ESOMEPRAZOL ARISTO 20 mg HARD GASTRO-RESISTANT CAPSULES

2. What you need to know before you take Esomeprazol Aristo

Do not take Esomeprazol Aristo

• if you are allergic to esomeprazole or any of the other ingredients of this medicine (listed in section 6),
• if you are allergic to other proton pump inhibitor medicines (e.g. pantoprazole, lansoprazole, rabeprazole, omeprazole),
• if you are taking a medicine containing nelfinavir (used to treat HIV infection).
• if you have ever had a skin reaction after treatment with a medicine similar to esomeprazole that reduces stomach acid.

If any of the above apply to you, do not take esomeprazole. If you are not sure, talk to your doctor or pharmacist before taking esomeprazole.

Warnings and precautions

Talk to your doctor or pharmacist before taking esomeprazole

• if you have severe liver problems;
• if you have severe kidney problems;
• if you have ever had a skin reaction after treatment with a medicine similar to esomeprazole that reduces stomach acid. Serious skin reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS) and erythema multiforme have been reported with esomeprazole (see section 4). If you get any of the symptoms listed above, stop taking esomeprazole and contact your doctor immediately;
• if you are due to have a specific blood test (Chromogranin A).

Esomeprazole may hide the symptoms of other diseases. Therefore, if you notice any of the following before or while you are taking esomeprazole, contact your doctor immediately:

• you lose a lot of weight for no reason and have problems swallowing;
• you have stomach pain or indigestion;
• you start vomiting food or blood;
• your stools are black (a sign of bleeding in the stomach).

If you have been prescribed esomeprazole “on demand” (to take only when you have symptoms), you should contact your doctor if your symptoms persist or get worse.

If you take esomeprazole for more than three months, it is possible that the levels of magnesium in your blood may fall. Low levels of magnesium can make you feel tired, dizzy, shaky, confused or cause muscle cramps, fits or a rapid heartbeat. If you get any of these symptoms, tell your doctor immediately. Low levels of magnesium can also lead to a reduction in the levels of potassium and calcium in the blood. Your doctor may decide to perform regular blood tests to monitor your levels of magnesium.

Taking a proton pump inhibitor like esomeprazole, especially over a period of more than one year, may slightly increase your risk of fracture in the hip, wrist or spine. Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).

Skin rash and skin reactions

If you get a rash, especially in areas of the skin exposed to the sun, or if you experience any weeping, peeling or purging of the skin, you should consult your doctor as soon as possible, as you may need to stop taking esomeprazole. Remember to also mention any other side-effects like joint pain or fever. Rare skin reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS) and erythema multiforme have been reported with esomeprazole (see section 4). If you develop any of these symptoms, stop taking esomeprazole and contact your doctor immediately.

Children under 12 years

Esomeprazole is not recommended for children under 12 years.

Other medicines and Esomeprazol Aristo

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines that you buy without a prescription. This is because esomeprazole may affect how these medicines work or these medicines may affect how esomeprazole works.

Do not take esomeprazole capsules if you are taking a medicine containing nelfinavir (used to treat HIV infection).

Tell your doctor or pharmacist if you are taking any of the following medicines:

• Atazanavir (used to treat HIV infection).
• Clopidogrel (used to prevent blood clots).
• Ketoconazole, itraconazole or voriconazole (used to treat fungal infections).
• Erlotinib (used to treat cancer).
• Citalopram, imipramine or clomipramine (used to treat depression).
• Diazepam (used to treat anxiety, relax muscles or for epilepsy).
• Phenytoin (used to treat epilepsy). If you are taking phenytoin, your doctor may need to monitor you when you start or stop taking esomeprazole.
• Medicines used to thin the blood, such as warfarin. Your doctor may need to monitor you when you start or stop taking esomeprazole.
• Cilostazol (used to treat intermittent claudication – a condition where the legs do not get enough blood).
• Cisapride (used for indigestion and heartburn).
• Digoxin (used for heart problems).
• Methotrexate (a chemotherapy medicine used to treat cancer) – if you are taking a high dose of methotrexate, your doctor may need to temporarily stop your esomeprazole treatment.
• Tacrolimus (used to prevent organ rejection after transplant).
• Rifampicin (used to treat tuberculosis).
• St John’s Wort (Hypericum perforatum) (used to treat depression).

