Drug Notebook

FDA Alerts

Special Alerts:

[UPDATE 12/11/2007] FDA informed healthcare professionals of the issuance of the Agency’s follow-up communication regarding its review of safety data for the drugs omeprazole (Prilosec) and esomeprazole (Nexium) that raised concerns about a potential increased risk of heart problems for patients treated with these drugs. The Agency conducted a comprehensive review of the data from two studies that were submitted to FDA. FDA continues to believe that long-term use of omeprazole or esomeprazole is not likely to be associated with an increased risk of heart problems and recommends that healthcare providers continue to prescribe and patients continue to use these products in the manner described in the labeling for the two products. See the “Update of Safety Review” for information regarding the two studies that were reviewed. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Omeprazole and http://www.fda.gov/cder/drug/early_comm/omeprazole_esomepazole_update.htm.

[Posted August 09, 2007] FDA issued an early communication about the ongoing review of new safety data for the proton pump inhibitors, omeprazole (Prilosec) and esomeprazole (Nexium). The new safety data was from two small long-term clinical studies in patients with severe gastroesophageal reflux disease (GERD). In both studies, patients were randomly assigned to receive treatment with a drug (either omeprazole or esomeprazole) or to have surgery to control their GERD.

The results from the study of omeprazole and analyses from an ongoing study of esomeprazole raised concerns that long-term use of omeprazole or esomeprazole may have increased the risk of heart attacks, heart failure, and heart-related sudden death in those patients taking either one of the drugs compared to patients who received surgery. After reviewing these and other data submitted by the company, FDA’s preliminary conclusion at this time, is that collectively, these data do not suggest an increased risk of heart problems for patients treated with omeprazole or esomeprazole. Healthcare providers should not change their prescribing practices and patients should not change their use of these products at this time.

Both drugs are used for the treatment of GERD, esophageal erosions and for maintenance of healing erosions of the esophagus. They are also used for the treatment of ulcers. Omeprazole is also sold over the counter for frequent heartburn. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Omeprazole and http://www.fda.gov/cder/drug/early_comm/omeprazole_esomeprazole.htm.

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esomeprazole
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(ee so MEP ra zol)

Cautions

Contraindications

Warnings/Precautions

General Precautions

Pending revision, the material in this section should be considered in light of more recently available information in the MEDWATCH notification at the beginning of this monograph.

GI Effects

Response to esomeprazole does not preclude presence of occult gastric neoplasm. Atrophic gastritis reported occasionally with long-term omeprazole use.

Respiratory Effects

Administration of proton-pump inhibitors has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).

Specific Populations

Pregnancy

Category B.

Lactation

Not known whether esomeprazole is distributed into milk, but omeprazole is distributed into milk. Discontinue nursing or the drug.

Pediatric Use

Safety and efficacy of oral esomeprazole for short-term treatment of GERD in adolescents 12–17 years of age is supported by controlled clinical trials in adults and safety and pharmacokinetic studies in adolescents. Adverse effects and pharmacokinetics similar in adolescents and adults.

Safety and efficacy of oral esomeprazole for short-term treatment of GERD in children <12 years of age or for other uses in pediatric patients not established.

Safety and efficacy of IV esomeprazole in pediatric patients not established.

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.

Hepatic Impairment

Use with caution. (See Hepatic Impairment under Dosage and Administration.)

Common Adverse Effects

Headache, dizziness, diarrhea, nausea, flatulence, dyspepsia, abdominal pain, constipation, dry mouth.

Drug Interactions

Extensively metabolized by CYP isoenzymes, principally CYP2C19; also to lesser extent by CYP3A4. May inhibit CYP2C19; unlikely to inhibit CYP3A4, 1A2, 2A6, 2C9, 2D6, or 2E1.

Drugs Metabolized by Hepatic Microsomal Enzymes

Potential to inhibit metabolism of drugs metabolized by CYP2C19. Interaction unlikely with drugs metabolized by other CYP isoenzymes.

Specific Drugs

Drug Interaction Comments
Amoxicillin Pharmacokinetic interaction unlikely
Atazanavir Possibility of substantially decreased plasma atazanavir concentrations and possible loss of therapeutic effect Concomitant use not recommended
Clarithromycin Increased plasma concentrations of esomeprazole and 14-hydroxyclarithromycin Not considered clinically important
Diazepam Decreased diazepam metabolism and increased plasma concentrations Not considered clinically important
Gastric pH-dependent drugs (e.g., digoxin, iron salts, ketoconazole) Esomeprazole may decrease drug absorption
NSAIAs (naproxen, rofecoxib) Pharmacokinetic interaction unlikely
Oral contraceptives No change in esomeprazole pharmacokinetics
Phenytoin Pharmacokinetic interaction unlikely
Quinidine Pharmacokinetic interaction unlikely
Sucralfate Possible delayed proton-pump inhibitor absorption and decreased bioavailability Administer proton-pump inhibitor at least 30 minutes before sucralfate
Warfarin Potential for decreased warfarin metabolism and changes in prothrombin measures Monitor PT and INR
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