Emanera 20 mg and 40 mg gastro-resistant capsules – esomeprazole for reflux (GORD) and ulcers

Emanera contains esomeprazole, a medicine from the group of proton pump inhibitors (PPIs), which reduces the amount of acid produced by the stomach. In Serbia, 20 mg and 40 mg gastro-resistant hard capsules are authorised in packs of 14 and 28 capsules.

According to the leaflet, Emanera is used in adults to treat gastro-oesophageal reflux disease (GORD), ulcers infected with Helicobacter pylori (with antibiotics), ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) and their prevention, for prolonged treatment after intravenous prevention of ulcer rebleeding, and in Zollinger-Ellison syndrome. In adolescents aged 12 and over it is used for GORD and H. pylori ulcers.

What is Emanera used for and how is it taken correctly?

Key facts about the medicine

What is Emanera used for?

• Adults: gastro-oesophageal reflux disease (GORD) – stomach acid flowing back into the oesophagus, causing pain, inflammation and heartburn; stomach or upper intestinal ulcers infected with Helicobacter pylori (combined with antibiotics); stomach ulcers caused by NSAIDs and their prevention in people taking NSAIDs; prolonged treatment after intravenous prevention of ulcer rebleeding with esomeprazole; Zollinger-Ellison syndrome (excess acid due to a pancreatic tumour).
• Adolescents aged 12 and over: GORD and ulcers caused by H. pylori infection (with antibiotics).

How is it taken and dosed?

Your doctor decides the number of capsules and the duration of treatment according to your condition, age and liver function. Recommended doses according to the leaflet (adults):

• GORD with a mildly damaged oesophagus: 40 mg once daily for 4 weeks, possibly another 4 weeks if not healed; after healing 20 mg once daily.
• GORD without oesophageal damage: 20 mg every day; once the condition is controlled, your doctor may advise taking it as needed, up to 20 mg daily.
• H. pylori ulcers: 20 mg twice daily for one week, together with the antibiotics amoxicillin and clarithromycin.
• NSAID-related ulcers: 20 mg once daily for 4–8 weeks; prevention of ulcers with NSAIDs: 20 mg once daily.
• After intravenous prevention of ulcer rebleeding: 40 mg once daily for 4 weeks.
• Zollinger-Ellison syndrome: 40 mg twice daily; the doctor adjusts the dose, up to 80 mg twice daily.

You can take the capsules at any time of day, with food or on an empty stomach. Swallow the capsule whole with plenty of water; do not chew or crush it, as the coated pellets protect the medicine from stomach acid. If you cannot swallow the capsule, open it, empty the pellets into half a glass of still (non-fizzy) water (no other liquid), stir and drink immediately or within 30 minutes, then rinse the glass with another half glass of water and drink it. For people unable to swallow, the contents can be given through a gastric tube.

Special patient groups

• Adolescents aged 12 and over: GORD with a mildly damaged oesophagus – 40 mg once daily for 4 weeks (possibly another 4), then 20 mg; GORD without damage – 20 mg daily; H. pylori ulcer – 20 mg twice daily for one week with antibiotics.
• Children under 12: use is not recommended.
• Older people: no dose adjustment is needed.
• Severe liver problems: your doctor may give a lower dose; also talk to your doctor if you have serious kidney problems.

Contraindications – when the medicine must not be used

Do not take Emanera:

• if you are allergic to esomeprazole or any of the excipients;
• if you are allergic to other proton pump inhibitors (e.g. pantoprazole, lansoprazole, rabeprazole, omeprazole);
• if you are taking nelfinavir (an HIV medicine).

Warnings and precautions

Talk to your doctor before taking the medicine if you have serious liver or kidney problems, have previously had a skin reaction to a similar medicine, or are due to have a chromogranin A blood test.

• Masking other diseases: talk to your doctor immediately if you lose a lot of weight for no reason, have difficulty swallowing, stomach pain or indigestion, vomit food or blood, or have black stools.
• Taking as needed: contact your doctor if symptoms persist or change in character.
• Gut infections: slightly increased risk of infections caused by Salmonella and Campylobacter.
• Vitamin B12: the medicine may reduce absorption of vitamin B12, which matters if your stores are low or you have risk factors.
• Fractures: use for more than a year may slightly increase the risk of hip, wrist or spine fractures – tell your doctor if you have osteoporosis or take corticosteroids.
• Skin reactions: report a skin rash, especially on sun-exposed areas, or joint pain to your doctor; with a severe rash with sores in the mouth, nose, genitals, conjunctivitis, blisters and peeling skin, with fever, stop taking it and contact your doctor immediately.
• Sucrose: the capsules contain sucrose.

Interactions with other medicines, food and drink

Tell your doctor or pharmacist about all medicines, including non-prescription ones. Do not take Emanera with nelfinavir. Tell your doctor in particular if you take:

• atazanavir, saquinavir (with ritonavir); clopidogrel; ketoconazole, itraconazole, voriconazole; erlotinib;
• citalopram, imipramine, clomipramine; diazepam; phenytoin (monitoring when starting and stopping);
• warfarin and other blood thinners (monitoring); cilostazol; cisapride; digoxin;
• high-dose methotrexate (your doctor may pause Emanera); tacrolimus; rifampicin;
• St John’s wort (Hypericum perforatum).

