Esdom is a combination of esomeprazole and domperidone. esomeprazole inhibits the H + /K + - AT Pase enzyme(proton pump inhibitor), which is responsible for gastric acid secretion in the parietal cells of the stomach and irreversibly block the final step of acid secretion. It increases motility of GI tract by inhibiting the action of dopamine and fastens gastric emptying. Domperidone stimulates GI activity by acting as a competitive antagonist at dopamine D2-receptor.

1. STOP BURNING OF STOMACH
BY
ESDOM 1

2. 2

3.  Anti-Ulcer Drugs
 Anti-ulcer drugs are the drugs that are used for treating the
peptic ulcers and intestinal ulcers:
 Pharmacological classification of the anti-ulcer
drugs:
 1. Reduction of gastric acid secretion:
 H2 antihistaminics – Cimetidine, Ranitidine, Famotidine,
Roxatidine, Loxatidine etc.
 Proton Pump Inhibitors – Omeprazole, Lansoprazole,
Pantoprazole, Rabeprazole etc.
 Anti-cholinergics – Pirenzepine, Propantheline etc.
 Prostaglandin analogues - Misoprostil, Enprostil, Rioprostil etc.
 2. Neutralization of gastric acid:
 Antacids are used for neutralising the gastric acid in the stomach.
These drugs are known as antacids.
 Systemic antacids – sodiumbicarbonate (NaHCO3), sodium
citrate etc.
 Non systemic antacids – Magnesium hydroxide (Mg(OH)2),
Magnesium trisilicate, Alminium hydroxide gel, Calcium
carbonate (CaCO3) etc. 3

4.  3. Ulcer protective:
 Ulcer protective protect the ulcers by covering them and they consist of mainly
polymers.
 Sucralfate, Colloidal Bismuth subcitrate etc.
 4. Ulcer Healing Drugs:
 Carbenoxolone sodium
 5. Anti H-Pylori drugs:
 Ulcer is also caused due to the action of the bacterium Helicobacter Pylori, so
for treating the ulcers caused by the bacterium, anti biotics are given:
 Amoxicillin
 Tinidazole
 Tetracyclin
 Metronidazole
 Etc.
4

5. Digestion:
“The process by which food is
broken down into simple
chemical compounds that can be
absorbed and used as nutrients
or eliminated by the body.”
5

6. o The start of the process - the mouth:
In the human body, the mouth (oral cavity) is a specialized organ for
receiving food and breaking up large organic masses. In the mouth,
food is changed mechanically by biting and chewing. Humans have four
kinds of teeth: incisors are chisel-shaped teeth in the front of the mouth
for biting; canines are pointed teeth for tearing; and premolars and
molars are flattened, ridged teeth for grinding, pounding, and crushing
food.
In the mouth, food is moistened by saliva, a sticky fluid that binds food
particles together into a soft mass. Three pairs of salivary glands—the
parotid glands, the sub maxillary glands, and the sublingual glands—
secrete saliva into the mouth. The saliva contains an enzyme called
amylase, which digests starch molecules into smaller molecules of the
disaccharide maltose.
During chewing, the tongue moves food about and manipulates it into a
mass called a bolus. The bolus is pushed back into the pharynx (throat)
and is forced through the opening to the esophagus.
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7. o On the way to the stomach: the
esophagus the food enters the esophagus.
The esophagus is a long tube that runs from
the mouth to the stomach.
o In the stomach The stomach is a large,
sack-like organ that churns the food and
bathes it in a very strong acid (gastric acid).
Food in the stomach that is partly digested
andThe stomach stores food and prepares it
for further digestion. In addition, the
stomach plays a role in protein digestion.
Gastric glands called chief cells secrete
pepsinogen. Pepsinogen is converted to the
enzyme pepsin in the presence of
hydrochloric acid. Hydrochloric acid is
secreted by parietal cells in the stomach
lining. The pepsin then digests large
proteins into smaller proteins called
peptides mixed with stomach acids is called
chyme.
7
Stomach

8. o In the small intestine – Food is absorbed here. After
being in the stomach, food enters the duodenum, the
first part of the small intestine. It then enters the
jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the
liver and stored in the gall bladder), pancreatic
enzymes, and other digestive enzymes produced by
the inner wall of the small intestine help in the
breakdown of food.
o In the large intestine - After passing through the
small intestine, food passes into the large intestine.
Many microbes (bacteria like Escherichia coli) in the
large intestine help in the digestion process
o The end of the process - Solid waste is then stored in
the rectum until it is excreted via the anus.
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9.  Liver
The liver has an important function in processing the products of human digestion.
Thirty per cent of the blood pumped through the heart in one minute passes through
the body's chemical factory, which is called the liver. The liver cleanses the blood and
processes nutritional molecules, which are distributed to the tissues. The liver also
receives bright red blood from the lungs, filled with vital oxygen to be delivered to the
heart. The only part of the body which receives more blood than the liver is the brain.
The liver is located at the top of the abdomen, just below the diaphragm and has two
main lobes. It is the largest gland in the body, weighing 3.2 to 3.7 pounds. When we
eat, more blood is diverted to the intestines to deal with digestive processes; when not
eating, three-fourths of the blood supply to the liver comes from the intestines. It also
produces about two and one-half pints of bile in its ducts, which is delivered to the
gallbladder through a small tube called the "cystic duct" for storage.
 Gallbladder
 The gallbladder is a storage sac for excess bile. Bile made in the liver travels to the
small intestine via the bile ducts. If the intestine doesn't need it, the bile travels into
the gallbladder where it awaits the signal from the intestines that food is present. Bile
emulsify the fats.
 Pancreas
 The pancreas is located deep in the abdomen, partially behind the stomach. The other
part is nestled in the curve of the duodenum (small intestine). Among other
functions, the pancreas is the chief factory for digestive enzymes that are secreted into
the duodenum. These enzymes break down protein, fats, and carbohydrate.
9

