Your Health
12:47 PM - Public
Esomeprazole is a proton pump inhibitor (brand name Nexium) is used in the treatment of dyspepsia, peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD/GERD) and Zollinger-Ellison syndrome.
Esomeprazole is a proton pump inhibitor which reduces acid secretion through inhibition of ATPase in gastric parietal cells. By inhibiting the functioning of this enzyme, the drug prevents formation of gastric acid.
Esomeprazole is a competitive inhibitor of the enzymes CYP2C19 and CYP2C9, and may therefore interact with drugs that depend on them for metabolism, such as diazepam and warfarin;
Conversely, Clopidogrel (Plavix) is an inactive prodrug that partially depends on CYP2C19 for conversion to its active form; inhibition of CYP2C19 blocks the activation of clopidogrel, thus reducing its effects.
Drugs that depend on stomach pH for absorption may interact with omeprazole; drugs that depend on an acidic environment (such as ketoconazole or atazanavir) will be poorly absorbed, whereas drugs that are broken down in acidic environments (such as erythromycin) will be absorbed to a greater extent than normal.
http://en.wikipedia.org/wiki/Esomeprazole
Esomeprazole is a proton pump inhibitor which reduces acid secretion through inhibition of ATPase in gastric parietal cells. By inhibiting the functioning of this enzyme, the drug prevents formation of gastric acid.
Esomeprazole is a competitive inhibitor of the enzymes CYP2C19 and CYP2C9, and may therefore interact with drugs that depend on them for metabolism, such as diazepam and warfarin;
Conversely, Clopidogrel (Plavix) is an inactive prodrug that partially depends on CYP2C19 for conversion to its active form; inhibition of CYP2C19 blocks the activation of clopidogrel, thus reducing its effects.
Drugs that depend on stomach pH for absorption may interact with omeprazole; drugs that depend on an acidic environment (such as ketoconazole or atazanavir) will be poorly absorbed, whereas drugs that are broken down in acidic environments (such as erythromycin) will be absorbed to a greater extent than normal.
http://en.wikipedia.org/wiki/Esomeprazole
Your Health
12:41 PM - Public
Label warnings
This medication is to be swallowed whole, not chewed.
Use with caution in
Severely decreased kidney function.
Severely decreased liver function.
Common side-effects
Headache
Constipation
Diarrhoea
Feeling or being sick, stomach ache, flatulence
http://www.netdoctor.co.uk/digestive-health/medicines/nexium.html
This medication is to be swallowed whole, not chewed.
Use with caution in
Severely decreased kidney function.
Severely decreased liver function.
Common side-effects
Headache
Constipation
Diarrhoea
Feeling or being sick, stomach ache, flatulence
http://www.netdoctor.co.uk/digestive-health/medicines/nexium.html
Your Health
12:31 PM - Public
My doctor currently has me on Nexium to treat Gastritis. Nexium is a proton pump inhibitor and works by restricting the production of stomach acids. It works very well and I've used it on and off for a year and a half as my symptoms come and go. Its been over two months since my symptoms resurfaced (I believe it is triggered by stress and exacerbated by my other habits like not eating regularly and drinking coffee), but I'm reluctant to go back on a prescription. I've been looking for natural remedies and lifestyle changes that will allow me to treat or prevent Gastritis without having to give up coffee and orange juice altogether.
This article from University of Maryland Medical Centre provides a detailed explanation of the causes of Gastritis and several prevention and treatment options including lifestyle and homeopathy. I see peppermint and cranberry herb as viable options I can explore right away in addition to trying hard to avoid white bread and processed foods and increasing protein intake (sounds very Dukan Diet to me, count me in). Also, rather than nibbling cheese when my symptoms are severe, I'll be nibbling berries and almonds.
This article from University of Maryland Medical Centre provides a detailed explanation of the causes of Gastritis and several prevention and treatment options including lifestyle and homeopathy. I see peppermint and cranberry herb as viable options I can explore right away in addition to trying hard to avoid white bread and processed foods and increasing protein intake (sounds very Dukan Diet to me, count me in). Also, rather than nibbling cheese when my symptoms are severe, I'll be nibbling berries and almonds.
