Indications

Nexum MUPS is indicated in:

• Gastro-esophageal Reflux Disease (GERD).
• Risk reduction in NSAID associated gastric ulcer.
• H. pylori eradication (Triple therapy).
• Zollinger-Ellison syndrome and idiopathic hypersecretion.

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Composition

Esomeprazole MUPS 20 Tablet: Each MUPS tablet contains 133.333 mg (15%w/w) of Esomeprazole enteric coated pellets equivalent to 20 mg Esomeprazole (as Esomeprazole Magnesium Trihydrate USP).

Esomeprazole MUPS 40 Tablet: Each MUPS tablet contains 266.67 mg (15% w/w) of Esomeprazole enteric coated pellets equivalent to 40 mg Esomeprazole (as Esomeprazole Magnesium Trihydrate USP).

Description

MUPS is abbreviation for Multiple-Unit Pellet System. However, from pharmaceutical industry and research perspective, the term in general refers to MUPS compacted into tablets. Thus, the resulting tablets prepared by compaction of modified release coated multiparticulates or pellets are called as MUPS. It is the more recent and challenging technologies that combine the advantages of both tablets and pellet-filled capsules in one dosage form.

• Ensures greater bioavailability.
• Ensures uniform emptying of micro pellets from stomach into small intestine facilitates rapid dissolution of enteric coating and drug release resulting in early Tmax and Cmax
• Ensures lesser possibility of dose dumping.
• Is a combination of fast acting and sustained action.
• Ensures uniform drug release.
• Once daily dosing.
• Ensures lesser chance of localized irritation.
• Ensures better and more uniform drug absorption.
• Is better than capsules in reducing the esophageal residence time.
• Minimizes fluctuation in plasma concentration of drug.

MUPS ensure rapid and uniform gastric emptying and subsequently uniform drug dissolution of pellets in the gastrointestinal tract due to their small size and larger surface,uniform drug absorption is facilitated which results in consistent and controlled pharmacological action.

A further reduction in inter- and intra-subject variability in drug absorption and clinical response is facilitated since the number of pellets per MUPS dosage form is much more than a conventional pellet-filled capsule and possibility of dose dumping (in stomach) and incomplete drug release is further minimized.

Pharmacology

The proton pump inhibitor Esomeprazole inhibits gastric acid by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the proton pump) of the gastric parietal cell. Proton pump inhibitors are effective for short-term treatment of gastric and duodenal ulcers. Esomeprazole is also used in the prevention and treatment of NSAID associated gastric ulcers.

Dosage

Erosive esophagitis-

• Adult (≥18 years): 40 mg once daily for 4 weeks.
• Children & adolescents (12-18 years): 40 mg once daily for 4 weeks.

Maintenance of healing of erosive esophagitis-

• Adult (≥18 years): 20 mg once daily.
• Children & adolescents (12-18 years): 20 mg once daily.

Risk reduction in NSAID associated gastric ulcer-

• Adult (≥18 years): 20 mg once daily for 4-8 weeks.

H. pylori eradication (Esomeprazole MUPS tablet with 1000 mg Amoxicillin and 500 mg Clarithromycin)-

• Adult (≥18 years): 20 mg twice daily for 7 days.
• Children & adolescents (12-18 years): 20 mg twice daily for 7 days.

Zollinger-Ellison syndrome and idiopathic hypersecretion-

• Adult (≥18 years): 40-80 mg twice daily.

Children 1-11 years:

• Erosive esophagitis: Weight <20 kg: 10 mg once daily for 8 weeks. Weight ≥20 kg: 10 mg or 20 mg once daily for 8 weeks
• Maintenance of healing of erosive esophagitis: 10 mg once daily

Children below the age of 1 year: Esomeprazole MUPS tablet is not approved for use in children younger than 1 year.

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Administration

Esomeprazole MUPS tablets should be swallowed whole with liquid. The tablets should not be chewed or crushed. If required, the tablets can also be dispersed in half a glass of non-carbonated water (mineral water is not suitable). No other liquids should be used. Stir until the tablets disintegrate and drink the liquid with the pellets immediately or within 30 minutes. Rinse the glass with half a glass of water and drink. The pellets must not be chewed or crushed.

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Interaction

Nexum MUPS is extensively metabolized in the liver by CYP2C19 and CYP3A4. In vitro and in vivo studies have shown that Nexum MUPS is not likely to inhibit CYPs 1A2, 2A6, 2C9, 2D6, 2E1 and 3A4. No clinically relevant interactions with drugs metabolized by these CYP enzymes would be expected. Drug interaction studies have shown that Nexum MUPS does not have any clinically significant interactions with phenytoin, warfarin, quinidine, clarithromycin or amoxicillin.

