When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to esomeprazole or similar medicines.

How to Use This Medicine:
Delayed Release Capsule, Packet

• Your doctor will tell you how much medicine to use. Do not use more than directed. Take all of the medicine in your prescription, even if you feel better after a few days.
• Follow the instructions on the medicine label if you are using this medicine without a prescription.
• Take this medicine at least 1 hour before a meal.
• Delayed-release capsule:
  
  • Swallow the capsule whole. Do not crush or chew it.
  • If you cannot swallow the capsule, you may use open it and pour the medicine into 1 tablespoon of applesauce. Stir the mixture well and swallow it right away. Do not chew. Throw away any remaining mixture.
• Packets:
  
  • 2.5- or 5-milligram (mg) packet: Mix with 1 teaspoon (5 milliliters (mL)) of water and stir well.
  • 10-, 20-, or 40-mg packet: Mix with 1 tablespoon (15 mL) of water and stir well.
  • Let the mixture thicken for 2 to 3 minutes. Stir once more, and drink within 30 minutes. Add more water to any leftover medicine and drink it right away.
• Feeding tube:
  
  • Capsule contents:
    
    • Open the capsule and pour the contents into a 60-mL catheter-tipped syringe. Pour 50 mL of water into the syringe. Do not use any other liquids or syringes.
    • Place the syringe plunger back into the syringe and shake well for 15 seconds. Make sure no medicine is stuck in the tip of the syringe. Inject the medicine into the NG tube right away.
    • Use water to rinse any leftover medicine through the tube.
  • Packet contents:
    
    • 2.5- or 5-mg packets: Add 5 mL (1 teaspoon) of water into a catheter-tipped syringe. Pour the 2.5- or 5-mg packet into the syringe, shake well right away, and let the medicine thicken for 2 to 3 minutes.
    • 10-, 20-, or 40-mg packets: Add 15 mL (1 tablespoon) of water into a catheter-tipped syringe. Pour the 10-, 20-, or 40-mg packet into the syringe, shake well right away, and let the medicine thicken for 2 to 3 minutes.
    • Shake the thickened mixture once more, and inject the medicine into the tube within 30 minutes.
    • Refill the syringe with the same amount of water that was used in the mixture (5 or 15 mL). Shake it gently, and inject it into the tube to rinse any leftover medicine through the tube.
  • This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
  • Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how esomeprazole works. Tell your doctor if you are using any of the following:
  
  • Atazanavir, cilostazol, diazepam, digoxin, erlotinib, ketoconazole, methotrexate, mycophenolate mofetil, nelfinavir, rifampin, saquinavir, St John's wort, tacrolimus, voriconazole
  • Blood thinner (such as clopidogrel or warfarin)
  • Diuretic (water pill)
  • Iron supplements

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have liver disease or osteoporosis.
• This medicine may cause the following problems:
  
  • Kidney problems
  • Broken bones in the hip, wrist, or spine
  • Low levels of vitamin B12 or magnesium in the blood
• This medicine can cause diarrhea. Call your doctor if the diarrhea becomes severe, does not stop, or is bloody. Do not take any medicine to stop diarrhea until you have talked to your doctor. Diarrhea can occur 2 months or more after you stop taking this medicine.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Fast, pounding, or uneven heartbeat
• Fever, joint pain, swelling in your body, unusual weight gain, changes in how much or how often you urinate
• Seizures, dizziness, muscle cramps, or twitching
• Severe diarrhea that does not go away, fever
• Stomach pain, nausea, vomiting, weight loss, bloody or black stools

If you notice these less serious side effects, talk with your doctor:

• Headache
• Mild diarrhea, constipation, or gas

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088