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Gastroenterology (Expert Forum)

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IS 80MG of Nexium too Much

Answered by

Kevin Pho, MD - Internal Medicine

Kevin Pho, MD Boston - MA

This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.

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MedHelp Member's Question

IS 80MG of Nexium too Much

by imabat, Apr 01, 2004 12:00AM

Tags: erosive, esophagitis, oral, Stomach Conditions, treatment

I'm 28 year old male. With a bad history of stomach acid problems and acid reflux. Also history of IBS. I had a Nissen Wrap done about 8 months ago. But I still need to take the Nexium. I take 80 mg .... this is what the Drs said to take. I still have stomach problems ( pain in the right side ) . It comes and gos. I'm worried about taking all that Nexium. If I drop down to only 40mg it doesn't work. What should I do ? Can I get cancer by taking too much of this Nexium?

Doctor's Answer

by Kevin Pho, MD

, Apr 01, 2004 12:00AM

Here is the dosing of Nexium from the Drug Information Handbook:

"DOSING: ADULTS

Healing of erosive esophagitis: Oral: 20-40 mg once daily for 4-8 weeks; may consider an additional 4-8 weeks of treatment if patient is not healed

Maintenance of healing of erosive esophagitis: Oral: 20 mg once daily; clinical trials evaluated therapy for 6 months

Symptomatic gastroesophageal reflux: Oral: 20 mg once daily for 4 weeks; may consider an additional 4 weeks of treatment if symptoms do not resolve

Helicobacter pylori eradication: Oral: 40 mg once daily; requires combination therapy"

Thus, typically Nexium does not go above 40mg.  The proton pump inhibitors are an extremely safe class of drugs. However, differences in their metabolism may lead to specific drug interactions. The long-term safety of these drugs has been best established with omeprazole since it was the first to become available clinically. These data suggest that its use for more than 15 years is safe.

I am not aware of an association with cancer due to long term exposure with these class of medications.  If you are still having symptoms despite maximal doses of Nexium, you may want to consider a revision of the surgery as an option.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,

Kevin, M.D.

Bibliography:

Wolfe.  Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders.  UptoDate, 2004.

Member Comments (3)

by momhelp, Apr 01, 2004 12:00AM

Here is what I know. Also check out link at bottom.

U.S./Canadian Brand Names

Nexium�

Therapeutic Category

Proton Pump Inhibitor

Use

Short-term (4-8 weeks) treatment of erosive esophagitis; maintaining symptom resolution and healing of erosive esophagitis; treatment of symptomatic gastroesophageal reflux disease; as part of a multidrug regimen for Helicobacter pylori eradication in patients with duodenal ulcer disease (active or history of within the past 5 years)

Usual Dosage

Note: Delayed-release capsules should be swallowed whole and taken at least 1 hour before eating

  Children: Safety and efficacy have not been established in pediatric patients

  Adults: Oral:

  Erosive esophagitis (healing): 20-40 mg once daily for 4-8 weeks; maintenance: 20 mg once daily

  Symptomatic GERD: 20 mg once daily for 4 weeks

  H. pylori eradication: 40 mg once daily with amoxicillin 1000 mg twice daily and clarithromycin 500 mg twice daily for a total of 10 days

Dosage Forms

Capsule, delayed-release: 20 mg, 40 mg

http://www.drugs.com/xq/cfm/pageid_0/htm_d04749A1.htm/type_mtm/tgid_27/bn_Nexium/qx/index.htm

by tessa0825, Apr 01, 2004 12:00AM

I take 60mg daily of nexium post fundo surgery..Prior to surgery I took 100mg daily for more than a year..I have never heard that nexium causes cancer...I do know that acid-reflux can cause cancer. If you are still having reflux following fundoplication surgery, nexium seems to provide alot of protection...Do you still follow the GERD diet and other lifestyle changes since surgery?

by Alpha_Consumer, Apr 03, 2004 12:00AM

To: Natural Cure?

Antacids can have serious side effects. Antacids can make the stomach more vulnerable to food poisoning. Normally, Vibrio vulnificus, a potentially fatal bacteria found in raw shellfish, is killed by stomach juices. But, the bacteria can survive up to two hours in the presence of antacids, causing severe vomiting, diarrhea, and stomach cramps.23

Antacids interact with or prevent the absorption of many medications including:

� allopurinol

� aspirin, salicylates

� benzodiazepines

� blood thinners

� chloroquine

� corticosteroids

� diabetic medicines

� digoxin

� ethambutol

� flecainide

� iron

� isoniazid

� nitrofurantoin

� penicillamine

� phenothiazines

� phenytoin type drugs

� quinidine

� tetracycline

� thyroid medications

� ticlopidine

� ulcer medications23,24

H2-receptor blockers, such as Tagamet�, are a different type of heartburn medication. H2-receptor blockers sharply decrease hydrochloric acid production, impairing vitamin B12 and calcium absorption from food. Vitamin B12 in food is attached to proteins. Stomach acid separates them and allows the B12 to be absorbed. Without adequate stomach acid, the B12 remains attached to the proteins.24

Proton pump inhibitors (PPIs) work by inhibiting the hydrochloric acid production. In fact, they almost completely shut down the stomach�s ability to produce acid.25

Nexium�, Prevacid�, and Prilosec� are some of the most prescribed medications in the U.S. In 1999, Americans spent more than $7 billion on Prilosec and other PPIs. While PPIs may be safe for short-term use, the long-term consequences of total hydrochloric acid blocking are unknown.26 The package insert in the Physicians� Desk Reference states these medications are only for short-term use, but they are generally being used for long periods of time.

In contrast to all these remedies, orange peel extract is a safe and effective option for complete resolution of symptoms...

For the complete article and peer reviewed references. Check out

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