If your doctor has prescribed the antibiotics amoxicillin and clarithromycin with your esomeprazole for treatment of ulcers caused by Helicobacter pylori, it is very important that you tell your doctor about any other medicines you are taking.

Using Esomeprazol Aristo with food and drink

You can take the capsules with or without food.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Your doctor will decide whether you can take esomeprazole during this time.

It is not known if esomeprazole passes into breast milk. Therefore, you should not take esomeprazole during breast-feeding.

Driving and using machines

Esomeprazole is not likely to affect your ability to drive or use any tools or machines. However, side effects such as dizziness or blurred vision (see section 4) may uncommonly or rarely occur. Do not drive or use any tools or machines if you are affected by these side effects.

Esomeprazol Aristo contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per capsule, which is essentially ‘sodium-free’.

3. How to take Esomeprazol Aristo

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

• If you are taking this medicine for a long time, your doctor will want to monitor you (especially if you take it for more than one year).
• If your doctor has told you to take this medicine as and when you need it, tell your doctor if your symptoms change.

How much to take

• Your doctor will tell you how many capsules to take and when to take them. This will depend on your condition, age and liver function.
• The recommended doses are described below.

Use in adults aged 18 years and above

For the treatment of gastro-oesophageal reflux disease (GORD):

• If your doctor has found that your gullet (oesophagus) is slightly damaged, the recommended dose is one 40 mg capsule once a day for 4 weeks. Your doctor may tell you to take the same dose for another 4 weeks if your oesophagus has not healed yet.
• Once the oesophagus has healed, the recommended dose is one 20 mg capsule once a day.
• If your gullet (oesophagus) is not damaged, the recommended dose is one 20 mg capsule each day.
• If you have severe liver problems, your doctor may give you a lower dose.

For the treatment of stomach ulcers caused byHelicobacter pyloriinfection and to stop them coming back:

• The recommended dose is one 20 mg capsule twice a day for one week. Your doctor will also prescribe two antibiotics called amoxicillin and clarithromycin for you to take with this medicine.

For the treatment of stomach ulcers caused by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

• The recommended dose is one 20 mg capsule once a day for 4-8 weeks.

To prevent stomach ulcers if you are taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

• The recommended dose is one 20 mg capsule once a day.

For the treatment of too much acid in the stomach caused by a tumour in the pancreas (Zollinger-Ellison syndrome):

• The recommended dose is one 40 mg capsule twice a day. Your doctor will adjust the dose depending on your needs and will also decide how long you need to take the medicine for. The maximum dose is two 80 mg capsules a day.

For prevention of re-bleeding from gastric or duodenal ulcers induced by a particular treatment (esomeprazole intravenous):

• The recommended dose is one 40 mg capsule once a day for 4 weeks.

Use in adolescents aged 12 years and above

For the treatment of gastro-oesophageal reflux disease (GORD):

• If your doctor has found that your gullet (oesophagus) is slightly damaged, the recommended dose is one 40 mg capsule once a day for 4 weeks. Your doctor may tell you to take the same dose for another 4 weeks if your oesophagus has not healed yet.
• Once the oesophagus has healed, the recommended dose is one 20 mg capsule once a day.
• If your gullet (oesophagus) is not damaged, the recommended dose is one 20 mg capsule each day.
• If you have severe liver problems, your doctor may give you a lower dose.

For the treatment of stomach ulcers caused byHelicobacter pyloriinfection and to stop them coming back:

• The recommended dose is one 20 mg capsule twice a day for one week. Your doctor will also prescribe two antibiotics called amoxicillin and clarithromycin for you to take with this medicine.

