arsoz 40mg injection - Esomeprazole (40mg) medicine

Adyom 40mg Tablet (Esomeprazole): Complete Guide

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🏭 Archmed Biotech Pvt Ltd 📦 Varies by brand 💊 Allopathy 📅 Updated: Sep 23, 2026
⚠️ Nephrotoxicity Risk 📋 Prescription Required 💊 Generic Available
Medically Reviewed
12 min read
Evidence: Well-established for approved indications.
Reviewed by
SaathiMed Expert Panel | Sep 23, 2026

When to Call Your Doctor IMMEDIATELY

  • Blood in vomit or black, tarry stools
  • Severe abdominal pain or difficulty swallowing
  • Chest pain or shortness of breath
  • Signs of allergic reaction: rash, swelling of face, lips, or throat, difficulty breathing
  • Yellowing of skin or eyes, dark urine, or severe fatigue
  • Decreased urine output or swelling in legs
  • Severe diarrhea with fever or abdominal cramps
  • Irregular heartbeat or muscle cramps (possible low magnesium)

If experiencing severe symptoms, call emergency services immediately.

What is arsoz 40mg injection used for?

This medicine is a proton pump inhibitor used to treat acid reflux, heartburn, and ulcers by reducing stomach acid production. It is taken orally once daily, usually for 4 to 8 weeks, and should be used under medical supervision.

  • Generic Name: Esomeprazole
  • Manufacturer: Archmed Biotech Pvt Ltd
  • Form: Allopathy
  • Pregnancy Category: Consult doctor
  • Prescription Required: Yes

🇮🇳 arsoz 40mg injection के बारे में (Hindi Summary)

उपयोग: यह दवा एसोमेप्राजोल 40mg टैबलेट है, जिसका उपयोग एसिड रिफ्लक्स, हार्टबर्न, गैस्ट्रोएसोफेजियल रिफ्लक्स डिजीज (GERD), पेट और आंतों के अल्सर, और हेलिकोबैक्टर पाइलोरी संक्रमण के इलाज में किया जाता है। यह पेट में एसिड का उत्पादन कम करती है, जिससे जलन, दर्द और अन्य लक्षणों में राहत मिलती है। यह दवा डॉक्टर के पर्चे के बिना नहीं लेनी चाहिए।

साइड इफेक्ट्स: आम दुष्प्रभावों में सिरदर्द, दस्त, मतली, पेट दर्द, गैस, कब्ज और मुँह सूखना शामिल हैं। गंभीर दुष्प्रभाव दुर्लभ हैं, लेकिन त्वचा पर गंभीर रैश, गुर्दे की समस्या, मैग्नीशियम की कमी और लंबे समय तक उपयोग से हड्डियों के फ्रैक्चर का खतरा बढ़ सकता है। कोई भी असामान्य लक्षण दिखने पर तुरंत डॉक्टर से संपर्क करें।

सुरक्षा सलाह: इस दवा को डॉक्टर के बताए अनुसार ही लें। गोली को पूरा निगलें, चबाएं या तोड़ें नहीं। इसे हर दिन एक ही समय पर लें। अल्कोहल से बचें क्योंकि इससे पेट में जलन बढ़ सकती है। यदि आपको लीवर की समस्या, मैग्नीशियम की कमी, या खून पतला करने वाली दवाएं ले रहे हैं, तो डॉक्टर को बताएं। बिना डॉक्टर की सलाह के दवा बंद न करें।

💡 Did You Know? The first generic medicine was introduced in India in 1970 after the Patents Act was amended.

