Esomeprazole 40mg - 28 Gastro-Resistant Tablets

Esomeprazole is a proton pump inhibitor (PPI), the strongest class of acid-reducing medicine available, and the one most GPs reach for when heartburn is frequent, severe or has started to damage the oesophagus. Esomeprazole 40mg is the full healing dose: it is prescribed for four to eight weeks when acid reflux has inflamed or ulcerated the lining of the oesophagus (erosive reflux oesophagitis), and in the rare acid-overproducing condition Zollinger-Ellison syndrome. One tablet a day switches off most of the acid pumps in the stomach lining for around 24 hours, so acid that would otherwise rise into the throat is reduced at source.

This is a generic, prescription-only medicine (the same active ingredient as the brand Nexium) supplied through our Acid Reflux & Heartburn online clinic. You answer a short consultation, a UK prescriber reviews it, and if it is suitable a private prescription is issued and the pack is dispensed by our pharmacy. Pack of 28 gastro-resistant tablets; the manufacturer may vary.

Esomeprazole is the active half (the S-isomer) of omeprazole. Because the body clears it more slowly, it keeps acid lower for longer at the same dose, which is why it is often chosen when omeprazole hasn't fully controlled symptoms. The tablets contain the same esomeprazole as the 40mg gastro-resistant capsules; which you receive is simply a matter of preference and availability.

Esomeprazole treats conditions caused by too much stomach acid, or acid in the wrong place:

• Gastro-oesophageal reflux disease (GORD): heartburn and acid regurgitation that happen more than twice a week, or that keep returning after antacids and alginates such as Gaviscon.
• Reflux oesophagitis: inflammation or erosions in the lower oesophagus caused by reflux, usually diagnosed at an endoscopy. Healing uses 40mg; 20mg keeps it healed.
• Stomach protection with anti-inflammatory painkillers: people who need regular ibuprofen, naproxen or diclofenac and are at risk of ulcers.
• Helicobacter pylori: as part of a seven-day triple therapy with two antibiotics, prescribed by a GP after a positive test.
• Zollinger-Ellison syndrome: a rare condition in which a tumour drives acid overproduction; managed by specialists.

40mg is the healing strength, not the everyday one. Once the oesophagus has healed, or if you have reflux symptoms without any damage to the lining, the usual dose is esomeprazole 20mg once a day, and many people need it only on the days their symptoms flare.

By cutting acid production, esomeprazole relieves the burning pain behind the breastbone that rises after meals or when lying down, the sour or acidic taste of regurgitation, belching and bloating after food, the night-time cough or hoarseness that acid can cause, and the gnawing upper-stomach pain of an ulcer. It is a treatment for the cause, so it takes a little longer to work than an antacid: expect a clear improvement within two to three days and full effect within a week. It does not treat the sudden, occasional heartburn after a big meal as quickly as an alginate does; the two can be used together while the PPI gets going.

Each pack contains 28 tablets, which is a four-week course at one a day. Our prescriber approves one pack per order; if you need ongoing treatment you can reorder, and after three months of continuous use we will ask you to review your symptoms with your GP, as the NHS recommends.

Esomeprazole is licensed for adults and children from 12; this clinic prescribes for adults only. It can't be taken with the HIV medicine nelfinavir, or by anyone allergic to esomeprazole, omeprazole or other PPIs (lansoprazole, pantoprazole, rabeprazole).

The consultation will ask about other medicines because esomeprazole changes how several are handled: it reduces the effect of clopidogrel, raises levels of methotrexate, digoxin and tacrolimus, needs extra INR checks with warfarin, lowers the absorption of ketoconazole, itraconazole, erlotinib and some HIV medicines, and is itself weakened by St John's wort and rifampicin. It will also ask about liver disease (the dose is capped at 20mg in severe liver impairment) and about low magnesium, osteoporosis and vitamin B12 deficiency, which matter for longer courses.

It is not prescribed through this clinic in pregnancy, when planning a pregnancy or while breastfeeding. Most importantly, anyone with difficulty swallowing, unexplained weight loss, repeated vomiting, blood in vomit or black stools, or new symptoms over 55 needs to see a GP before taking an acid suppressant, because these medicines can mask something more serious.

Most people take esomeprazole without any problems. Common side effects (up to 1 in 10 people) are headache, stomach pain, constipation, diarrhoea, wind and feeling sick; these usually settle in the first week. Benign polyps in the stomach lining are also common with long-term use and need no treatment. Uncommon effects include dizziness, dry mouth, difficulty sleeping, pins and needles and skin rash.

With courses longer than a year, or high doses, there is a small increase in the risk of hip, wrist and spine fractures, low magnesium (muscle cramps, palpitations) and low vitamin B12, which is why the prescriber keeps the dose as low as possible and asks for a GP review after three months. Stop and seek urgent help for a severe skin rash, especially with blistering or mouth ulcers, for swelling of the face or throat, or for a rash on sun-exposed skin with joint pain. Report any suspected side effect through the MHRA Yellow Card scheme.

They are close relatives: omeprazole is a mixture of two mirror-image forms, and esomeprazole is the one of the two that does the work. Milligram for milligram esomeprazole suppresses acid a little more and more consistently, and studies in erosive oesophagitis show slightly higher healing rates with esomeprazole 40mg than omeprazole 20mg. For simple heartburn the difference is small, so if omeprazole already controls your symptoms there is no need to switch; if it doesn't, esomeprazole is a reasonable next step before stronger measures. Lansoprazole and pantoprazole sit in the same class and are equally valid choices. The prescriber will choose between them based on what you've already tried.

Start from the Acid Reflux & Heartburn clinic page and complete the consultation first; you are not asked to choose a medicine until the questions are done. A UK-registered prescriber then reviews your answers and either approves the treatment you requested, suggests a more suitable one, or declines and refunds you with an explanation. Every prescription is checked by our pharmacist before it leaves the dispensary. Stock My Medicine is a GPhC-registered UK pharmacy; orders go by Royal Mail Tracked, usually within three to five working days. If you are unsure whether this clinic is right for you, talk to our pharmacist first.