Package leaflet: Information for the patient

Esomep 20 mg gastro-resistant tablets

Esomep 40 mg gastro-resistant tablets

esomeprazole

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.

• If you have any further questions, ask your doctor or pharmacist.

• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

• If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1. What Esomep is and what it is used for

2. What you need to know before you take Esomep

3. How to take Esomep

4. Possible side effects

5. How to store Esomep

6. Contents of the pack and other information

1. What Esomep is and what it is used for

Esomep contains a medicine called esomeprazole. This belongs to a group of medicines called ‘proton pump inhibitors’. They work by reducing the amount of acid that your stomach produces.

Esomep is used to treat the following conditions:

Adults

• ‘Gastroesophageal reflux disease’ (GERD). This is where acid from the stomach escapes into the gullet (the tube which connects your throat to your stomach) causing pain, inflammation and heartburn.

• Ulcers in the stomach or upper part of the gut (intestine) that are infected with bacteria called ‘Helicobacter pylori’. If you have this condition, your doctor may also prescribe antibiotics to treat the infection and allow the ulcer to heal.

• Stomach ulcers caused by medicines called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Esomep can also be used to stop stomach ulcers from forming if you are taking NSAIDs.

• Too much acid in the stomach caused by a growth in the pancreas (Zollinger-Ellison syndrome).

• Prolonged treatment after prevention of rebleeding of ulcers with intravenous Esomep.

Adolescents aged 12 years and above

2. What you need to know before you take Esomep

Do not take Esomep :

• If you are allergic to esomeprazole or any of the other ingredients of this medicine (listed in Section 6).

• If you are allergic to other proton pump inhibitor medicines (e.g. pantoprazole, lanzoprazole, rabeprazole, omeprazole).

• If you are taking a medicine containing nelfinavir (used to treat HIV infection).

Do not take Esomep if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Esomep.

Warnings and precautions

Talk to your doctor or pharmacist before taking Esomep:

• If you have severe liver problems.

• If you have severe kidney problems.

• If you have ever had a skin reaction after treatment with a medicine similar to Esomep that reduces stomach acid.

Esomep may hide the symptoms of other diseases. Therefore, if any of the following happen to you before you start taking Esomep or while you are taking it, talk to your doctor straight away:

• You lose a lot of weight for no reason and have problems swallowing.

• You get stomach pain or indigestion.

• You begin to vomit food or blood.

• You pass black stools (blood-stained faeces).

If you have been prescribed Esomep “on demand” you should contact your doctor if your symptoms continue or change in character.

Taking a proton pump inhibitor like Esomep, especially over a period of more than one year, may slightly increase your risk of fracture in the hip, wrist or spine. Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).

If you get a rash on your skin, especially in areas exposed to the sun tell your doctor as soon as you can, as you may need to stop your treatment with Esomep. Remember to also mention any other ill- effects like pain in your joints.

Children under the age of 12 years

Esomep gastro-resistant tablets are not recommended for children less than 12 years old.

Other medicines and Esomep

Tellyour doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This includes medicines that you buy without a prescription. This is because Esomep can affect the way some medicines work and some medicines can have an effect on Esomep.

Do not take Esomep Tablets if you are taking a medicine containing nelfinavir (used to treat HIV infection).

Tell your doctor or pharmacist if you are taking any of the following medicines:

• Atazanavir (used to treat HIV infection).

• Clopidogrel (used to prevent blood clots).

• Ketoconazole, itraconazole or voriconazole (used to treat infections caused by a fungus).

• Erlotinib (used to treat cancer)

• Citalopram, imipramine or clomipramine (used to treat depression).

• Diazepam (used to treat anxiety, relax muscles or in epilepsy).

• Phenytoin (used in epilepsy). If you are taking phenytoin, your doctor will need to monitor you when you start or stop taking Esomep.

• Medicines that are used to thin your blood, such as warfarin. Your doctor may need to monitor you when you start or stop taking Esomep.

• Cilostazol (used to treat intermittent claudication – a pain in your legs when you walk which is caused by an insufficient blood supply).

• Cisapride (used for indigestion and heartburn).

• Digoxin (used for heart problems).

• Methotrexate (a chemotherapy medicine used in high doses to treat cancer) – if you are taking a high dose of methotrexate, your doctor may temporarily stop your Esomep treatment.

• Tacrolimus (organ transplantation).

• Rifampicin (used for treatment of tuberculosis).

• St. John’s wort (Hypericum perforatum) (used to treat depression).

If your doctor has prescribed the antibiotics amoxicillin and clarithromycin as well as Esomep to treat ulcers caused by Helicobacter pylori infection, it is very important that you tell your doctor about any other medicines you are taking.

Esomep with food and drink

You can take your tablets with food or on an empty stomach.

Pregnancy, breast-feeding and fertility

If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Your doctor will decide whether you can take Esomep during this time.

