Nexium 24HR Pharmacy Training

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Mildred Wheeler
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1 Nexium 24HR Pharmacy Training Your pharmacist's advice is required. Always read the label. Use only as directed. If symptoms persist, consult your doctor/ healthcare professional. Pfizer Consumer Healthcare Wharf Rd West Ryde NSW 2114

2 Agenda Basics of Anatomy Quick Revision What is Heartburn? Causes & Symptoms Heartburn Sufferers Impact on life OTC Treatments Available Why Nexium 24HR? A new solution Nexium 24HR An appropriate first line treatment Your pharmacist's advice is required. Always read the label. Use only as directed. If symptoms persist, consult your doctor/ healthcare professional. Pfizer Australia PTY Limited Wharf Rd West Ryde NSW 2114 Pfizer 2015

3 Basics of Anatomy Quick Revision

gastrointestinal tract into bloodstream Elimination Excretion of indigestible parts of food that cannot

4 The Digestive System Ingestion Food enters the body Digestion Food is broken down into nutrients by physical and chemical processes so it can be used by cells of the body Absorption Nutrients pass from gastrointestinal tract into bloodstream Elimination Excretion of indigestible parts of food that cannot be absorbed into the bloodstream Lower Oesophageal Sphincter Small Intestine Oesophagus Stomach Large Intestine

5 What is Heartburn

tightly, allowing acid escape out of the stomach Gastric Acid Oesophagus Stomach

6 Heartburn Heartburn is caused by the REFLUX, or back flow, of GASTRIC ACID into the OESOPHAGUS It occurs when the lower oesophageal sphincter (LOS) does not close tightly, allowing acid escape out of the stomach Gastric Acid Oesophagus Stomach

7 Heartburn Typical Symptoms include; Oesophagus a painful, burning feeling behind the breastbone an acidic taste in the back of the throat (acid regurgitation) 1 Gastric Acid Some of the Triggers are; spicy foods, caffeine, tobacco, pregnancy, stress, and hiatal hernia 1 Stomach 1.

8 Heartburn Sufferers

Occasional or Frequent Occasional Heartburn Occurs sporadically the cause is usually obvious often overeating, spicy foods, rich desserts or alcohol Frequent Heartburn

9 Occasional or Frequent Occasional Heartburn Occurs sporadically the cause is usually obvious often overeating, spicy foods, rich desserts or alcohol Frequent Heartburn Occurs 2 or more times a week more common after meals and at night stress and foods may be triggers but not always cause PSA Protocol GORD. guidance for provision of PPI s.

adults 40% of these people have frequent heartburn

10 Prevalence It is estimated that 30% of Australian adults suffer from Heartburn That s 4M Australian adults 40% of these people have frequent heartburn Source: Forbes Consulting Group Australian U&A Study Dec 2014

11 Unmet Need Frequent heartburn has a SIGNIFICANT IMPACT on the physical, mental and social well being of sufferers causes severe pain affects food and drink choices impacts sleep Source: Forbes Consulting Group Australian U&A Study Dec 2014

12 Real Impact on Life Regardless of severity, frequent heartburn impacts quality of life Farup C et al. Arch Intern Med. 2001;161:45-52

13 What Patients Want Treat the cause rather than the symptoms Prevent heartburn / reflux in first place To be in control - target complete relief To be symptom free even lying down. More effective treatment Not have to treat throughout the day Above all they want normality Not having to watch out for triggers in diet Not having sleep affected Source: Forbes Consulting Group Australian U&A Study Dec 2014

14 OTC Treatments

OTC Treatment Options PPIs are an effective

treat the root cause rather than symptoms

Neutralise stomach acid Put a barrier over

that stimulate acid production Block all 3

15 OTC Treatment Options PPIs are an effective way of treating frequent heartburn They treat the root cause rather than symptoms Antacids Alginates H2 blockers PPI s Neutralise stomach acid Put a barrier over stomach contents Block 1 of the 3 signals that stimulate acid production Block all 3 signals that stimulate acid production Sporadic Frequent

16 Why Nexium 24HR

17 Nexium is #1Worldwide The #1 selling Acid Blocker Brand Worldwide is now available without a prescription for Heartburn and Acid Reflux IMS OTC global data 2015

18 Not all PPI s are the same Esomeprazole is the first PPI developed as a single optical isomer 1 Esomeprazole and omeprazole contain the same compound but with a different composition of isomers (geometric configurations, called S or R) 1,2 Omeprazole Esomeprazole 50% S form 50% R form 100% S form mixture of S and R isomers Pure S isomer 1. Tonini M et al. Dig Liver Dis. 2001;33: Summary of Product Characteristics.

With Nexium 24HR, 70% more active drug reaches the source of acid

than omeprazole, leaving more drug available to act on proton pumps

Metabolism by the liver 100% 64% 38% S isomer R isomer 1.Tonini M et al.

