At the moment, it describes very rare cases of intentional overdose. Oral administration of esomeprazole in a dose of 280 mg was accompanied by general weakness and symptoms of gastro-intestinal tract.Single dose of esomeprazole 80 mg did not cause any adverse effects.
The specific antidote is known. Esomeprazole is bound to plasma proteins, therefore, dialysis is ineffective. In case of overdose should be carried out is symptomatic and general supportive treatment.
Interaction with other drugs
The study trenbolone acetate price was conducted esomeprazole interactions only adult patients. Effect of esomeprazole on the pharmacokinetics of other drugs Low acidity in the stomach in the treatment of esomeprazole can reduce or enhance absorption of other drugs, the absorption of which depends on the acidity of the medium. Just as the use of other drugs that suppress acid secretion or antacids, esomeprazole treatment can lead to decreased absorption of ketoconazole, itraconazole and erlotinib, and increase the absorption of drugs such as digoxin. Simultaneous use of esomeprazole 20 mg / day and digoxin increases the bioavailability of digoxin, 10% (bioavailability of digoxin was increased by up to 30% in two of 10 patients). About digitalis intoxication is rarely reported, however, caution should be exercised when treating elderly patients with high doses of esomeprazole. An enhanced monitoring of serum digoxin concentration. It has been shown that some of esomeprazole is reacted with antiretroviral drugs. Mechanisms and clinical significance of this interaction is not always known. The increase in pH during treatment with esomeprazole may interfere with the absorption of antiretroviral drugs. It is also possible to isoenzyme CYP2C19 interaction level. With simultaneous use of esomeprazole and some antiretroviral drugs, such as atazanavir and nelfinavir, there is a decrease in the blood serum concentrations, so their simultaneous use is not recommended. The simultaneous use of esomeprazole (40 mg once daily) with atazanavir 300 mg / ritonavir 100 mg to healthy volunteers resulted in a significant decrease in the bioavailability of atazanavir (area under the curve “concentration-time» (AUC), C max and C min plasma decreased approximately 75%). Increasing the dose of atazanavir to 400 mg of an offset lower its bioavailability exposed esomeprazole. The simultaneous use of esomeprazole (20 mg / day) with atazanavir 400 mg / 100 mg ritonavir in healthy volunteers resulted in a decrease of atazanavir bioavailability by approximately 30% compared to the bioavailability when using atazanavir 300 mg / 100 mg ritonavir without a proton pump inhibitor (PPI). The simultaneous use of esomeprazole with other drugs in the metabolism of which isozyme is involved CYP2C19, such as diazepam, citalopram, imipramine, clomipramine, phenytoin, et al., May lead to increased concentrations of these drugs in the blood plasma and require dose reduction. This cooperation is especially important to remember when using esomeprazole “as necessary.” With trenbolone acetate price the simultaneous ingestion of esomeprazole 30 mg and diazepam 45% reduced clearance of diazepam, which is a substrate isozyme of CYP2C19. With the simultaneous ingestion of esomeprazole 40 mg and phenytoin have epileptic patients was increased by 13% residual concentration of phenytoin in blood plasma. In this regard, it is recommended control phenytoin plasma concentration at the beginning of esomeprazole treatment and its cancellation. Application esomeprazole 40 mg once a day resulted in an increase in AUC and C max of voriconazole (substrate isoenzyme CYP2C19) at the 15% and 41%, respectively . When using the oral dose of esomeprazole 40 mg patients receiving warfarin clotting time remained within acceptable values. However, several reported cases of clinically significant increase MHO index (international normalized ratio), while the use of warfarin and esomeprazole. In this regard, it is recommended monitoring INR at the beginning and the joint application end esomeprazole and warfarin or other coumarin derivatives. Application of esomeprazole 40 mg in healthy volunteers, once a day resulted in an increase in C max and AUC cilostazol is 18% and 26%, respectively ; for one of the active metabolites cilostazol increase was 29% and 69%, respectively. In healthy volunteers inside the simultaneous use of esomeprazole and 40 mg of cisapride by 32% and increased the AUC value of 31% increased T 1/2cisapride; C max cisapride plasma while not significantly changed. A slight lengthening the interval QT, which was observed during monotherapy cisapride, adding esomeprazole is not increased. It was noted pharmacokinetic / pharmacodynamic interaction between clopidogrel (loading dose of 300 mg / maintenance dose of 75 mg), and esomeprazole (40 mg / day), which leads to a decrease in the active exposure metabolite of clopidogrel in average and reducing 40% maximal inhibition of ADP-induced platelet aggregation in average 14%. When clopidogrel together with a fixed combination of esomeprazole (20 mg / day) and aspirin (81 mg / day) there was a decrease exposure of the active metabolite of clopidogrel by 40% compared to a monotherapy clopidogrel, with maximal levels of inhibition of ADP-induced platelet aggregation were identical . During observations and clinical studies have provided conflicting data on the presence or absence of an increased risk of cardiovascular events, however, should be used with caution in conjunction with clopidogrel esomeprazole. Some patients have noted an increased concentration of methotrexate in the background of a joint application with the PPI. When high doses of methotrexate should be considered a temporary cancellation of esomeprazole. With simultaneous use of esomeprazole and tacrolimus showed an increase in serum concentrations of tacrolimus, which must be carefully monitored and the dose adjusted accordingly. Also to be assessed renal function (creatinine clearance, glomerular filtration rate). It is shown that esomeprazole does not cause clinically significant changes in the pharmacokinetics of amoxicillin and quinidine. Studies evaluating the short-term simultaneous use of esomeprazole and naproxen or rofecoxib did not reveal any clinically significant pharmacokinetic interaction. The effect of drugs on pharmacokinetics of esomeprazole in the metabolism of esomeprazole involved isoenzymes CYP2C19 and CYP3A4. Combined use inside esomeprazole and clarithromycin inhibitor isoenzyme CYP3A4 (500 mg, 2 times daily) resulted in a twofold increase in AUC of esomeprazole. Simultaneous use of esomeprazole and a combined inhibitor of isozyme CYP3A4 and CYP2C19, for example, voriconazole may increase AUC esomeprazole to 280% . Typically, in such cases does not require esomeprazole dose adjustment. Dose adjustment of esomeprazole may be required in patients with severe hepatic impairment and if long-term it is used. Drugs that induce isoenzymes CYP2C19 and of CYP3A4, such as rifampicin and drugs St. John’s wort,while the use of esomeprazole may lead to a reduction of esomeprazole plasma trenbolone acetate price concentrations of by accelerating its metabolism. anabolic steroids buy