<p><strong>Esomeprazole</strong> (<a href="http://en.wikipedia.org/wiki/International_Phonetic_Alphabet" title="International Phonetic Alphabet">IPA</a>: <span titleclass="Pronunciation in IPA" classtitle="Pronunciation in IPA">[ɛs oʊˈmɛprəzoʊl]</span>) is a <a href="http://en.wikipedia.org/wiki/Proton_pump_inhibitor" title="Proton pump inhibitor">proton pump inhibitor</a> (brand names <strong>Nexium</strong>&reg;; <strong>Lucen</strong>&reg;; <strong>Esopral</strong>&reg; and <strong>Axagon</strong>&reg; in Italy) developed and marketed by <a href="http://en.wikipedia.org/wiki/AstraZeneca" title="AstraZeneca">AstraZeneca</a> which is used in the treatment of dyspepsia, <a href="http://en.wikipedia.org/wiki/Peptic_ulcer" title="Peptic ulcer">peptic ulcer disease</a> (PUD), <a href="http://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a> (GORD/GERD) and <a href="http://en.wikipedia.org/wiki/Zollinger-Ellison_syndrome" title="Zollinger-Ellison syndrome">Zollinger-Ellison syndrome</a>. Esomeprazole is the <em>S</em>-<a href="http://en.wikipedia.org/wiki/Enantiomer" title="Enantiomer">enantiomer</a> of <a href="http://en.wikipedia.org/wiki/Omeprazole" title="Omeprazole">omeprazole</a> (marketed as Losec/Prilosec), and AstraZeneca claims improved <a href="http://en.wikipedia.org/wiki/Efficacy" title="Efficacy">efficacy</a> of this single enantiomer product over the <a href="http://en.wikipedia.org/wiki/Racemic" title="Racemic">racemic</a> mixture of omeprazole. However, this greater efficacy has been disputed, with some claiming it offers no benefit from its older form. (see below). Esomeprazole was the third biggest selling pharmaceutical drug in the world for 2005, totaling $5.7 billion in sales for the year of 2005.<sup class="noprint Template-Fact"><span title="This claim needs references to reliable sources since June 2007" style="whiteWHITE-spaceSPACE: nowrap;">[<em><a href="http://en.wikipedia.org/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources">citation needed</a></em>]</span></sup></p><table id="toc" class="toc" summary="Contents"> <tbody> <tr> <td> </td> </tr> </tbody></table> <p><a nameid="Pharmacology" idname="Pharmacology"></a></p>

<dl><dd><div class="noprint"><em>Main article: <a href="http://en.wikipedia.org/wiki/Proton_pump_inhibitor" title="Proton pump inhibitor">Proton pump inhibitor</a></em></div></dd></dl><p>Esomeprazole is a proton pump inhibitor which reduces <a href="http://en.wikipedia.org/wiki/Stomach" title="Stomach">gastric</a> acid secretion through inhibition of H⁺/K⁺-ATPase in gastric <a href="http://en.wikipedia.org/wiki/Parietal_cell" title="Parietal cell">parietal cells</a>. By inhibiting the functioning of this enzyme, the drug prevents formation of gastric acid. HETA</p><p><a nameid="Clinical_use" idname="Clinical_use"></a></p>

<a href="http://en.wikipedia.org/wiki/Proton_pump_inhibitor" title="Proton pump inhibitor"></a></em></div>

<p><a nameid="Use_in_Helicobacter_pylori_eradication" idname="Use_in_Helicobacter_pylori_eradication"></a></p>

<p>Esomeprazole is combined with the antibiotics <a href="http://en.wikipedia.org/wiki/Clarithromycin" title="Clarithromycin">clarithromycin</a> and <a href="http://en.wikipedia.org/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> (or <a href="http://en.wikipedia.org/wiki/Metronidazole" title="Metronidazole">metronidazole</a> in patients with &szlig;-lactam hypersensitivity) in the 10-day eradication triple therapy for <em><a href="http://en.wikipedia.org/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></em>. Infection by <em>H. pylori</em> is the causative factor in the majority of <a href="http://en.wikipedia.org/wiki/Peptic_ulcer" title="Peptic ulcer">peptic and duodenal ulcers</a>.</p><p><a nameid="Evidence_of_efficacy" idname="Evidence_of_efficacy"></a></p>

<p>An alternative rationale suggested for the use of esomeprazole was the reduction in interindividual variability in efficacy. However the clinical advantage of this hypothesis has not thoroughly been tested in large-scale trials.<span class="reference"><sup id="ref_SomogyiSomogyi_2004"><a href="http://en.wikipedia.org/wiki/Nexium#endnote_SomogyiSomogyi_2004" title="">[Somogyi 2004]</a></sup></span></p>