If amoxicillin and clarithromycin have been prescribed with Emanera for H. pylori, be sure to tell your doctor about all other medicines you take. The capsules can be taken with food or on an empty stomach.

Pregnancy and breast-feeding

• Pregnancy: consult your doctor before taking the medicine – your doctor will decide whether you may take Emanera during pregnancy.
• Breast-feeding: it is not known whether the medicine passes into breast milk, so it should not be taken while breast-feeding.

Driving and using machines

Emanera has a minor influence on the ability to drive and use machines. If you experience dizziness (uncommon) or blurred vision (rare), do not drive or use machines.

Possible side effects

Stop taking the medicine and contact your doctor immediately if you notice yellow skin, dark urine and tiredness (liver problems – rare); sudden difficulty breathing, swelling of the lips, tongue, throat or body, rash, fainting or difficulty swallowing (serious allergic reaction – rare); sudden severe rash or reddening with blisters or peeling skin, bleeding of the lips, eyes, mouth, nose or genitals (very rare; e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS).

• Common (up to 1 in 10): headache; diarrhoea, stomach pain, constipation, wind, nausea or vomiting; benign stomach polyps.
• Uncommon (up to 1 in 100): swelling of the feet and ankles, insomnia, fainting, pins and needles, sleepiness, vertigo, dry mouth, changes in liver tests, rash, hives and itching, fractures of the hip, wrist or spine (with high doses and long-term use).
• Rare (up to 1 in 1,000): low white blood cell or platelet count, low sodium, agitation, confusion or depression, taste changes, blurred vision, bronchospasm, inflammation of the mouth, fungal gut infection, jaundice, hair loss, rash in sunlight, joint and muscle pain, feeling unwell, increased sweating.
• Very rare (up to 1 in 10,000): pancytopenia and agranulocytosis, aggression, hallucinations, severe liver problems, muscle weakness, serious kidney problems, breast enlargement in men.
• Not known: with use for more than three months, low blood magnesium may occur (weakness, muscle twitching, disorientation, cramps, fainting, fast heartbeat), which may also lower potassium and calcium; inflammation of the gut causing diarrhoea; rash, possibly with joint pain.

If you develop an infection with fever and a seriously worsened general condition, or fever with pain in the neck, throat or mouth or problems passing urine, see your doctor as soon as possible and say that you are taking this medicine – a blood test is needed.

Overdose, missed dose and stopping treatment

• Overdose: if you have taken more than prescribed, contact your doctor or pharmacist immediately.
• Missed dose: take it as soon as you remember; if it is almost time for the next one, skip the missed dose. Do not take a double dose.
• Longer treatment: if you take the medicine for a long time (especially over a year), your doctor will monitor your condition.

Related information

For additional support with heartburn and reflux, see also the category Heartburn (excess acid) – products in this category do not replace the medicine prescribed for you.

Composition, pack and manufacturer

• Active substance: esomeprazole – 20 mg or 40 mg per capsule, as esomeprazole magnesium dihydrate.
• Excipients: core – sugar spheres (sucrose and maize starch); povidone K30; sodium lauryl sulfate; talc; macrogol 6000; heavy magnesium carbonate; methacrylic acid – ethyl acrylate copolymer (1:1) dispersion 30%; polysorbate 80; titanium dioxide (E171); Opadry II White 85F28751. Capsule – gelatin; titanium dioxide (E171); red iron oxide (E172).
• Pack: blisters of 7 capsules; carton with 2 or 4 blisters (14 or 28 capsules).
• Marketing authorisation holder: Krka-Farma d.o.o. Belgrade, Jurija Gagarina 26/V/II, Belgrade. Manufacturer: Krka, d.d., Novo Mesto, Šmarješka cesta 6, Novo Mesto, Slovenia.

Storage

• Store below 30 °C in the original package to protect from moisture, out of the sight and reach of children.
• Shelf life: 2 years; do not use after the expiry date on the pack.
• Return unused medicine to a pharmacy that collects unused medicines.

Frequently asked questions

When should Emanera be taken – before or after meals?

According to the leaflet, you can take the capsules at any time of day, with food or on an empty stomach. What matters is to swallow them whole with plenty of water.

Can I open the capsule if I cannot swallow it?

Yes. Empty the pellets into half a glass of still water, stir and drink immediately or within 30 minutes, then rinse the glass with another half glass of water. The pellets must not be chewed or crushed.

How long may I take Emanera?

As long as your doctor decides – from one week (for H. pylori) to long-term treatment. With use for more than a year your doctor monitors your condition, and with use for more than three months blood magnesium may fall.

What is the difference between Emanera 20 mg and 40 mg?

The 40 mg strength is used, for example, to heal a damaged oesophagus in GORD, after intravenous prevention of ulcer bleeding and in Zollinger-Ellison syndrome, while 20 mg is used for maintenance, GORD without damage, H. pylori and NSAID-related ulcers. The dose is set by your doctor.

Sources

• ALIMS – Summary of Product Characteristics, Emanera® 20 mg and 40 mg gastro-resistant hard capsules (SmPC, Serbian)
• ALIMS – Patient leaflet, Emanera® 20 mg and 40 mg gastro-resistant hard capsules (PIL, November 2022, Serbian)

Sources checked on: 25 October 2026.