“One 40mg esomeprazole magnesium dose vs. 2 20mg doses?”
My grandson is currently being examined as to why he is producing excess stomach acid causing him to vomit frequently, especially during the night and early in the morning. Before seeing a doctor last week, I had him taking OTC Nexium which seemed to help. The doctor prescribed the one-a-day 40mg dose which is wearing off after about 15 hours and he’s still sick during the night. Is there a difference between taking one 40mg dose vs. two 20mg doses 12 hours apart?
Male | 19 years old
Complaint duration: 12 months
Medications: 40 mg esomeprazole magnesium
4 Answers
You can try using 20 mg twice daily for a week or so and then update your physician with the results.
Difficult to answer this without knowing the results of an endoscopy. If having problems mainly at night, would take one 40mg dose 1/2 hr before supper. This will coveR him through the night. This commonly occurs in those with a hiatal hernia or just a poor pinch at the lower esophageal sphincter If he has problems day and night would take 20mg 1/2 hr before breakfast and 1/2 hr before supper. No caffeine, chocolate, carbonated beverages, or peppermint. To sleep in left side
Yes, there is a difference. Since the half life of esomeprazole is only 1-2 hours, the antacid effect will tend to wear off by the end of the day and overnight. Therefore, twice a day dosing may provide better control of acid over 24 hours.
Keep in mind, however, that I find dubious the working theory of too much acid in your grandson's case. The vast majority of people have normal acid production. It is not common to produce too much acid (H pylori infection can do this, and gastrinoma is an extremely rare condition that can also do it). A competent GI doctor should be able to properly diagnose the issue if the Nexium is not resolving it.
Good luck.
Keep in mind, however, that I find dubious the working theory of too much acid in your grandson's case. The vast majority of people have normal acid production. It is not common to produce too much acid (H pylori infection can do this, and gastrinoma is an extremely rare condition that can also do it). A competent GI doctor should be able to properly diagnose the issue if the Nexium is not resolving it.
Good luck.
That is a good question. That is about right; Nexium and the other PPIs generally do not last the full 24 hours. Dexilant has the best data in terms of lasting the full 24 hours, as it has a dual delayed release mechanism. He may do better with the 20mg dose twice a day, however, what I would do first is have him take the 40mg Nexium about 30 min prior to dinner. This way, it will last through the night and into the morning, when the majority of your grandson's symptoms occur.
Jesse P. Houghton, MD, FACG
Jesse P. Houghton, MD, FACG
