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In adultssymptomatic response to therapy with NEXIUM does not preclude the presence of gastric malignancyConsider additional follow-up and diagnostic testing in adult patients who have a suboptimal response or an early symptomatic relapse after completing treatment with a PPIIn older patientsalso consider an endoscopy.

In a juvenile rat toxicity studyesomeprazole was administered with both magnesium and strontium salts at oral doses about 34 to 68 times a daily human dose of 40 mg based on body surface areaIncreases in death were seen at the high doseand at all doses of esomeprazolethere were decreases in body weightbody weight gainfemur weight and femur lengthand decreases in overall growthsee Nonclinical Toxicology

Hypersensitivity Reactionssee CONTRAINDICATIONSAcute Interstitial Nephritissee WARNINGS AND PRECAUTIONSClostridium difficile Associated Diarrheasee WARNINGS AND PRECAUTIONSBone Fracturesee WARNINGS AND PRECAUTIONSCutaneous and Systemic Lupus Erythematosussee WARNINGS AND PRECAUTIONSCyanocobalaminVitamin B-12Deficiencysee WARNINGS AND PRECAUTIONSHypomagnesemiasee WARNINGS AND PRECAUTIONSDrug Interactions Advise patients to let you know if they are takingor begin takingother medicationsbecause NEXIUM can interfere with antiretroviral drugs and drugs that are affected by gastric pH changessee DRUG INTERACTIONS

Avoid administration of PPIs for longer than medically indicatedIf signs or symptoms consistent with CLE or SLE are noted in patients receiving NEXIUMdiscontinue the drug and refer the patient to the appropriate specialist for evaluationMost patients improve with discontinuation of the PPI alone in 4 to 12 weeks.

This medicine can cause diarrheawhich may be a sign of a new infectionIf you have diarrhea that is watery or bloodycall your doctor before using anti-diarrhea medicine.

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