💊 arsoz 40mg injection Uses & Benefits

  • [{"condition":"Gastroesophageal reflux disease (GERD)","description":"Reduces stomach acid to relieve heartburn, regurgitation, and esophageal irritation.","evidence":"Well-established"},{"condition":"Erosive esophagitis","description":"Heals acid-induced damage to the esophagus and prevents recurrence.","evidence":"Well-established"},{"condition":"Duodenal ulcers","description":"Promotes healing of ulcers in the first part of the small intestine.","evidence":"Well-established"},{"condition":"Gastric ulcers","description":"Helps heal ulcers in the stomach lining.","evidence":"Well-established"},{"condition":"Helicobacter pylori eradication","description":"Used in combination with antibiotics to eliminate H.
  • pylori infection.","evidence":"Well-established"},{"condition":"NSAID-associated ulcer prevention","description":"Reduces the risk of stomach ulcers in patients taking nonsteroidal anti-inflammatory drugs.","evidence":"Well-established"},{"condition":"Zollinger-Ellison syndrome","description":"Controls excessive acid production in this rare condition.","evidence":"Well-established"}]

Off-label uses: [{"condition":"Barrett's esophagus","description":"May be used to reduce acid exposure in patients with Barrett's esophagus.","evidence":"Limited"},{"condition":"Functional dyspepsia","description":"Sometimes prescribed for persistent upper abdominal discomfort without clear cause.","evidence":"Limited"}]

Primary treatment for: Gastroesophageal reflux disease (GERD)

Also treats: Erosive esophagitis, Duodenal ulcers, Gastric ulcers, Helicobacter pylori infection, Zollinger-Ellison syndrome, NSAID-associated ulcer prevention

📋 Drug Information

Generic Name(s)Esomeprazole
Brand NameAdyom 40mg Tablet
ManufacturerArchmed Biotech Pvt Ltd
Packaging / FormVaries by brand (Allopathy)
Therapeutic ClassGASTRO INTESTINAL
Action ClassProton pump inhibitors
Route of AdministrationOral
StorageStore at room temperature between 15°C and 30°C (59°F to 86°F). Keep in the original container, tightly closed, away from moisture and heat. Do not refrigerate.
Shelf Life24 months from the date of manufacture.
WHO GuidelineNot established from the available information.
ICMR GuidelineNot established from the available information.

👨‍⚕️ Doctor's Practical Tips

Evidence-based practical advice from experienced clinicians

1
Take this medicine at the same time each day, preferably before breakfast, to maintain consistent acid suppression.
2
Swallow the tablet whole; do not crush or chew it, as this can affect its release and efficacy.
3
If you are also taking antacids, take them at least 2 hours apart from this medicine to avoid absorption issues.
4
Long-term use may require periodic monitoring of magnesium and vitamin B12 levels; discuss with your doctor.
5
Do not stop this medicine abruptly without consulting your doctor, especially if you have been on it for several weeks.
6
Report any unusual symptoms like severe diarrhea, rash, or muscle cramps to your doctor promptly.
7
If you have osteoporosis or are at risk of fractures, discuss calcium and vitamin D supplementation with your doctor.

🔍 Is This Medicine Right for Your Symptom?

Educational reference. Always consult a doctor for diagnosis.

Heartburn
This medicine is commonly prescribed for frequent heartburn.
Likely Use
Regurgitation
Helps reduce acid regurgitation.
Likely Use
Difficulty swallowing
May be used if due to acid-related esophageal damage.
Likely Use
Fever
This medicine is not a fever reducer.
Not Primary
Headache
This medicine is not for headache relief; it may cause headache as a side effect.
Not Primary

🔬 How This Medicine Works (Pharmacology)