Nexum MUPS may potentially interfere with CYP2C19, the major Nexum MUPS metabolizing enzyme. Co-administration of Nexum MUPS 30 mg anddiazepam, a CYP2C19 substrate has resulted in a 45% decrease in clearance of diazepam. Increased plasma levels of diazepam have been observed 12 hours after dosing and onwards. Nexum MUPS inhibits gastric acid secretion. Therefore, Nexum MUPS may interfere with the absorption of drugs where gastric pH is an important determinant of bioavailability (e.g., ketoconazole, iron salts and digoxin).

Co-administration of oral contraceptives, diazepam, phenytoin, or quinidine do not seem to change the pharmacokinetic profile of Nexum MUPS.

Combination Therapy with Clarithromycin: Co-administration of Nexum MUPS, clarithromycin, and amoxicillin has resulted in increases in the plasma levels of Nexum MUPS and 14-hydroxyclarithromycin.

Contraindications

Esomeprazole is contraindicated in patient with known hypersensitivity to any of the formulation.

Side Effects

The most frequently occurring adverse events reported with Nexum MUPS include headache, diarrhoea, nausea, flatulence, abdominal pain, constipation and dry mouth. There are no difference in types of related adverse events seen during maintenance treatment upto 12 months compared to short term treatment.

Pregnancy & Lactation

The manufacturer advises caution. It is not known if Esomeprazole or its metabolites appear in human breast milk.

Precautions & Warnings

Nexum MUPS should be used carefully if the patient has severe liver dysfunction and severe renal impairment. Taking a proton pump inhibitor like Nexum MUPS may slightly increase the risk of hip, wrist and spine fracture, particularly when it is taken over a period of more than one year.

Storage Conditions

Store in a cool & dry place below 25ºC, protect from light. Keep out of reach of children.

Chemical Structure

Common Questions about Nexum MUPS 20 mg Tablet

What is Nexum MUPS 20 mg MUPS Table?

Nexum MUPS 20 mg MUPS Table is a proton pump inhibitor (PPI). PPIs work by reducing the amount of acid produced in the stomach. Nexum MUPS 20 mg MUPS Table is used to treat gastroesophageal reflux disease (GERD), ulcers, and other conditions that involve too much stomach acid.

What is MUPS Tablet?

MUPS is abbreviation for Multiple-Unit Pellet System. This tablets prepared by compaction of modified release coated multiparticulates or pellets are called as MUPS.

What is Nexum MUPS 20 mg MUPS Table used for?

Nexum MUPS 20 mg MUPS Table has multiple uses. It relieves heartburn and GERD symptoms. It also aids in healing erosive esophagitis, a condition caused by stomach acid damaging the esophagus lining. Additionally, Nexum MUPS 20 mg MUPS Table effectively prevents erosive esophagitis recurrence.

What are the side effects of Nexum MUPS 20 mg MUPS Table?

Nexum MUPS 20 mg MUPS Table may cause common side effects like headaches, diarrhea, nausea, gas, stomach pain, constipation, and dry mouth. There aren't any differences in the types of side effects between long-term (up to 12 months) and short-term use.

Can I take Nexum MUPS 20 mg MUPS Table if I am pregnant or breastfeeding?

Nexum MUPS 20 mg MUPS Table doesn't have any side-effects if you are pregnant or breastfeeding. You still should talk to your doctor about the risks and benefits of taking Nexum MUPS 20 mg MUPS Table.

How long does it take for Nexum MUPS 20 mg MUPS Table to work?

Nexum MUPS 20 mg MUPS Table usually starts to work within a few hours of taking it.

Quick Tips

• Nexum MUPS 20 mg MUPS Table is a well-tolerated medicine and provides relief for a long time.
• Avoid eating late at night or before bedtime.
• Inform your doctor if you get watery diarrhea, fever or stomach pain that does not go away.
• Long-term use of Nexum MUPS 20 mg MUPS Table can cause weak bones and a deficiency of minerals such as magnesium. Take adequate dietary intake of calcium and magnesium or their supplements as prescribed by your doctor.
• Consult your doctor right away if you develop decreased urination, edema (swelling due to fluid retention), lower back pain, nausea, fatigue, and rash or fever. These could be signs of a kidney problem.

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