<p><a nameid="Dosage_forms" idname="Dosage_forms"></a></p>

<p>Esomeprazole is available as delayed-release capsules in the United States or as delayed release tablets in Australia and Canada (containing esomeprazole magnesium) in strengths of 20 mg and 40 mg; and as a powder (esomeprazole sodium) for <a href="http://en.wikipedia.org/wiki/Intravenous" title="Intravenous">intravenous</a> injection/infusion. Oral esomeprazole preparations are <a href="http://en.wikipedia.org/wiki/Enteric_coating" title="Enteric coating">enteric-coated</a>, due to the rapid degradation of the drug in the <a href="http://en.wikipedia.org/wiki/Acid" title="Acid">acidic</a> conditions of the <a href="http://en.wikipedia.org/wiki/Stomach" title="Stomach">stomach</a>. This is achieved by formulating capsules using the multiple-unit pellet system.</p>

<div class="thumbinner" style="widthWIDTH: 182px;"><a hrefimg class="http://en.wikipedia.org/wiki/Image:Nexium_%28esomeprazole_magnesium%29_pills.JPGthumbimage" classheight="image185" titlealt="40 mg Nexium® brand esomeprazole capsules"><img width="180" height="185" border="0" alt="40 mg Nexium® brand esomeprazole capsules" src="http://upload.wikimedia.org/wikipedia/commons/thumb/0/00/Nexium_%28esomeprazole_magnesium%29_pills.JPG/180px-Nexium_%28esomeprazole_magnesium%29_pills.JPG" class="thumbimage" /></a>

<div class="magnify" style="floatFLOAT: right;"><a hrefimg height="http://en.wikipedia.org/wiki/Image:Nexium_%28esomeprazole_magnesium%29_pills.JPG11" classalt="internal" title="Enlarge"><img width="15" height="11" src="http://en.wikipedia.org/skins-1.5/common/images/magnify-clip.png" alt="" /></a></div>

<p><a nameid="Multiple_unit_pellet_system" idname="Multiple_unit_pellet_system"></a></p>

<p>Esomeprazole capsules are formulated as a &quot;multiple unit pellet system&quot; (MUPS). Essentially, the <a href="http://en.wikipedia.org/wiki/Capsule" title="Capsule">capsule</a> consists of extremely small enteric-coated granules (pellets) of the esomeprazole formulation inside an outer shell. When the capsule is immersed in an aqueous solution, as happens when the capsule reaches the stomach, water enters the capsule by <a href="http://en.wikipedia.org/wiki/Osmosis" title="Osmosis">osmosis</a>. The contents swell from water absorption causing the shell to burst, releasing the enteric-coated granules. For most patients, the multiple-unit pellet system is of no advantage over conventional enteric-coated preparations. Patients for which the formulation is of benefit include those requiring <a href="http://en.wikipedia.org/wiki/Nasogastric_tube" title="Nasogastric tube">nasogastric tube</a> feeding and those with difficulty swallowing (<a href="http://en.wikipedia.org/wiki/Dysphagia" title="Dysphagia">dysphagia</a>).</p><p>The granules are manufactured in a <a href="http://en.wikipedia.org/w/index.php?title=Fluid_bed&amp;action=edit" class="new" title="Fluid bed">fluid bed</a> system with small sugar spheres as the starting material. The sugar spheres are sequentially spray-coated with a <a href="http://en.wikipedia.org/wiki/Suspension_%28chemistry%29" title="Suspension (chemistry)">suspension</a> containing esomeprazole, a protective layer to prevent degradation of the drug in manufacturing, an enteric coating and an outer layer to reduce granule aggregation. The granules are mixed with other inactive <a href="http://en.wikipedia.org/wiki/Excipient" title="Excipient">excipients</a> and compressed into tablets. Finally, the tablets are film-coated to improve the stability and appearance of the preparation.</p><p><a nameid="Financial_impact" idname="Financial_impact"></a></p>

<p>Between the launch of esomeprazole in 2001 and 2005, the drug has netted AstraZeneca about $14.4 billion.<sup id="_ref-0" class="reference"><a hrefid="http://en.wikipedia.org/wiki/Nexium#_note_ref-0" title="">[1]</a></sup></p><p><a nameid="Controversy" idname="Controversy"></a></p>