Pharmacokinetics

AbsorptionThis medicine is rapidly absorbed after oral administration, with peak plasma concentrations occurring approximately 1 to 2 hours after dosing. The absorption is delayed if taken with food. The enteric coating protects it from degradation by stomach acid, allowing it to reach the small intestine for absorption.
DistributionThis medicine is widely distributed in the body, with a volume of distribution of approximately 16 liters. It is highly bound to plasma proteins, primarily albumin.
Protein BindingApproximately 97% bound to plasma proteins.
MetabolismThis medicine is extensively metabolized in the liver by the cytochrome P450 enzyme system, primarily CYP2C19 and to a lesser extent CYP3A4. Its metabolites are inactive.
Half-LifeThe elimination half-life is approximately 1 to 1.5 hours after repeated dosing.
ExcretionAbout 80% of a dose is excreted in urine as metabolites, and the remaining 20% is excreted in feces.
BioavailabilityThe oral bioavailability is approximately 64% after a single dose and increases to about 89% after repeated dosing.
Onset of ActionAcid suppression begins within 1 hour of oral administration, but maximum effect may take up to 4 days of daily dosing.
Peak Plasma TimePeak plasma concentration is reached approximately 1 to 2 hours after oral administration.
Duration of ActionAcid suppression lasts for more than 24 hours due to irreversible binding to the proton pump.

How It Works

This medicine works by irreversibly blocking the hydrogen-potassium adenosine triphosphatase enzyme system, also known as the proton pump, located in the parietal cells of the stomach lining. By inhibiting this pump, it suppresses the final step of acid secretion, leading to a significant reduction in both basal and stimulated gastric acid production. This action helps relieve symptoms and allows damaged esophageal and gastric tissues to heal.

Mechanism Steps

1
Accumulation in acidic environment: This medicine is a weak base that concentrates in the acidic canaliculi of gastric parietal cells.
2
Activation to active form: In the acidic environment, it is converted to its active sulfenamide form.
3
Irreversible binding to proton pump: The active form binds covalently to cysteine residues on the H+/K+ ATPase enzyme, permanently inhibiting it.
4
Suppression of acid secretion: This inhibition blocks the final step of acid production, leading to reduced gastric acid output.
5
Gradual recovery of acid secretion: New proton pumps are synthesized over time, restoring acid secretion after the medicine is stopped.

💡 How to Take arsoz 40mg injection

Strength: Esomeprazole 40mg immediate-release tablet for oral administration.

1Take this medicine exactly as prescribed by your doctor.
2Swallow the tablet whole with a glass of water; do not crush, chew, or break it.
3You may take it with or without food, but taking it at the same time each day is best.
4If you are also taking antacids, take them at least 2 hours apart from this medicine.
5Do not stop taking this medicine without consulting your doctor, even if you feel better.
6If you miss a dose, follow the missed dose instructions.
7Store the medicine properly and keep out of reach of children.

Dosage Information

Adult DosageThe usual adult dose for gastroesophageal reflux disease is 20 mg or 40 mg once daily for 4 to 8 weeks. For erosive esophagitis, 20 mg or 40 mg once daily for 4 to 8 weeks. For H. pylori eradication, 40 mg once daily in combination with antibiotics for 10 days. For Zollinger-Ellison syndrome, starting dose is 40 mg twice daily, adjusted as needed. Dose must be individualized by a qualified clinician based on indication, age, weight, renal and hepatic function.
Pediatric DosagePediatric dosing is not established from available information. Consult a pediatrician.
Elderly DosageNo specific dose adjustment is required for elderly patients, but they may be more susceptible to side effects such as bone fractures and low magnesium levels. Use with caution and monitor closely.
Renal ImpairmentNo dose adjustment is required for patients with mild to moderate renal impairment. Use with caution in severe renal impairment.
Hepatic ImpairmentFor patients with mild to moderate hepatic impairment, a maximum dose of 20 mg once daily is recommended. For severe hepatic impairment, use with caution and consider dose reduction.
Maximum Daily Dose40 mg per day for most indications; up to 80 mg per day for Zollinger-Ellison syndrome under specialist supervision.

Dosage Timeline

🌅 Morning ❌ ☀️ Afternoon ❌ 🌆 Evening ❌ 🌙 Night ❌

🍽️ Food Timing Guide

With or without food
May take with or without food
Food delays absorption but does not significantly affect efficacy.
Grapefruit juice
Avoid large amounts
May increase drug levels by affecting liver enzymes.
Alcohol
Avoid
May worsen stomach irritation and acid reflux.

