeprazole dose should not exceed 20 mg and must be taken approximately 12 hours prior to atazanavir 300 mg with ritonavir 100 mg dose.
Effects on the Ability to Drive and Use Machines: Esomeprazole is not likely to affect the ability to drive or use machines.
Nexpro IV: Do not use Esomeprazole if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged. If you also take an imidazole antifungal (eg, ketoconazole), take it at least 2 hours before using Esomeprazole.
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