19 With Nexium 24HR, 70% more active drug reaches the source of acid production 1,2 Nexium 24HR is less extensively metabolised by the liver than omeprazole, leaving more drug available to act on proton pumps with longer-lasting acid-control 1,2 Nexium 24HR Omeprazole 100% Metabolism by the liver 100% 64% 38% S isomer R isomer 1.Tonini M et al. Dig Liver Dis. 2001;33:600-6; 2. Lind T et al. Aliment Pharmacol Ther. 2000;14:861-7

20 Nexium 24HR Posology Nexium 24HR is taken: Once daily until complete relief is achieved Complete relief is defined, in clinical trials, as zero heartburn for seven consecutive days It can be taken for up to 14 consecutive days If symptoms persist or recur within 2 weeks of completing of the course, customer should be advised to consult their doctor Your pharmacist's advice is required. Always read the label. Use only as directed. If symptoms persist, consult your doctor/ healthcare professional. Pfizer Consumer Healthcare Wharf Rd West Ryde NSW 2114 Refer to Product Information for full details

21 The Nexium 24HR benefit Continuous 24-hour protection from heartburn 1 Significant resolution of night-time heartburn 2 Restores quality of life 1. Data of File Clinical study report Next I and Next II 2. Johnson 2015 Curr Med Res Opin p243

The 24HR benefit 8 out of 10 people reported

time to first night being heartburn free

22 The 24HR benefit 8 out of 10 people reported first resolution of their heartburn within the first week of treatment 4 out of 5 nights were heartburn free with the median time to first night being heartburn free after 1 day Source: Johnson 2015 Curr Med Res Opin p243

23 Nexium 24HR an appropriate first line treatment

PSA GORD protocol supports PPI s as first-line treatment for

treatment for treating frequent heartburn 1 Response to treatment

provides an opportunity for heartburn to be ruled out 2 1.

24 PSA GORD protocol supports PPI s as first-line treatment for heartburn Initial treatment with a PPI is the current first line treatment for treating frequent heartburn 1 Response to treatment with a PPI demonstrates whether or not symptoms are acid related, and provides an opportunity for heartburn to be ruled out 2 1. PSA Protocol GORD. guidance for provision of PPI s Haag S et al. Digestion. 2009;80:

25 PPI s are first-line treatment for frequent heartburn Not treating with a PPI falls short of providing the protection frequent heartburn sufferers want

26 Could treatment with Nexium 24HR mask a serious condition? Heartburn symptoms may accompany more serious problems for example: oesophageal adenocarcinoma (cancer) or Barrett s oesophagus 1,2 Such conditions are very rare, particularly when compared with the high occurrence of heartburn 1,2 of individuals with reflux symptoms referred for endoscopy (10% of newly diagnosed patients), <1% had Barrett s oesophagus and <0.5% had oesophageal adenocarcinoma 3 The likelihood of Nexium 24HR covering up a serious condition is extremely low, in fact, it is the same as with antacids or alginates 1. Haag S et al. Digestion. 2009;80: Holtmann G et al. Int J Clin Pharm. 2011;33: Ruigomez A et al. Dis Esophagus. 2008;21:251-6.

27 Symptoms of serious conditions Nexium 24H is appropriate for people whose main symptoms are heartburn or acid reflux, at least twice a week The following signs may indicate a more serious problem and the customer should be advised to see their GP Serious Symptoms Atypical and/or Unspecific Symptoms Unintentional weight loss Vomiting of blood Black faeces / blood in stool Chest pain Predominant epigastric pain Belching Difficulty swallowing Painful swallowing Severe symptoms Hoarseness Sore throat Cough PSA Protocol GORD. guidance for provision of PPI s.

28 Summary

29 Summary Heartburn is a common condition which can have a significant, negative impact on sufferers quality of life PPI s are the most effective OTC solution for treating frequent heartburn New Nexium 24HR is indicated for the short-term treatment of reflux symptoms (heartburn and acid regurgitation) in adults PSA guidelines support PPI s as a first-line treatment for frequent heartburn

30 Summary The active in Nexium 24HR, esomeprazole, is less extensively metabolised by the liver than omeprazole resulting in a more efficient delivery of the drug to the parietal cells which also gives longer-lasting acid-control Nexium 24HR has a well established safety profile and is associated with mostly minor adverse reactions. The likelihood of Nexium 24HR masking a serious condition is extremely low, and in fact, it is the same as with antacids or alginates

Hiatus Hernia. Endoscopy Department. Patient information leaflet

Hiatus Hernia. Endoscopy Department. Patient information leaflet Hiatus Hernia Endoscopy Department Patient information leaflet You will only be given this leaflet if you have been diagnosed with a hiatus hernia. The information below outlines normal anatomy, conditions,