⏰ What to Do If You Miss a Dose

📌 Less than half the dosing interval has passed
→ Take the missed dose as soon as you remember.
💡 Continue with the regular schedule.
📌 More than half the dosing interval has passed
→ Skip the missed dose.
💡 Do not double dose to catch up.

⚠️ Side Effects of arsoz 40mg injection

✅ Common Side Effects

Headache (Common (5-10%))
Usually resolves on its own. Consult doctor if persistent or severe.
Diarrhea (Common (5-10%))
Stay hydrated. Consult doctor if diarrhea persists or becomes severe.
Nausea (Common (5-10%))
Take with food if it helps. Consult doctor if it continues.
Flatulence (Common (5-10%))
Usually harmless. Consult doctor if bothersome.
Abdominal pain (Common (5-10%))
Report to doctor if severe or persistent.
Constipation (Common (5-10%))
Increase fiber and fluid intake. Consult doctor if it persists.
Dry mouth (Common (5-10%))
Sip water regularly. Consult doctor if it interferes with daily activities.

🚨 Serious Side Effects

Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis) (Rare (<0.1%))
Seek immediate medical attention if you develop rash, blisters, peeling skin, or sores in mouth.
Acute interstitial nephritis (Rare (<0.1%))
Seek immediate care if you notice decreased urine output, swelling, or fatigue.
Hypomagnesemia (Uncommon (0.1-1%))
Report muscle cramps, tremors, or irregular heartbeat to your doctor.
Clostridium difficile-associated diarrhea (Uncommon (0.1-1%))
Seek medical attention if you develop severe, persistent diarrhea or fever.
Bone fractures (hip, wrist, spine) with long-term use (Uncommon (0.1-1%))
Discuss calcium and vitamin D intake with your doctor, especially if you have osteoporosis risk.
Cutaneous lupus erythematosus (Rare (<0.1%))
Report new or worsening skin rash, especially on sun-exposed areas.

⚠️ Rare Side Effects

Agranulocytosis
Seek immediate care if you develop fever, sore throat, or unusual infections.
Hepatotoxicity
Report yellowing of skin or eyes, dark urine, or abdominal pain to your doctor.
Pancreatitis
Seek immediate care for severe abdominal pain radiating to the back.
Anaphylaxis
Call emergency services if you experience difficulty breathing, swelling of face or throat, or hives.

Consult your doctor if you experience any unusual symptoms.

🔬 Drug Interactions

Drug Severity Effect
Nelfinavir Major
Warfarin Major
Clopidogrel Major
Methotrexate Major
Diazepam Moderate
Phenytoin Moderate
Ketoconazole Moderate
Atazanavir Moderate
Antacids Minor
Sucralfate Minor

🚨 Major Interactions

  • Nelfinavir
  • Warfarin
  • Clopidogrel
  • Methotrexate

⚡ Moderate Interactions

  • Diazepam
  • Phenytoin
  • Ketoconazole, Itraconazole
  • Atazanavir

🍷 Alcohol Interaction

Alcohol can irritate the stomach lining and may worsen acid-related conditions. It is advisable to avoid or limit alcohol while taking this medicine to prevent increased stomach irritation and potential worsening of symptoms.

🔎 Check Your Other Medicines

Educational tool. Always confirm with your doctor or pharmacist.

🛡️ Safety & Warnings

🚫 Contraindications

["Known hypersensitivity to Esomeprazole or other proton pump inhibitors","Concomitant use with Nelfinavir","Not for immediate relief of heartburn"]

⚠️ Warnings & Precautions

["Long-term use may increase risk of bone fractures, especially in elderly.","May cause low magnesium levels with prolonged use; monitor levels.","Increased risk of Clostridium difficile-associated diarrhea.","May mask symptoms of stomach cancer; rule out malignancy before treatment.","Use with caution in patients with liver disease; dose adjustment may be needed.","Avoid use in patients with known osteoporosis unless benefits outweigh risks.","Not recommended for children under 1 year for GERD, or under 12 years for other indications without specialist advice."]

