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The following safety information outlines important risks and precautions associated with the use of esomeprazole (Nexium). Please review these details carefully and discuss any concerns with your healthcare provider.

• Potential Symptom Masking: Frequent heartburn may indicate a serious condition like stomach cancer. If your symptoms worsen or return after using esomeprazole (Nexium), or if you experience poor appetite, unexplained weight loss, or weakness, contact your healthcare provider promptly.

• Kidney Concerns: Some individuals have experienced sudden kidney issues while on esomeprazole (Nexium). Symptoms such as changes in urination, nausea, weakness, fever, rash, or joint pain should be reported to your provider immediately.

• Severe Diarrhea Risk: Esomeprazole (Nexium) may increase the likelihood of a C. difficile bacterial infection, leading to severe diarrhea. This risk is elevated in older adults, those with recent hospital or nursing home stays, or weakened immune systems. To minimize risk, use the lowest effective dose for the shortest duration. Seek medical attention if you experience severe or watery diarrhea, fever, abdominal pain, loss of appetite, or nausea.

• Bone Fracture Risk: Long-term or high-dose use of esomeprazole (Nexium) can increase the risk of fractures in the hip, wrist, or spine, especially if used for over a year or if you have osteoporosis. Consider discussing this with your provider before starting the medication.

• Serious Skin Reactions: Rare but severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), may occur. Symptoms like fever, body aches, rash, skin peeling, painful blisters, or facial swelling require immediate medical attention.

• Lupus Symptoms: Esomeprazole (Nexium) may trigger new or worsening lupus symptoms. Common signs include joint pain and rash. Discontinue use and consult your provider if these symptoms develop.

• Nutrient Deficiencies: Prolonged use of esomeprazole (Nexium) can lead to low vitamin B12 and magnesium levels, especially after more than one year. If symptoms such as dizziness, muscle weakness, pale skin, fatigue, or tingling in the limbs occur, seek medical advice.

• Drug Interactions: Certain medications can affect esomeprazole (Nexium) levels in your body, impacting its effectiveness and side effects. Avoid using St. John’s Wort and rifampin (Rifadin) while on this medication.

Contraindications:

• Do not use esomeprazole (Nexium) if you have an allergy to PPIs or are taking Edurant (rilpivirine) or medications containing rilpivirine, such as Complera. Consult your healthcare provider for guidance.

Common side effects:

• headaches
• abdominal pain
• diarrhea
• nausea
• passing gas
• constipation
• dry mouth

Less common but important to monitor:

• feeling weak
• experiencing back pain
• chest pain
• swelling
• hot flushes
• tiredness
• flu-like symptoms
• rapid heartbeat
• acid reflux
• ringing in the ears
• changes in weight
• trouble sleeping
• migraines
• loss of taste

Serious side effects:

• severe stomach pain
• persistent diarrhea
• changes in urination
• joint pain and skin rashes that worsen in sunlight
• blistering or peeling skin reactions
• severe intestinal condition caused by C. difficile bacteria
• unstoppable diarrhea
• abdominal pain
• vitamin B-12 deficiency
• unusual weakness
• numbness
• severe allergic reactions
• fever
• swollen lymph nodes
• difficulty breathing

Interactions with high risk of serious adverse effects and should be avoided:

• Rilpivirine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Clopidogrel
• Atazanavir
• Methotrexate
• Erlotinib
• Ketoconazole
• Nelfinavir
• Pazopanib
• Posaconazole
• Omeprazole

Interactions with low risk that usually do not require a change in therapy:

• Itraconazole
• Levothyroxine
• Risedronate
• Voriconazole
• Warfarin