It is not known if Esomep passes into breast milk. Therefore, you should not take Esomep if you are breastfeeding.

Driving andusing machines

Esomep is not likely to affect you being able to drive or use any tools or machines. However, side effects such as dizziness and blurred vision may uncommonly or rarely occur (see section 4). If affected, you should not drive or use machines.

Esomep contains sucrose

Esomep contains sugar spheres which contain sucrose, a type of sugar. If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before taking this medicine.

3. How to take Esomep

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

• If you are taking this medicine for a long time, your doctor will want to monitor you (particularly if you are taking it for more than a year).

• If your doctor has told you to take this medicine as and when you need it, tell your doctor if your symptoms change.

How much to take

• Your doctor will tell you how many tablets to take and how long to take them for. This will depend on your condition, how old you are and how well your liver works.

• The recommended doses are given below.

Adults aged 18 and above

To treat heartburn caused by gastroesophageal reflux disease (GERD):

The recommended dose once the gullet has healed is one Esomep 20 mg gastro-resistant tablet once a day

• If your gullet has not been damaged, the recommended dose is one Esomep 20 mg gastro-resistant tablet each day. Once the condition has been controlled, your doctor may tell you to take your medicine as and when you need it, up to a maximum of one Esomep 20 mg gastro-resistant tablet each day.

• If you have severe liver problems, your doctor may give you a lower dose.

To treat ulcers caused by Helicobacter pylori infection and to stop them coming back:

To treat stomach ulcers caused by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

To prevent stomach ulcers if you are taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

To treat too much acid in the stomach caused by a growth in the pancreas (Zollinger-Ellison syndrome):

• The recommended dose is Esomep 40 mg twice a day.

• Your doctor will adjust the dose depending on your needs and will also decide how long you need to take the medicine for. The maximum dose is 80 mg twice a day.

Prolonged treatment after prevention of rebleeding of ulcers with intravenousEsomep:

The recommended dose is one Esomep 40 mg tablet once a day for 4 weeks.

Adolescents aged 12 or above

To treat heartburn caused by gastroesophageal reflux disease (GERD):

• The recommended dose once the gullet has healed is one Esomep 20 mg gastro-resistant tablet once a day.

• If your gullet has not been damaged, the recommended dose is one Esomep 20 mg gastro-resistant tablet each day.

• If you have severe liver problems, your doctor may give you a lower dose.

Taking this medicine

• You can take your tablets at any time of the day.

• You can take your tablets with food or on an empty stomach.

• Swallow your tablets whole with a drink of water. Do not chew or crush the tablets. This is because the tablets contain coated pellets which stop the medicine from being broken down by the acid in your stomach. It is important not to damage the pellets.

What to do if you have trouble swallowing the tablets

• If you have trouble swallowing the tablets:

  • Put them into a glass of still (non-fizzy) water. Do not use any other liquids.

  • Stir until the tablets break up (the mixture will not be clear). Then drink the mixture straight away or within 30 minutes. Always stir the mixture just before drinking it.

  • To make sure that you have drunk all of the medicine, rinse the glass very well with half a glass of water and drink it. The solid pieces contain the medicine - do not chew or crush them.

• If you cannot swallow at all, the tablet can be mixed with some water and put into a syringe. It can then be given to you through a tube directly into your stomach (‘gastric tube’).

Elderly

Dose adjustment is not required in the elderly.

If you take more Esomep than you should

If you take more Esomep than prescribed by your doctor, talk to your doctor or pharmacist straight away.

If you forget to take Esomep

• If you forget to take a dose, take it as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose.

• Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you notice any of the following serious side effects, stop taking Esomepand contact a doctor immediately:

• Sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties in swallowing (severe allergic reaction).

• Reddening of the skin with blisters or peeling. There may also be severe blisters and bleeding in the lips, eyes, mouth, nose and genitals. This could be ‘Stevens-Johnson syndrome’ or ‘toxic epidermal necrolysis’.

• Yellow skin, dark urine and tiredness which can be symptoms of liver problems.

These effects are rare, and may affect up to 1 in 1,000 people.

Other side effects include:

Common (may affect up to 1 in 10 people)

• Headache.

• Effects on your stomach or gut: diarrhoea, stomach pain, constipation, wind (flatulence).

• Feeling sick (nausea) or being sick (vomiting).

Uncommon (may affect up to 1in 100 people)

• Swelling of the feet and ankles.

• Disturbed sleep (insomnia).

• Dizziness, tingling feelings such as “pins and needles”, feeling sleepy.

• Spinning feeling (vertigo).

• Dry mouth.

• Changes in blood tests that check how the liver is working.

• Skin rash, lumpy rash (hives) and itchy skin.

• Fracture of the hip, wrist or spine (if Esomep is used in high doses and over long duration).

Rare (may affect up to 1in 1,000people)

• Blood problems such as a reduced number of white cells or platelets. This can cause weakness, bruising or make infections more likely

• Low levels of sodium in the blood. This may cause weakness, being sick (vomiting) and cramps.