Taking this medicine

• You can take the capsules at any time of the day.
• You can take the capsules with or without food.
• Swallow the capsules whole with a glass of water. Do not chew or crush the capsules or their contents. This is because the capsules contain coated granules which stop the medicine from being broken down by the acid in your stomach. It is important not to damage the granules.

What to do if you have difficulty swallowing the capsules

If you have difficulty swallowing the capsules:

• Open the capsule and mix the contents with half a glass of non-fizzy water.
• Stir the mixture and drink it immediately or within 30 minutes. Always stir the mixture before drinking it. The mixture will not be clear.
• To make sure that you have taken all the medicine, rinse the glass with half a glass of water and drink it. The solid particles contain the medicine - do not chew or crush them.

Use in children under 12 years

Esomeprazole is not recommended for children under 12 years.

Elderly patients

No dose adjustment is necessary for elderly patients.

If you take more Esomeprazol Aristo than you should

If you take more esomeprazole than you should, talk to your doctor or pharmacist straight away.

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately. In case of overdose or accidental ingestion, contact the National Poison Centre on 91 562 04 20, stating the name of the medicine and the amount taken.

If you forget to take Esomeprazol Aristo

• If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue as usual.
• Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them.

If you observe any of the following serious adverse effects, stop taking esomeprazol and contact a doctor immediately:

• Yellow skin, dark urine, and fatigue that can be symptoms of liver problems. These effects are rare and can affect up to 1 in 1,000 people.
• Sudden difficulty breathing, swelling of lips, tongue, and throat, or body in general, skin rash, fainting, or difficulty swallowing (severe allergic reaction). These effects are rare and can affect up to 1 in 1,000 people.
• Sudden appearance of a severe skin rash or redness of the skin with blisters or peeling, even after several weeks of treatment. Important blisters and bleeding of the lips, eyes, mouth, nose, and genitals may also appear. Skin rashes can become severe and widespread skin damage (exfoliation of the epidermis and superficial mucous membranes) with potentially fatal consequences. This could be a "erythema multiforme", "Stevens-Johnson syndrome", "toxic epidermal necrolysis", or "drug reaction with eosinophilia and systemic symptoms". These effects are very rare and can affect up to 1 in 10,000 people.
• Widespread rash, high body temperature, and increased lymph node size (DRESS syndrome or drug hypersensitivity syndrome), which is very rare.

Other adverse effects include:

Frequent:can affect up to 1 in 10 people

• Headache.
• Effects on the stomach or intestine: diarrhea, stomach pain, constipation, gas (flatulence).
• Nausea or vomiting.
• Benign polyps in the stomach.

Infrequent:can affect up to 1 in 100 people

• Swelling of feet and ankles.
• Sleep disturbance (insomnia).
• Dizziness, tingling sensation, and numbness, drowsiness.
• Vertigo sensation.
• Dry mouth.
• Alteration of blood tests that determine liver function.
• Skin rash, hives, skin itching.
• Hip, wrist, or spine fracture (if esomeprazol is used at high doses and for a long period)

Rare:can affect up to 1 in 1,000 people

• Blood disorders such as a decrease in the number of white blood cells or platelets. This can cause weakness, bruising, or increase the likelihood of infections.
• Low sodium levels in the blood. This can cause weakness, vomiting, and cramps.
• Agitation, confusion, or depression.
• Taste alteration.
• Eye disorders such as blurred vision.
• Sudden sensation of shortness of breath or difficulty breathing (bronchospasm).
• Inflammation inside the mouth.
• An infection known as "candidiasis" that can affect the esophagus and is caused by a fungus.
• Liver problems, including jaundice, which can cause yellow skin, dark urine, and fatigue.
• Hair loss (alopecia).
• Sunlight-induced dermatitis.
• Joint pain (arthralgia) or muscle pain (myalgia).
• General feeling of discomfort and lack of energy.
• Increased sweating.

