Esomeprazole

What it is

Esomeprazole is a proton pump inhibitor: it shuts down the acid-secreting enzyme in the stomach lining, cutting acid output for most of the day. It is used for heartburn and reflux, and for the healing and prevention of stomach and duodenal ulcers. Because it blocks acid production rather than neutralising acid already present, the full effect builds over several days.

Used for

• Heartburn
• Ulcer

What to know while taking it

It is taken on an empty stomach before the morning meal, since the pumps it targets are activated by eating. Low stomach acid reduces absorption of vitamin B12, magnesium and iron, so on long courses magnesium, vitamin B12 and ferritin are worth checking. It reduces the activation of clopidogrel, weakening that drug's protection against clots, and it changes absorption of levothyroxine, so thyroid tests may shift. Extended use is associated with lower bone density, which is why the need for a long course is reassessed rather than renewed automatically.

When to see a doctor

See a doctor if heartburn continues despite treatment, or if there is difficulty swallowing, unintentional weight loss, vomiting of blood or black tarry stools. Muscle cramps, palpitations, persistent fatigue or new numbness may point to low magnesium or B12 and should be checked, as should any course that has quietly run on for months.

Worth knowing

• Reassess the need for long courses
• Long use affects bone density

Markers to watch

• Magnesium
• Vitamin B12
• Ferritin

Nutrients affected

• vitaminB12 — depleted by (Hemoglobin, Homocysteine, Mean cell volume (MCV))
• magnesium — depleted by (Glucose, HOMA-IR, Magnesium)
• iron — absorption blocked with (Ferritin, Hematocrit, Hemoglobin)