Adverse Events that long-term use of esomeprazole

There are a number of potential adverse events that might arise from Nexium use. These include the following:
Hip fracture

There is some evidence that long-term use of esomeprazole can increase the chances of hip fracture.

Proton pump inhibitors can interfere with calcium absorption, potentially weakening bones. Their use may also impact on normal bone recycling by inhibiting proton pumps that are involved in bone creation and remodeling.

Nexium could increase the risk of Clostridium difficile based diarrhea, according to a number of studies.
Clostridium difficile based diarrhea

Some evidence suggests that Nexium and other proton pump inhibitors might cause an increased rate of Clostridium difficile-based diarrhea.

One study found a 30% increased chance of developing hospital-acquired pneumonia in patients prescribed proton pump inhibitors.

Nexium and other proton pump inhibitors are associated with the development of benign polyps on the fundic glands (secretory areas of the stomach). Nexium is not, however, associated with cancer.

Kidney damage
Some studies have recently found a correlation between proton pump inhibitors and chronic kidney disease. At this stage, it is not clear whether the link is causal.10

Some evidence suggests that, because gastric acid breaks down food, there may be some nutritional deficits if the acid is not present. Some studies have shown a possible interference with the absorption of calcium, iron and vitamin B12.11

There are many confounding variables, however, and how these factors interact is not yet fully understood. The strongest evidence for nutritional shortfalls is in regard to magnesium.12
Nexium interactions with other drugs

Nexium is a competitive inhibitor of the enzyme CYP2C19, so other drugs that rely on this enzyme might be affected by its use. For instance, diazepam and warfarin are broken down by CYP2C19. Levels of these drugs in the body might rise if taken alongside a proton pump inhibitor.

Other drugs, such as clopidogrel (Plavix) depend on CYP2C19 to be converted into their active form; their effect will therefore be reduced if taken alongside esomeprazole.

A change in stomach acidity also changes the way certain drugs are absorbed. Some drugs require an acidic environment to be absorbed, such as ketoconazole or atazanavir. Others, including erythromycin, are degraded by stomach acid, so in more alkaline situations they will be absorbed in greater quantities.


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