Question & Answer

In your October 2020 article “Important Drug Interactions for the Stomach-Acid–Suppressing Drug Omeprazole,” you discussed drug interactions for omeprazole (PRILOSEC, PRILOSEC OTC, ZEGERID). Does esomeprazole (NEXIUM, NEXIUM 24HR, VIMOVO), which has essentially the same chemical makeup as omeprazole, have the same drug interactions as omeprazole?

Esomeprazole, like omeprazole, is a member of the family of drugs known as proton pump inhibitors. It is available as a single-active-ingredient drug by prescription under the brand name Nexium and over-the-counter (OTC) under the brand name Nexium 24HR, as well as in multiple prescription and OTC generic versions. The prescription versions of single-ingredient esomeprazole are approved by the Food and Drug Administration (FDA) to treat or prevent several stomach-acid disorders, including gastroesophageal reflux disease and ulcers in the stomach and duodenum (the first part of the small intestine).[1] OTC esomeprazole is FDA-approved only for treatment of frequent heartburn (occurs two or more days a week).[2]

Esomeprazole also is a component of a two-drug combination containing the non-steroidal anti-inflammatory drug naproxen sold under the brand name Vimovo.[3] The esomeprazole component is intended to decrease the risk of gastric ulcers that can be caused by naproxen.

Like many drugs, omeprazole itself is a mixture of two forms that have the same chemical makeup but are “mirror images” of each other, known scientifically as optical isomers. Esomeprazole contains only one of the two isomers that make up omeprazole. With some drugs, all of the therapeutic activity is associated with one optical isomer, but this is not the case with omeprazole; both optical isomers have similar stomach-acid–suppressing activity.[4]

Therefore, esomeprazole not surprisingly also interacts with most of the same medications identified in our October 2020 article describing important drug interactions for omeprazole.[5] The antiviral drugs indinavir (CRIXIVAN) and ritonavir (KALETRA, NORVIR, VIEKIRA PAK) and the seizure drug phenytoin (DILANTIN, PHENYTEK) appear to be the only drugs that interact with omeprazole but not esomeprazole.

If you need treatment with esomeprazole, review all your other medications with your doctor to assess your risk of potentially significant drug interactions. If you are taking certain medications that interact with esomeprazole, you may need to adjust the dosage of the interacting drug or undergo more frequent monitoring of the blood levels of the interacting drug, or your doctor may advise you to take a different drug for your stomach-acid condition.
 

References

[1] AstraZeneca Pharmaceuticals. Label: esomeprazole (NEXIUM). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021153s057,021957s024,022101s021lbl.pdf. Accessed January 10, 2021.

[2] Pfizer. Label: esomeprazole (NEXIUM 24HR). April 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/204655Orig1s011lbl.pdf. Accessed January 10, 2021.

[3] Horizon Medicines. Label: naproxen and esomeprazole (VIMOVO). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022511s025lbl.pdf. Accessed January 10, 2021.

[4] Esomeprazole (NEXIUM)—The fifth proton pump inhibitor to suppress stomach acid. Worst Pills, Best Pills News. November 2001. /newsletters/view/93. Accessed January 10, 2021.

[5] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “esomeprazole.” Accessed January 10, 2021.