Esomeprazole shares class contraindications with other proton pump inhibitors—rule out hypersensitivity and reassess long-term therapy hazards before continuing beyond the shortest effective duration.
Absolute contraindications include hypersensitivity to esomeprazole, omeprazole, or substituted benzimidazoles, and concurrent rilpivirine therapy. Relative precautions cover chronic high-dose use, severe hepatic impairment, magnesium depletion, and infections requiring gastric acidity for pathogen control.
Documented hypersensitivity (anaphylaxis, angioedema, severe cutaneous reaction) to esomeprazole, omeprazole, or other substituted benzimidazole proton pump inhibitors
Concomitant use with rilpivirine-containing antiretroviral regimens
Chronic therapy without periodic reassessment—monitor for C. difficile infection and micronutrient deficiencies
History of hypomagnesemia or concurrent diuretic therapy—check magnesium during prolonged use
Severe hepatic impairment—reduce maintenance dosing and observe for accumulation
Medications requiring acidic gastric pH for absorption (atazanavir, erlotinib, ketoconazole)—consider alternatives
High fracture risk or osteoporosis—chronic PPI therapy may reduce calcium absorption