• Feeling agitated, confused or depressed.

• Taste changes.

• Eyesight problems such as blurred vision.

• Suddenly feeling wheezy or short of breath (bronchospasm).

• An inflammation of the inside of the mouth.

• An infection called “thrush” which can affect the gut and is caused by a fungus.

• Liver problems, including jaundice which can cause yellow skin, dark urine, and tiredness.

• Hair loss (alopecia).

• Skin rash on exposure to sunshine.

• Joint pains (arthralgia) or muscle pains (myalgia).

• Generally feeling unwell and lacking energy.

• Increased sweating.

Very rare (may affect up to 1 in 10,000 people)

• Changes in blood count including agranulocytosis (lack of white blood cells)

• Aggression.

• Seeing, feeling or hearing things that are not there (hallucinations).

• Severe liver problems leading to liver failure and inflammation of the brain.

• Sudden onset of a severe rash or blistering or peeling skin. This may be associated with a high fever and joint pains (Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis).

• Muscle weakness.

• Severe kidney problems.

• Enlarged breasts in men.

Not known (frequency cannot be estimated from the available data)

• Inflammation in the gut (leading to diarrhoea)

• Rash, possibly with pain in the joints.

Esomep may in very rare cases affect the white blood cells leading to immune deficiency. If you have an infection with symptoms such as fever with a severelyreduced general condition or fever with symptoms of a local infection such as pain in the neck, throat or mouth or difficulties in urinating, you must consult your doctor as soon as possible so that a lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important for you to give information about your medication at this time.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

You can also report side effects directly via the national reporting system listed in AppendixV. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Esomep

• Keep this medicine out of the sight and reach of children.

• Do not store above 30°C.

• Do not use this medicine after the expiry date which is stated on the carton and bottle after EXP. The expiry date refers to the last day of that month.

• Store this medicine in the original package (blister) or keep the bottle tightly closed in order to protect from moisture.

• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines that are no longer required. These measures will help to protect the environment.

6. Contents of the pack and other information

What Esomep contains

• The active substance is esomeprazole. Esomep gastro-resistant tablets come in two strengths containing 20 mg or 40 mg of esomeprazole (as magnesium trihydrate).

• The other ingredients are glycerol monostearate 40-55, hydroxypropylcellulose, hypromellose, iron oxide (20 mg: reddish-brown; yellow; 40 mg reddish‑brown) (E172), magnesium stearate, methacrylic acid ethyl acrylate copolymer (1:1) dispersion 30 per cent, microcrystalline cellulose, synthetic paraffin, macrogol, polysorbate 80, crospovidone, sodium stearyl fumarate, sugar spheres (sucrose and maize starch), talc, titanium dioxide (E171), triethyl citrate.

What Esomep looks like and contents of the pack

• Esomep 20 mg gastro-resistant tablets are light pink with an on one side and 20 mg on the other side.

• Esomep 40 mg gastro-resistant tablets are pink with an on one side and 40 mg on the othe r side.

• Your tablets will come in a blister pack in wallets and/or cartons containing
  20 mg, 40 mg: Bottles of 2, 5, 7, 14, 15, 28, 30, 56, 60, 100, 140(5x28) tablets.
  20 mg, 40 mg: Blister packs in wallet and/or carton of 3, 7, 7x1, 14, 15, 25x1, 28, 30, 50x1, 56, 60, 90, 98, 100x1, 140 tablets
  
  

• Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

[To be completed nationally]

This medicine is authorised in the Member states of the EEA under the following names:

Member State	Name of medicinal product
Austria	Durotiv
Greece, Italy, Luxembourg, Sweden	Esomep
Portugal	Esomeprazol AstraZeneca

This leaflet was last revised in 2016-04-01

Other sources of information

Detailed information on this medicine is available on the web site of {MS/Agency}

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The following information is intended for healthcare professionals only:

Administration through gastric tube

1. Put the tablet into an appropriate syringe and fill the syringe with approximately 25 ml water and approximately 5 ml air. For some tubes, dispersion in 50 ml water is needed to prevent the pellets from clogging the tube.

2. Immediately shake the syringe for approximately 2 minutes to disperse the tablet.

3. Hold the syringe with the tip up and check that the tip has not clogged.

4. Attach the syringe to the tube whilst maintaining the above position.

5. Shake the syringe and position it with the tip pointing down. Immediately inject 5 – 10 ml into the tube. Invert the syringe after injection and shake (the syringe must be held with the tip pointing up to avoid clogging of the tip)

6. Turn the syringe with the tip down and immediately inject another 5 – 10 ml into the tube. Repeat this procedure until the syringe is empty.

7. Fill the syringe with 25 ml of water and 5 ml of air and repeat step 5 if necessary to wash down any sediment left in the syringe. For some tubes, 50 ml water is needed.