Your Health
12:31 PM - Public
Warning About Long-Term Use of Nexium, Prilosec, Protonix and Other PPI Heartburn Medications Issued in U.K.
The U.K.'s MHRA indicates that long-term use of these popular medications may increase the risk of bone fractures, particularly among elderly. We have been investigating potential cases for individuals who suffered fractures while on the medications since the FDA issued similar warnings in 2010. However, while the U.K. warning indicates the problems apply to over-the-counter versions, the FDA updated their warning in March 2011 to indicate they did not appear to be effected.
A second warning was issued about a risk of hypomagnesaemia from long-term use of the PPI drugs, recommending that users have hteir magnesium levels checked regularly.
The U.K.'s MHRA indicates that long-term use of these popular medications may increase the risk of bone fractures, particularly among elderly. We have been investigating potential cases for individuals who suffered fractures while on the medications since the FDA issued similar warnings in 2010. However, while the U.K. warning indicates the problems apply to over-the-counter versions, the FDA updated their warning in March 2011 to indicate they did not appear to be effected.
A second warning was issued about a risk of hypomagnesaemia from long-term use of the PPI drugs, recommending that users have hteir magnesium levels checked regularly.
Your Health
12:28 PM - Public
The interaction between Trazodone + Citalopram notes the following:
"MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids,dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.
MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout period is recommended following use of fluoxetine before administering another serotonergic agent. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary."
The interaction between Citalopram + Nexium notes the following:
"ADJUST DOSE: Coadministration with CYP450 2C19 inhibitors may increase the plasma concentrations of citalopram, which is partially metabolized by the isoenzyme. In 12 healthy subjects who had received citalopram 40 mg once a day for 21 days, administration ofcimetidine 400 mg twice a day for 8 days increased the steady-state citalopram peak serum concentration (Cmax) and systemic exposure (AUC) by 39% and 43%, respectively. In addition to inhibiting CYP450 2C19, cimetidine is also an inhibitor of CYP450 2D6 and 3A4, both of which participates in the metabolism of citalopram. The extent to which sole inhibitors of CYP450 2C19 may inhibit citalopram metabolism is unknown. Clinically, high plasma levels of citalopram may increase the risk of QT interval prolongation and torsade de pointes arrhythmia.
In general, the risk of ventricular arrhythmia in association with QT prolongation is largely unpredictable, but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia).
MANAGEMENT: Given the risk of dose-dependent QT prolongation, citalopram dosage should not exceed 20 mg/day when prescribed in combination with CYP450 2C19 inhibitors such as Nexium (esomeprazole). Alternatives should be considered when possible, and hypokalemia or hypomagnesemia should be corrected prior to initiation of citalopramtreatment and periodically monitored. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, irregular heartbeat, shortness of breath, or syncope."
"MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids,dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.
MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout period is recommended following use of fluoxetine before administering another serotonergic agent. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary."
The interaction between Citalopram + Nexium notes the following:
"ADJUST DOSE: Coadministration with CYP450 2C19 inhibitors may increase the plasma concentrations of citalopram, which is partially metabolized by the isoenzyme. In 12 healthy subjects who had received citalopram 40 mg once a day for 21 days, administration ofcimetidine 400 mg twice a day for 8 days increased the steady-state citalopram peak serum concentration (Cmax) and systemic exposure (AUC) by 39% and 43%, respectively. In addition to inhibiting CYP450 2C19, cimetidine is also an inhibitor of CYP450 2D6 and 3A4, both of which participates in the metabolism of citalopram. The extent to which sole inhibitors of CYP450 2C19 may inhibit citalopram metabolism is unknown. Clinically, high plasma levels of citalopram may increase the risk of QT interval prolongation and torsade de pointes arrhythmia.
In general, the risk of ventricular arrhythmia in association with QT prolongation is largely unpredictable, but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia).
MANAGEMENT: Given the risk of dose-dependent QT prolongation, citalopram dosage should not exceed 20 mg/day when prescribed in combination with CYP450 2C19 inhibitors such as Nexium (esomeprazole). Alternatives should be considered when possible, and hypokalemia or hypomagnesemia should be corrected prior to initiation of citalopramtreatment and periodically monitored. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, irregular heartbeat, shortness of breath, or syncope."
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