🤱 Lactation Safety

Limited data available. Esomeprazole is excreted in small amounts in breast milk. Consult your doctor before use during breastfeeding; monitor infant for potential effects.

💊 Overdose Management

Symptoms of overdose may include drowsiness, nausea, headache, and dry mouth. Treatment is supportive and symptomatic. Contact a poison control center or emergency department immediately if overdose is suspected. Hemodialysis is not effective in removing this medicine.

⏰ Missed Dose

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.

Additional Safety Advice

General Safety

Take this medicine exactly as prescribed by your doctor. Swallow the tablet whole with a glass of water; do not crush, chew, or break it. You may take it with or without food, but taking it at the same time each day helps maintain consistent levels. Do not stop taking this medicine suddenly without consulting your doctor, especially if you have been on it for a long time. Avoid alcohol while taking this medicine as it can worsen stomach irritation. Inform your doctor if you have liver problems, low magnesium levels, or are taking blood thinners like Warfarin. Do not take antacids within two hours of this medicine unless your doctor approves. Keep out of reach of children and store at room temperature away from moisture and heat.

👴 Special Considerations for Elderly

💡 For Patients Above 65

Elderly patients may be at higher risk of bone fractures, low magnesium levels, and kidney problems with long-term use. Use with caution and monitor renal function and magnesium levels periodically.

🤰 Pregnancy Planning (TTC)

If you are planning pregnancy or are pregnant, consult your doctor before using this medicine. Esomeprazole is generally considered acceptable when needed, but the lowest effective dose for the shortest duration is recommended.

🏥 Post-Surgery Considerations

This medicine may be continued after surgery if indicated for acid suppression. Inform your surgeon and anesthesiologist about all medicines you are taking. It does not typically interfere with surgical recovery, but follow your doctor's instructions.

🦷 Dental Procedures

No specific precautions are required for dental procedures. However, inform your dentist about all medicines you are taking. If you have a history of acid reflux, take your medicine as usual to prevent symptoms during dental work.

💚 Lifestyle Tips for Better Results

🏃
Maintain a healthy weight to reduce pressure on the stomach and esophagus.
🥗
Avoid lying down for at least 2-3 hours after meals.
😴
Elevate the head of your bed by 6-8 inches to reduce nighttime reflux.
💧
Eat smaller, more frequent meals instead of large heavy meals.
🧘
Avoid trigger foods such as spicy, fatty, or acidic foods, and caffeine.
🌞
Quit smoking and limit alcohol consumption.
🚭
Practice stress-reduction techniques like yoga or meditation.

🏋️ Exercise Considerations

Moderate exercise is generally safe while taking this medicine. However, avoid vigorous exercise immediately after meals as it may worsen reflux. If you experience dizziness or muscle cramps, consult your doctor before continuing strenuous activities.

🥗 Diet Recommendations

Include high-fiber foods like whole grains, fruits, and vegetables.
Choose lean proteins such as chicken, fish, and tofu.
Avoid spicy, fatty, and fried foods that can trigger acid reflux.
Limit caffeine and carbonated drinks.
Stay well hydrated with water throughout the day.
Consider smaller, more frequent meals.

💼 Impact on Daily Work & Life

This medicine is unlikely to affect your ability to work or drive. However, if you experience dizziness, drowsiness, or headache, avoid driving or operating heavy machinery until you know how it affects you. It is generally safe to continue your daily activities as prescribed.

🛑 When to Stop This Medicine

Do not stop taking this medicine without consulting your doctor. If you experience severe side effects or your symptoms resolve, your doctor may advise tapering or stopping. Abrupt discontinuation after long-term use may cause rebound acid hypersecretion.

