• Esomeprazole

    (es oh me' pray zol)

    WHY is this medicine prescribed?

    Esomeprazole is used to treat gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach). Esomeprazole is used to treat the symptoms of GERD, allow the esophagus to heal, and prevent further damage to the esophagus. Esomeprazole is also used to decrease the chance that people who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers (sores in the lining of the stomach or intestine). It is also used with other medications to treat and prevent the return of stomach ulcers caused by a certain type of bacteria (H. pylori). Esomeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-Ellison syndrome. Esomeprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.

    HOW should this medicine be used?

    Esomeprazole comes as a delayed-release (long-acting) capsule to take by mouth or to open, mix with water, and give through a feeding tube and as granules to mix with water and take by mouth or give through a feeding tube. Esomeprazole is usually taken once a day at least 1 hour before a meal. When esomeprazole is used to treat certain conditions in which the stomach makes too much acid, it is taken twice a day. Take esomeprazole at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take esomeprazole exactly as directed. Do not take more or less of it or take it more often than or for a longer period of time than prescribed by your doctor or stated on the package.
    Swallow the capsules whole; do not split, chew, or crush them. If you cannot swallow the capsule, put 1 tablespoon of cool, soft applesauce in an empty bowl. Open one esomeprazole capsule and carefully sprinkle the pellets onto the applesauce. Mix the pellets with the applesauce and swallow the entire tablespoonful of the applesauce and pellet mixture immediately. Do not chew the pellets in the applesauce. Do not save the pellets and applesauce for later use.
    To mix the granules, follow these steps:
    1. Place 1 tablespoon (15 mL) of water into a cup.
    2. Open the esomeprazole packet and empty the granules into the cup containing the water.
    3. Stir the granules into the water and leave the mixture alone for 2 to 3 minutes so that it will thicken.
    4. Stir the mixture again, and drink all of the mixture within 30 minutes.
    5. If any material remains in the cup after drinking, add some more water and stir. Drink all of the mixture immediately.
    The granules and the contents of the capsules can both be given through a feeding tube. If you have a feeding tube, ask your doctor or pharmacist how you should take the medication. Follow those directions carefully.
    It may take several weeks or longer for you to feel the full benefit of esomeprazole. Call your doctor if your symptoms worsen or do not improve during this time. Continue to take esomeprazole even if you feel well. Do not stop taking esomeprazole without talking to your doctor.
    If your condition does not improve or gets worse, call your doctor.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking esomeprazole,
    • tell your doctor and pharmacist if you are allergic to esomeprazole, dexlansoprazole (Dexilant), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (AcipHex), any other medications, or any of the ingredients in esomeprazole capsules or powder. Ask your pharmacist for a list of the ingredients.
    • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin); certain antifungals such as ketoconazole (Nizoral) and voriconazole (Vfend); cilostazol (Pletal); diazepam (Valium); digoxin (Digitek, Lanoxicaps, Lanoxin); diuretics ('water pills'); iron supplements; and certain medications for human immunodeficiency virus (HIV) such as atazanavir (Reyataz), nelfinavir (Viracept), and saquinavir (Invirase). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had a low level of magnesium in your blood or liver disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking esomeprazole, call your doctor.
    • if you are 50 years of age or older, ask your doctor if it is safe for you to use esomeprazole. The risk that you may develop a severe form of diarrhea caused by bacteria or that you may fracture your wrist, hip, or spine may be higher if you are an older adult.
    • you may take antacids with esomeprazole. If you feel you need an antacid, ask your doctor to recommend one and to tell you when and how to take it.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Esomeprazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • headache
    • nausea
    • gas
    • constipation
    • dry mouth
    Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately, or get emergency medical help:
    • blisters or peeling skin
    • hives
    • rash
    • itching
    • difficulty breathing or swallowing
    • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    • hoarseness
    • irregular, fast, or pounding heartbeat
    • excessive tiredness
    • dizziness
    • lightheadedness
    • muscle spasms
    • uncontrollable shaking of a part of the body
    • seizures
    • watery stool
    • stomach pain
    • fever
    People who take proton pump inhibitors such as esomeprazole may be more likely to fracture their wrists, hips, or spine than people who do not take one of these medications. The risk is highest in people who take high doses of one of these medications or take them for one year or longer. Talk to your doctor about the risk of taking esomeprazole.
    Esomeprazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include the following:
    • confusion
    • drowsiness
    • blurred vision
    • fast heartbeat
    • nausea
    • sweating
    • flushing
    • headache
    • dry mouth

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your doctor may order certain laboratory tests before and during your treatment, especially if you have severe diarrhea..
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Nexium®
    • Vimovo® (as a combination product containing Esomeprazole, Naproxen)

    Naproxen

    (na prox' en)

    IMPORTANT WARNING:

    People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as naproxen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.
    If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take naproxen right before or right after the surgery.
    NSAIDs such as naproxen may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or who drink three or more alcoholic drinks per day while taking naproxen. Tell your doctor if you take any of the following medications: anticoagulants (''blood thinners'') such as warfarin (Coumadin); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) and ketoprofen (Orudis KT, Actron); or oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone). Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking naproxen and call your doctor: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
    Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to naproxen. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
    Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with prescription naproxen and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

    WHY is this medicine prescribed?

