Zoom Cap 40 Mg 2x10s (esomeprazole magnesium)-Potential overview

• Brand Name: Zoom Cap
• Generic Name: Esomeprazole Magnesium
• Strength: 40 mg
• Pack Size: 2×10 capsules (20 capsules per box)

Zoom Cap 40 mg (Esomeprazole Magnesium) is a delayed-release proton pump inhibitor (PPI) used for managing conditions related to excessive stomach acid production. Below is a summary of its key aspects:

Indications

Zoom Cap 40 mg is indicated for:

1. Gastroesophageal Reflux Disease (GERD):
   • Alleviates symptoms such as heartburn and acid regurgitation.
   • Promotes healing of erosive esophagitis.
2. Peptic Ulcers:
   • Helps in the treatment and prevention of ulcers caused by Helicobacter pylori or NSAID use.
3. Zollinger-Ellison Syndrome:
   • Manages excessive gastric acid secretion caused by gastrin-secreting tumors.
4. Preventive Use:
   • Reduces the risk of rebleeding in gastric ulcers post-endoscopy.
   • Prevention of acid-related damage in at-risk patients.

Benefits

1. Prolonged Acid Suppression:
   • Once-daily dosing offers sustained relief, reducing symptoms and promoting healing.
2. Dual-Indication:
   • Effective for both symptomatic relief and preventive care in high-risk patients.
3. Improved Bioavailability:
   • Esomeprazole, the S-isomer of omeprazole, demonstrates enhanced and consistent absorption compared to its counterpart.

Mechanism of Action

Esomeprazole inhibits the H+/K+ ATPase enzyme (proton pump) in stomach lining cells, reducing gastric acid secretion by blocking the final step in acid production. This mechanism ensures relief from symptoms and promotes the healing of acid-related conditions.

Advantages Over Other PPIs

1. Enhanced Effectiveness:
   • Superior acid control and better healing rates for erosive esophagitis compared to omeprazole.
2. Minimal Interaction with CYP450:
   • Esomeprazole has fewer drug interactions, especially with medications metabolized via CYP2C19.
3. Patient Compliance:
   • Convenient dosing and flexibility with formulations (capsules, granules, etc.).

Potential Risks

1. Common Side Effects:
   • Headache, nausea, abdominal pain, constipation, or diarrhea.
2. Serious Risks:
   • Long-term use may lead to:
     • Vitamin B12 deficiency.
     • Hypomagnesemia (low magnesium levels).
     • Bone fractures (increased risk in elderly patients).
     • Increased susceptibility to Clostridioides difficile infections.
3. Drug Interactions:
   • May reduce the efficacy of drugs requiring acidic environments for absorption (e.g., ketoconazole).
   • Might enhance the effects of medications like warfarin or diazepam due to CYP450 inhibition.

Administration & Usage

• Recommended to be taken 1 hour before meals for optimal efficacy.
• Can be sprinkled on applesauce for patients unable to swallow capsules.
• Dosage adjustments may be needed for individuals with severe liver impairment.

Who Should Avoid It?

• Patients with known hypersensitivity to esomeprazole or substituted benzimidazoles.
• Caution is advised in those with:
  • Severe liver or kidney impairment.
  • Risk factors for osteoporosis or fractures.

Pharmacist Related Data

Chemical Information

• Chemical Name:
  5-Methoxy-2-[[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-1H-benzimidazole magnesium trihydrate.
• Molecular Formula:
  C34H36MgN6O6S2C_{34}H_{36}MgN_{6}O_{6}S_{2}C34​H36​MgN6​O6​S2​
• Molecular Weight:
  713.12 g/mol.

Pharmacokinetics

1. Absorption:
   • Esomeprazole is acid-labile and is administered as delayed-release capsules to protect it from stomach acid.
   • Peak plasma concentrations are reached 1.5–2 hours post-dose.
   • Bioavailability: ~64% after a single 40 mg dose; increases to ~90% with repeated doses.
2. Distribution:
   • Volume of distribution (Vd): Approximately 16 L.
   • High plasma protein binding (~97%).
3. Metabolism:
   • Esomeprazole is extensively metabolized in the liver by the cytochrome P450 system, primarily via CYP2C19 (to hydroxylated and desmethylated metabolites) and CYP3A4.
   • These metabolites are inactive.
4. Elimination:
   • Excreted mainly via the urine (~80%) and feces (~20%), primarily as inactive metabolites.
   • Half-life: ~1.5 hours, though its effect on acid suppression lasts up to 24 hours due to irreversible proton pump binding.

Pharmacodynamics

• Mechanism of Action:
  • Esomeprazole irreversibly inhibits the H+/K+ ATPase enzyme (proton pump) in gastric parietal cells, blocking the final step in acid secretion. This reduces gastric acid levels regardless of the stimulus (food or fasting).
• Effect:
  • Significant reduction in gastric acid secretion, enabling healing of acid-related damage and alleviation of symptoms like heartburn.

Drug-Food Interactions

• Food Effects:
  • Food can delay the absorption of esomeprazole and slightly reduce its peak plasma concentration. It is recommended to take the capsule 1 hour before meals.

Drug-Drug Interactions

1. Increased Risk of Toxicity:
   • Diazepam, phenytoin, and warfarin: Esomeprazole may inhibit their metabolism, increasing their plasma levels.
2. Reduced Efficacy:
   • Drugs requiring an acidic stomach environment for absorption (e.g., ketoconazole, itraconazole, and iron salts) may have reduced absorption.
3. Other PPIs:
   • Concurrent use with other proton pump inhibitors may lead to additive effects or redundancy.
4. Methotrexate:
   • High-dose methotrexate can accumulate when co-administered with esomeprazole, increasing toxicity risk.