Nexicure Plus
(Esomeprazole 40 mg / Sodium Bicarbonate 1680 mg)

The combination of Esomeprazole and Sodium Bicarbonate is an immediate-release (IR) formulation designed to provide faster relief from gastric acid than standard delayed-release versions. 

Mechanism of Action:

• Esomeprazole: A proton pump inhibitor (PPI) that binds irreversibly to the H+/K+ -ATPase enzyme system in the stomach's parietal cells, blocking the final step of acid secretion.
• Sodium Bicarbonate: Acts as a buffering agent. It neutralizes existing stomach acid to protect the acid-sensitive esomeprazole from degradation, allowing it to be absorbed rapidly in the small intestine without the need for an enteric coating.

Pharmacokinetics: This combination reaches therapeutic pH levels (greater than 6) within minutes. Unlike traditional PPIs that take 1–3 hours to begin working, this formulation is quickly absorbed, offering a faster onset of acid suppression.

Indications: Used for the short-term treatment of active duodenal ulcers, erosive esophagitis, and symptomatic GERD. It is also employed to reduce the risk of upper GI bleeding in critically ill patients. 

Patient Disclaimer & Safety Information

• WARNING: Consult your doctor before use, especially if you are on a sodium-restricted diet.
• Sodium Load: Each dose contains a significant amount of sodium (often over 300 mg to 1,000 mg). This can be dangerous for patients with high blood pressure, congestive heart failure (CHF), kidney disease, or cirrhosis due to risks of fluid retention and edema.

Serious Side Effects:

• Long-term PPI Risks: Use for over a year increases the risk of bone fractures, Vitamin B12 deficiency, and severe magnesium depletion (which can cause irregular heartbeat or seizures).
• Infections: May increase the risk of severe diarrhea caused by C. difficile.
• Lupus: Can trigger new or worsening symptoms of systemic lupus erythematosus (joint pain or skin rash).
• Allergic Reactions: Seek emergency care for signs of a severe reaction, including facial swelling, hives, or difficulty breathing.
• Metabolic Risks: Excessive use can lead to metabolic alkalosis, particularly in patients with kidney problems. Symptoms include mood changes, muscle weakness, and tiredness. 

Usage Instructions

• Empty Stomach: Take at least one hour before a meal with a full glass of water for maximum effectiveness.
• Swallow Whole: If in capsule form, do not crush or chew, as this interferes with the protective buffering mechanism.
• Interactions: Avoid use with Clopidogrel (Plavix), as esomeprazole can significantly reduce its anti-clotting effectiveness.

Each sachet contains:

• Esomeprazole magnesium trihydrate 44.42 mg, equivalent to Esomeprazole 40 mg
• Sodium Bicarbonate 1680 mg

Storage conditions:
Store at a temperature not exceeding 25°C, in a dry place.

Warnings:

• Keep out of reach of children.
• For dosage and indications, refer to the enclosed leaflet.

Important precautions:

• Use with caution in patients who are required to reduce sodium (salt) intake.
• Not recommended for use in children.