    Prescription naproxen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), juvenile arthritis (a form of joint disease in children), and ankylosing spondylitis (arthritis that mainly affects the spine). Prescription naproxen tablets, extended-release tablets, and suspension are also used to relieve shoulder pain caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint), tendinitis (inflammation of the tissue that connects muscle to bone), gouty arthritis (attacks of joint pain caused by a build-up of certain substances in the joints), and pain from other causes, including menstrual pain (pain that happens before or during a menstrual period). Nonprescription naproxen is used to reduce fever and to relieve mild pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Naproxen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

    HOW should this medicine be used?

    Prescription naproxen comes as a regular tablet, an enteric coated tablet (delayed-release tablet), an extended-release (long-acting) tablet, and a suspension (liquid) to take by mouth. The extended-release tablets are usually taken once a day. The tablets, enteric coated tablets, and suspension are usually taken twice a day for arthritis. The tablets and suspension are usually taken every 8 hours for gout, and every 6 to 8 hours as needed for pain. If you are taking naproxen on a regular basis, you should take it at the same time(s) every day.
    Nonprescription naproxen comes as tablet and a gelatin coated tablet to take by mouth. It is usually taken with a full glass of water every 8 to 12 hours as needed. Nonprescription naproxen may be taken with food or milk to prevent nausea.
    Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take naproxen exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor or written on the package.
    Shake the liquid well before each use to mix the medication evenly. Use the measuring cup provided to measure each dose of the liquid.
    Swallow the enteric coated tablets and extended release tablets whole; do not split, chew, or crush them.
    If you are taking naproxen to relieve the symptoms of arthritis, your symptoms may begin to improve within 1 week. It may take 2 weeks or longer for you to feel the full benefit of the medication.
    Stop taking nonprescription naproxen and call your doctor if your symptoms get worse, you develop new or unexpected symptoms, the part of your body that was painful becomes red or swollen, your pain lasts for more than 10 days, or your fever lasts for more than 3 days.

    Are there OTHER USES for this medicine?

    Naproxen is also sometimes used to treat Paget's disease of bone (a condition in which the bones become abnormally thick, fragile, and misshapen) and Bartter syndrome (a condition in which the body does not absorb enough potassium, causing muscle cramping and weakness and other symptoms). Talk to your doctor about the risks of using this medication for your condition.
    This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking naproxen,
    • tell your doctor and pharmacist if you are allergic to naproxen, aspirin or other NSAIDs such as ibuprofen (Advil, Motrin) and ketoprofen (Orudis KT, Actron), any medications for pain or fever, or any other medications.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); diuretics ('water pills'); lithium (Eskalith, Lithobid), medications for diabetes, methotrexate (Rheumatrex); phenytoin (Dilantin); probenecid (Benemid); and sulfa antibiotics such as sulfisoxazole (Gantrisin) and sulfamethoxazole (in Bactrim, in Septra). If you are taking the enteric coated tablets, also tell your doctor if you are taking antacids or sucralfate (Carafate). Your doctor may need to change the doses of your medication or monitor you more carefully for side effects.
    • do not take nonprescription naproxen with any other medication for pain unless your doctor tells you that you should.
    • tell your doctor if you have been told to follow a low sodium diet and if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the inside of the nose); swelling of the hands, arms, feet, ankles, or lower legs; anemia (red blood cells do not bring enough oxygen to all parts of the body); or liver or kidney disease.
    • tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, you plan to become pregnant, or you are breast-feeding. If you become pregnant while taking naproxen, call your doctor.
    • talk to your doctor about the risks and benefits of taking naproxen if you are 65 years of age or older. Older adults should usually take lower doses of naproxen for short periods of time because higher doses used regularly may not be more effective and are more likely to cause serious side effects.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking naproxen.
    • you should know that this medication may make you dizzy, drowsy, or depressed. Do not drive a car or operate machinery until you know how this drug affects you.
    • remember that alcohol can add to the drowsiness caused by this medication.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Naproxen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • constipation
    • diarrhea
    • gas
    • sores in mouth
    • excessive thirst
    • headache
    • dizziness
    • lightheadedness
    • drowsiness
    • difficulty falling asleep or staying asleep
    • burning or tingling in the arms or legs
    • cold symptoms
    • ringing in the ears
    • hearing problems
    Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more naproxen until you speak to your doctor:
    • changes in vision
    • feeling that the tablet is stuck in your throat
    • unexplained weight gain
    • sore throat, fever, chills, and other signs of infection
    • blisters
    • rash
    • skin reddening
    • itching
    • hives
    • swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
    • difficulty breathing or swallowing
    • hoarseness
    • excessive tiredness
    • pain in the upper right part of the stomach
    • nausea
    • loss of appetite
    • yellowing of the skin or eyes
    • flu-like symptoms
    • bruises or purple blotches under the skin
    • pale skin
    • fast heartbeat
    • cloudy, discolored, or bloody urine
    • back pain
    • difficult or painful urination
    Naproxen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include the following:
    • dizziness
    • extreme tiredness
    • confusion
    • drowsiness
    • stomach pain
    • heartburn
    • nausea
    • vomiting
    • slow or difficult breathing
    • decreased urination

    What OTHER INFORMATION should I know?

    Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking naproxen.
    If you are taking prescription naproxen, do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Aleve®
    • Anaprox®
    • Anaprox® DS
    • EC-Naprosyn®
    • Naprelan®
    • Naprosyn®
    • Treximet® (as a combination product containing Naproxen, Sumatriptan)
    • Vimovo® (as a combination product containing Esomeprazole, Naproxen)
    • Also available generically
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