Change to traffic light status:

Esomeprazole capsules are now considered Green (3rd line).

The decision of September 2022 has been superceded BUT lansoprazole capsules remain the preferred PPI in patients with and without swallowing difficulties and in patients with an enteral feeding tube.

Note - 40mg esomeprazole capsules are restricted for short-term use prior to step down OR Zollinger-Ellison syndrome

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed esomeprazole capsules can continue to be prescribed for patients with no swallowing difficulty but should not be started in any new patients - alternatives are available as per below.

Most (but not all) brands of esomeprazole tablets, capsules and granules for oral suspension are licensed for administration via gastric tubes. They will disperse in water for administration. For patients with fine-bore enteral tubes, consider switching to lansoprazole orodispersible tablets, which have smaller micro-granules

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)