10. o Esomeprazole:
o Proton pump inhibitor.
o Domperidone:
o Antidopamine agent(Prokinetic)
10

11.  Esdom is a combination of esomeprazole and
domperidone. esomeprazole inhibits the H + /K + - AT
Pase enzyme(proton pump inhibitor), which is
responsible for gastric acid secretion in the parietal
cells of the stomach and irreversibly block the final
step of acid secretion. It increases motility of GI tract
by inhibiting the action of dopamine and fastens
gastric emptying. Domperidone stimulates GI activity
by acting as a competitive antagonist at dopamine D2-
receptor.
11

12. It is used in the treatment of:
o Dyspepsia: Recurrent pain in abdomen with filling full.
o Peptic ulcer disease: Painful sores or ulcers in the lining
of the stomach or first part of the small intestine, called the
duodenum.
o Gastroesophageal reflux disease: It is a chronic
symptom of mucosal damage caused by stomach acid
coming up from the stomach into the esophagus
o Zollinger-Ellison syndrome: gastrin-secreting tumor of
the pancreas that stimulates the acid-secreting cells of the
stomach to maximal activity, with consequent
gastrointestinal mucosal ulcer.
o NSAIDS associated ulcer: Pain killer also cause ulcer.
12

13. Absorption
o After oral administration peak plasma
levels occur at approximately 1-2 hour. The
Cmax increases proportionally when the dose is
increased, At repeated once-daily dosing with
40 mg, the systemic bioavailability is
approximately 90% compared to 64% after a
single dose of 40 mg.
13

14. o Domperidone peak plasma conc . Is achieved in 30
minutes.
Distribution
o Plasma protein binding of esomeprazole is
approximately 97%.
o Domperidone is 91% to 93% bound to plasma proteins.
Metabolism
o Esomeprazole is extensively metabolized in the
liver. The metabolites of Esomeprazole are inactive.
Domperidone is metabolized in liver.
14

15. Excretion
o The elimination half-life is
approximately 1-3 hours. Less than 1% of
parent drug is excreted in the urine.
Approximately 80% of an oral dose of
Esomeprazole is excreted as inactive
metabolites in the urine, and the
remainder is found as inactive
metabolites in the feces.
15

16.  In patients with normal hepatic or renal function: Depending on the
severity, 1 capsule of (Esomeprazole 40mg + Domperidone 30mg) orally once
daily for up to 4 weeks.
 Gastric ulcer: 40mg for 8-12 weeks
 Duodenal ulcer: 40mg 4-8 weeks
 Erosive Oesophagitis: 40mg daily for 4-8 weeks
 GERD: 40 mg for 4 weeks. If not treated then repeat the dose for further 4
weeks
 In case of ulcer with severe bleeding: start with I.V infusion 80mg over 30
minutes, then by continuous I.V infusion 8mg/hour for 72 hours, then by
mouth 40mg once daily for 4 weeks.
 Zollinger Syndrome: Initially dose is 40mg BD, exceed up to 160mg daily.
Note: Half life is small but binding to target enzyme is good enough, hence effect of the drug last for 24 hrs.
PPI have short plasma half-life but half life of inhibition of gastric acid secretion is substantially longer because of it strong
binding with proton pump.The half-life at the site of action is estimated to be approximately 24 hours. Dissociation of the
inhibitory complex is probably due to the effect of the endogenous antioxidant glutathione which leads to the release of
omeprazole sulfide and reactivation of the enzyme.
Ref: Shin, Jai Moo; Munson, Keith; Vagin, Olga; Sachs, George (2008). "The gastric HK-ATPase: Structure, function, and inhibition".
Pflügers Archiv - European Journal of Physiology 457 (3): 609–22. doi:10.1007/s00424-008-0495-4. PMC 3079481. PMID 18536934.
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17.  Pregnancy :
Pregnancy Category B
Reproductive studies in rats and rabbits with Esomeprazole
and multiple cohort studies in pregnant women with
omeprazole use during the first trimester do not show an
increased risk of congenital anomalies or adverse
pregnancy outcomes. There are no adequate and well
controlled studies of Esomeprazole use in pregnancy.
Because animal reproduction studies are not always
predictive of human response, this drug should be used
during pregnancy only if clearly needed.
 Lactation: Not Recommended
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