Hyperacidity, GERD, and ulcers:

Indications for NEXIUM IV:

Short-term (up to 10 days) alternative to oral therapy for GERD with erosive esophagitis. Risk reduction of rebleeding of gastric or duodenal ulcers following therapeutic endoscopy in adults.


GERD: Inject IV over ≥3 mins or infuse IV over 10–30 mins. ≥18yrs: 20–40mg once daily for ≤10 days; switch to oral form when feasible. Severe hepatic impairment: max 20mg/day. Risk reduction: initially 80mg IV over 30 mins, then 8mg/hr continuous infusion over 71.5hrs; switch to oral form when feasible. Hepatic impairment (mild-to-moderate): max continuous infusion at 6mg/hr; (severe): max 4mg/hr.


Infuse IV over 10–30 mins. <1 month: not recommended. 1 month–<1yr: 0.5mg/kg. 1yr–17yrs: <55kg: 10mg; ≥55kg: 20mg.


Symptomatic response does not preclude gastric malignancy. Discontinue if acute interstitial nephritis, cutaneous/systemic lupus erythematosus occurs. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12. Monitor magnesium levels during prolonged therapy. Increased risk of fundic gland polyps with long-term use (esp. >1yr) or osteoporosis-related fractures (hip, wrist or spine) with long-term (>1yr) and multiple daily dose PPI therapy. Use lowest dose for shortest duration appropriate to condition. Pregnancy. Nursing mothers.

Pharmacologic Class:

Proton pump inhibitor.


Concomitant St. John's wort, rifampin, atazanavir, nelfinavir: not recommended. May potentiate saquinavir; monitor and consider reducing saquinavir dose. May alter absorption of gastric pH-dependent drugs (eg, ketoconazole, iron salts, erlotinib, digoxin). Antagonizes clopidogrel; consider alternative anti-platelets. May affect drugs metabolized by CYP2C19. May potentiate tacrolimus, cilostazol (consider reduced dose), methotrexate (consider temporary withdrawal of PPI). Caution with drugs that may cause hypomagnesemia (eg, digoxin, diuretics); monitor. Monitor warfarin. May give antacids concomitantly. May cause false (+) results in diagnostic investigations for neuroendocrine tumors; discontinue esomeprazole 14 days prior to CgA level assessment.

Adverse Reactions:

Headache, diarrhea, abdominal pain, nausea, flatulence, constipation, dry mouth, inj site reactions, dizziness, vertigo; possible C. difficile-associated diarrhea; rare: rash, allergic reactions, hypomagnesemia. Children: Also, somnolence, regurgitation, tachypnea, increased ALT.


See Biaxin for more information on clarithromycin. See Amoxil for more information on amoxicillin.


Hepatic (CYP2C19, CYP3A4). 97% protein bound.


Renal (primarily), fecal.

Generic Availability:

Caps, IV (YES); Susp (NO)

How Supplied:

Caps—30, 90, 1000; Susp—30 packets/box; IV soln (single-use vial)—10