Proton pump inhibitors – esomeprazole

Last updated on August 26, 2024

Generic name

esomeprazole

Strength

20 mg, 40 mg

Form

tablet

Special Authority criteria

Approval period

1. For gastroesophageal reflux disease (GERD), reflux esophagitis, duodenal ulcer, or gastric ulcer

OR

2. For Barrett's esophagus, Zollinger-Ellison syndrome, connective tissue disease, e.g., lupus, scleroderma, CREST

Indefinite

3. For eradication of Helicobacter pylori, as part of triple therapy

Maximum 14 days

MORE

Failure of reasonable trials of, or intolerance to, rabeprazole AND pantoprazole magnesium

Practitioner exemptions

  • None

Special notes

  • CREST is an acronym for the five main features of the limited form of scleroderma: Calcinosis, Raynaud’s disease, Esophageal dysmotility, Sclerodactyly, and Telangiectasia
  • A reasonable trial of rabeprazole and pantoprazole magnesium is considered a trial at usual adult doses for at least 4 weeks each of rabeprazole and pantoprazole magnesium

Special Authority request form(s)