<p>There has been some controversy about <a href="http://en.wikipedia.org/wiki/AstraZeneca" title="AstraZeneca">AstraZeneca</a>'s behaviour in creating, patenting and marketing of the drug. Critics allege the company was trying to &quot;evergreen&quot; its patent for the drug's successful predecessor <a href="http://en.wikipedia.org/wiki/Omeprazole" title="Omeprazole">Omeprazole</a> by patenting a slight change to the original molecule and aggressively marketing the new medication to doctors<span class="reference plainlinksneverexpand" id="ref_NexiumDisNY">^{<a href="http://en.wikipedia.org/wiki/Esomeprazole#endnote_NexiumDisNY" class="external autonumber" title="http://en.wikipedia.org/wiki/Esomeprazole#endnote_NexiumDisNY" rel="nofollow">[1]</a>}</span>. <a href="http://en.wikipedia.org/wiki/Harvard_Medical_School" title="Harvard Medical School">Harvard Medical School</a> lecturer <a href="http://en.wikipedia.org/wiki/Marcia_Angell" title="Marcia Angell">Marcia Angell</a>, speaking to a German magazine on August 16, 2007, accused AstraZeneca's scientists of deceptively doctoring their comparative studies such that the difference to Omeprazole would look larger, providing a marketing advantage <span class="reference plainlinksneverexpand" id="ref_Stern">^{<a href="http://en.wikipedia.org/wiki/Esomeprazole#endnote_Stern" class="external autonumber" title="http://en.wikipedia.org/wiki/Esomeprazole#endnote_Stern" rel="nofollow">[2]</a>}</span>. For more information, see <a href="http://en.wikipedia.org/wiki/AstraZeneca#Nexium" title="AstraZeneca">AstraZeneca's article</a>.</p><p><a nameid="References" idname="References"></a></p>

<li><cite id="endnote_LindLind_2004"><a href="http://en.wikipedia.org/wiki/Nexium#ref_LindLind_2004" title=""><strong>^{Lind 2004}</strong></a></cite>&nbsp; <cite style="fontFONT-styleSTYLE: normal;">Lind, T.; Rydberg L., Kyleback A., Jonsson A., Andersson T., Hasselgren T., Holmberg J., Rohss K. (July 2000). &quot;Esomeprazole provides improved acid control vs. omeprazole In patients with symptoms of gastro-oesophageal reflux disease.&quot;. <em><a href="http://en.wikipedia.org/w/index.php?title=Alimentary_pharmacology_%26_therapeutics&amp;action=edit" class="new" title="Alimentary pharmacology &amp; therapeutics">Alimentary pharmacology &amp; therapeutics</a></em> <strong>14</strong> (7): 861&ndash;867. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=10886041" class="external" title="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=10886041">PMID 10886041</a>. Retrieved on <a href="http://en.wikipedia.org/wiki/2006" title="2006">2006</a>-<a href="http://en.wikipedia.org/wiki/December_2" title="December 2">12-02</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Esomeprazole+provides+improved+acid+control+vs.+omeprazole+In+patients+with+symptoms+of+gastro-oesophageal+reflux+disease.&amp;rft.jtitle=%5B%5BAlimentary+pharmacology+%26+therapeutics%5D%5D&amp;rft.date=2000&amp;rft.volume=14&amp;rft.issue=7&amp;rft.aulast=Lind&amp;rft.aufirst=T.&amp;rft.pages=861%26ndash%3B867">&nbsp;</span></li> <li><cite id="endnote_SomogyiSomogyi_2004"><a href="http://en.wikipedia.org/wiki/Nexium#ref_SomogyiSomogyi_2004" title=""><strong>^{Somogyi 2004}</strong></a></cite>&nbsp; Somogyi A., Bochner F., Foster D. (2004). Inside the isomers: the tale of chiral switches. <em>Aust Prescr</em> <strong>27</strong>, 47-49.</li> <li><a href="http://en.wikipedia.org/wiki/Malcolm_Gladwell" title="Malcolm Gladwell">Gladwell, Malcolm</a>. &quot;<a href="http://www.newyorker.com/critics/atlarge/?041025crat_atlarge" class="external text" title="http://www.newyorker.com/critics/atlarge/?041025crat_atlarge" rel="nofollow">High Prices: How to think about prescription drugs.</a>&quot;, <em>A Critic At Large</em>, <a href="http://en.wikipedia.org/wiki/The_New_Yorker" title="The New Yorker">The New Yorker</a>, October 25, 2004. Retrieved on <a href="http://en.wikipedia.org/wiki/2006" title="2006">2006</a>-<a href="http://en.wikipedia.org/wiki/December_2" title="December 2">12-02</a>.<span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&amp;rft.type=newspaperArticle&amp;rft.subject=News&amp;rft.aufirst=Malcolm&amp;rft.aulast=Gladwell&amp;rft.title=High+Prices%3A+How+to+think+about+prescription+drugs.&amp;rft.identifier=http%3A%2F%2Fwww.newyorker.com%2Fcritics%2Fatlarge%2F%3F041025crat_atlarge&amp;rft.source=A+Critic+At+Large&amp;rft.publisher=%5B%5BThe+New+Yorker%5D%5D&amp;rft.date=October+25%2C+2004">&nbsp;</span> <em>This article describes AstraZeneca's strategy for developing Nexium as a follow-on for Losec as the latter approached patent expiry.</em></li>