Very Rare:can affect up to 1 in 10,000 people

• Changes in the number of cells in the blood, including agranulocytosis (decrease in the number of white blood cells).
• Aggression.
• Seeing, feeling, or hearing things that do not exist (hallucinations).
• Liver disorders that can lead to liver failure or brain inflammation.
• Sudden appearance of severe skin rash, blisters, or peeling of the skin. These symptoms can be accompanied by high fever and joint pain (erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms).
• Muscle weakness.
• Severe kidney disorders.
• Increased breast size in men.

Frequency Not Known:frequency cannot be estimated from available data

• Inflammation of the intestine (can lead to diarrhea).
• Skin rash, possibly with joint pain.
• Low magnesium levels in the blood (hypomagnesemia) (see section 2 "Warnings and Precautions").

In very rare cases, esomeprazol can affect white blood cells, causing an immune deficiency. If you have an infection with symptoms such as fever with a severeworsening of your general condition or fever with symptoms of a local infection such as neck, throat, mouth, or difficulty urinating, you should consult your doctor as soon as possible to rule out a decrease in the number of white blood cells (agranulocytosis) through a blood test. It is important that, in this case, you inform your doctor about the medication you are taking.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that does not appear in this prospectus. You can also report them directly through the national notification system: Spanish Medicines Monitoring System for Human Use: www.notificaRAM.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Esomeprazol Aristo

• Keep this medicine out of sight and reach of children.
• Do not store above 25°C.
• Store in the original packaging (blister) or keep the container (bottle) perfectly closed to protect it from moisture.
• Do not use this medicine after the expiration date that appears on the packaging and on the blister or bottle after CAD. The expiration date is the last day of the month indicated.

Medicines should not be thrown away through the sewers or trash. Deposit the packaging and medicines you no longer need in the SIGRE Point of the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition of Esomeprazol Aristo gastro-resistant capsules:

• The active ingredient is esomeprazol.

There are two different doses of Esomeprazol Aristo gastro-resistant capsules that contain 20 mg or 40 mg of esomeprazol (as magnesium dihydrate salt).

• Other components are:

Contents of the capsules

Granules:carrageenan, microcrystalline cellulose, mannitol, sodium hydroxide, sodium carbonate

Insulating coating:polyethylene glycol-polyvinyl alcohol copolymer, sodium hydroxide, talc, titanium dioxide (E171), hydrated colloidal silica

Gastro-resistant coating:methacrylic acid-ethyl acrylate copolymer (1:1), triethyl citrate, talc, titanium dioxide (E171)

Capsule

Cap:gelatin, red iron oxide (E172), titanium dioxide (E171), yellow iron oxide (E172)

Body:gelatin, titanium dioxide (E171)

Product Appearance and Package Contents

Esomeprazol Aristo 20 mg hard gastro-resistant capsules

Capsule with a white opaque body and a yellow opaque cap that contains white or almost white gastro-resistant granules.

The capsules are presented in high-density polyethylene bottles with a desiccant capsule and with a polypropylene plug and aluminum/aluminum blisters. Do not ingest the desiccant capsule that comes in the bottle.

Package sizes:

14, 28, and 56 capsules.

Only some package sizes may be marketed.

Marketing Authorization Holder

Aristo Pharma Iberia, S.L.

C/ Solana, 26

28850 Torrejón de Ardoz

Madrid, Spain

Manufacturer

Medinsa (Laboratorios Medicamentos Internacionales S.A.)

C/ Solana, 26

28850 Torrejón de Ardoz (Madrid)

Spain

This medicine is authorized in the member states of the European Economic Area with the following names:

Germany: Esogasec 20 mg magensaftresistente Hartkapseln

Spain: Esomeprazol Aristo 20 mg hard gastro-resistant capsules EFG

France: ESOMEPRAZOLE EVOLUGEN PHARMA 20 mg, gélule gastro-résistante

Poland: Esogasec

Portugal: Esomeprazol Aristo 20 mg gastro-resistant capsules

Sweden: Esomeprazole Net 20 mg enterokapslar hard

Date of the last revision of this prospectus: April 2025

Detailed information about this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/.