ESORIS-DSR CAPS

• Esomeprazole is a proton pump inhibitor that markedly reduces gastric acid production, healing oesophagitis and relieving reflux symptoms.
• Domperidone increases gastric emptying and lower oesophageal sphincter tone, reducing the reflux itself rather than only neutralising its effect.
• The prokinetic action relieves the nausea, bloating and early fullness that acid suppression alone does not address.
• The sustained-release domperidone allows once-daily dosing.
• Particularly useful in reflux associated with delayed gastric emptying, including diabetic gastroparesis.

Not everyone gets these. Most are mild and settle as the course finishes.

• Domperidone prolongs the QT interval and has been associated with serious arrhythmia and sudden cardiac death. Contraindicated in known QT prolongation, significant electrolyte disturbance and underlying cardiac disease, and it should be used at the lowest effective dose for the shortest period — generally no more than a week.
• Contraindicated alongside other QT-prolonging drugs and strong CYP3A4 inhibitors including ketoconazole, erythromycin and clarithromycin.
• Contraindicated in gastrointestinal haemorrhage, mechanical obstruction or perforation, and in prolactin-releasing pituitary tumour.
• Take thirty to sixty minutes before food; a proton pump inhibitor taken after a meal is substantially less effective.
• Long-term proton pump inhibitor use is associated with low magnesium and vitamin B12, and with an increased risk of fracture and enteric infection. Review the need periodically rather than continuing indefinitely.
• Esomeprazole reduces the effect of clopidogrel; discuss an alternative in patients on it.
• Alarm features — weight loss, difficulty swallowing, vomiting blood, black stools, anaemia — need investigation before starting acid suppression, which can mask malignancy.
• Dose reduction is required in significant hepatic impairment; use in pregnancy and breastfeeding only on medical advice.