<p><a nameid="Notes" idname="Notes"></a></p><h3><span class="editsection"></span> <span class="mw-headline">Notes</span></h3>

<li><cite id="endnote_NexiumDisNYT" style="fontFONT-styleSTYLE: normal;"><a href="http://en.wikipedia.org/wiki/Nexium#ref_NexiumDisNYT" title=""><strong>^</strong></a></cite>&nbsp; Gladwell, Malcolm (October 25, 2004). &quot;<a href="http://www.newyorker.com/critics/atlarge/?041025crat_atlarge" class="external text" title="http://www.newyorker.com/critics/atlarge/?041025crat_atlarge" rel="nofollow">High Prices: How to think about prescription drugs</a>&quot;. <em><a href="http://en.wikipedia.org/wiki/The_New_Yorker" title="The New Yorker">The New Yorker</a></em>. Verified availability August 19, 2007.

<li id="_note-0"><strong><a href="http://en.wikipedia.org/wiki/Nexium#_ref-0" title="">^</a></strong> Financial impact information: <a href="http://www.astrazeneca.com/sites/7/imagebank/typeArticleparam511672/astrazeneca-2005-annual-review.pdf" class="external text" title="http://www.astrazeneca.com/sites/7/imagebank/typeArticleparam511672/astrazeneca-2005-annual-review.pdf" rel="nofollow">2005, $4.6 billion</a>; <a href="http://www.astrazeneca.com/sites/7/imagebank/typearticleparam511562/astrazeneca-2004-annual-report.pdf" class="external text" title="http://www.astrazeneca.com/sites/7/imagebank/typearticleparam511562/astrazeneca-2004-annual-report.pdf" rel="nofollow">2004, $3.9 billion</a>; <a href="http://www.astrazeneca.com/sites/7/imagebank/typearticleparam503063/AstraZeneca%20Annual%20Report%202003.pdf" class="external text" title="http://www.astrazeneca.com/sites/7/imagebank/typearticleparam503063/AstraZeneca%20Annual%20Report%202003.pdf" rel="nofollow">2003, $3.3 billion</a>; <a href="http://www2.astrazeneca.com/annualrep2002/pdf/694617_Report_front.pdf" class="external text" title="http://www2.astrazeneca.com/annualrep2002/pdf/694617_Report_front.pdf" rel="nofollow">2002, $2 billion</a>; <a href="http://www2.astrazeneca.com/annualrep2001/pdf/first.pdf" class="external text" title="http://www2.astrazeneca.com/annualrep2001/pdf/first.pdf" rel="nofollow">2001, launch and $580 million</a>.</li>

<li><cite id="endnote_Stern" style="fontFONT-styleSTYLE: normal;"><a href="http://en.wikipedia.org/wiki/Nexium#ref_Stern" title=""><strong>^</strong></a></cite>&nbsp; Grill, Markus and Hansen, Hans: &quot;Vorsicht, Pharma! Wie die Industrie &Auml;rzte manipuliert und Patienten t&auml;uscht.&quot; ('Caution, Pharma! How the industry manipulates physicians and deceives patients.') Published in the 16.08.2007 issue of the magazine <a href="http://en.wikipedia.org/wiki/Stern_%28magazine%29" title="Stern (magazine)">&quot;Der Stern&quot;</a> (Germany; pp. 100-107). Available as an e-paper <a href="http://www.stern.de/magazin/heft/595225.html" class="external text" title="http://www.stern.de/magazin/heft/595225.html" rel="nofollow">here</a>. }}</li>

<p><a nameid="External_links" idname="External_links"></a></p>

<li><a hrefclass="external text" title="http://www.nexium.net/" classrel="external textnofollow" titlehref="http://www.nexium.net" rel="nofollow/">The official International Nexium website</a></li> <li><a hrefclass="external text" title="http://www.purplepill.com/" classrel="external textnofollow" titlehref="http://www.purplepill.com" rel="nofollow/">The official U.S. Nexium website</a></li>