📅 Long-Term Use Effects

Long-term use of this medicine may lead to low magnesium levels, vitamin B12 deficiency, increased risk of bone fractures, and a higher chance of certain gut infections. Periodic monitoring of magnesium, vitamin B12, and bone health is advised. The need for continued therapy should be reviewed regularly by your doctor.

🌿 Non-Medicine Approaches

These can complement medicine but do not replace prescribed treatment.

Lifestyle modifications

Weight loss, dietary changes, and elevating the head of the bed can reduce reflux symptoms.

Evidence: Well-established
H2 receptor antagonists

Alternative acid-reducing medicines like ranitidine or famotidine may be used for milder symptoms.

Evidence: Well-established
Antacids

Provide quick but short-lasting relief for mild heartburn.

Evidence: Well-established

💉 Vaccination Considerations

💉 If You're Getting Vaccinated

No specific vaccine interactions are known. However, long-term use of this medicine may increase susceptibility to certain infections; ensure routine vaccinations are up to date.

📦 Storage Guide

✅ DO

Store at room temperature (15-30°C)

❌ DON'T

Do not refrigerate

✅ DO

Keep in original container

❌ DON'T

Do not transfer to unmarked containers

✅ DO

Keep away from direct sunlight and moisture

❌ DON'T

Do not store in bathroom cabinet

✈️ Traveling with This Medicine

When traveling, carry this medicine in its original packaging with a copy of your prescription. Store it at room temperature and protect it from moisture and heat. If crossing time zones, continue taking it at your usual schedule as much as possible; if significant time change, consult your doctor for adjustment. Keep it in your carry-on luggage to avoid loss. Check customs regulations for prescription medicines in your destination country.

💰 Cost Analysis & Savings

👥 Real Patient Stories

Educational, anonymized scenarios. Individual results may vary.

👤 A 45-year-old man with chronic heartburn and regurgitation
He was prescribed this medicine 40mg once daily for GERD. After 2 weeks, his heartburn episodes reduced significantly, and he could sleep better. He was advised to avoid late-night meals and alcohol. He reported mild headache initially, which resolved.
💡 Lesson: Consistent daily dosing and lifestyle modifications greatly improve GERD symptoms.
👤 A 60-year-old woman with osteoarthritis taking NSAIDs
She developed stomach pain and was found to have a gastric ulcer. She was started on this medicine 40mg daily along with discontinuation of NSAIDs. Her ulcer healed in 8 weeks, and she was advised to use alternative pain relief.
💡 Lesson: This medicine effectively heals NSAID-induced ulcers, but avoiding the offending agent is crucial.
👤 A 35-year-old woman with H. pylori infection
She was prescribed this medicine 40mg once daily along with two antibiotics for 10 days. After completing therapy, her H. pylori test was negative, and her ulcer symptoms resolved.
💡 Lesson: Combination therapy including this medicine is essential for eradicating H. pylori and preventing ulcer recurrence.

💬 Questions Patients Often Ask

Q: How long does it take to work?

A: This medicine starts reducing acid within 1 hour, but full symptom relief may take 1 to 4 days of daily dosing.

Q: Can I take it with food?

A: You may take it with or without food, but taking it at the same time each day is best. Food may delay absorption but does not reduce effectiveness.

Q: What are the common side effects?

A: Common side effects include headache, diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth. These are usually mild and temporary.

Q: Is it safe for long-term use?

A: Long-term use may increase the risk of bone fractures, low magnesium, and vitamin B12 deficiency. Regular monitoring and periodic review with your doctor are recommended.

Q: Can I drink alcohol while taking this medicine?

A: It is advisable to avoid alcohol as it can worsen stomach irritation and acid reflux symptoms.

Q: What if I miss a dose?

A: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.

Q: Is it safe during pregnancy?

A: Esomeprazole is generally considered acceptable for use in pregnancy when clearly needed. Consult your doctor to weigh benefits and risks.

Q: Does it interact with other medicines?

A: Yes, it can interact with certain medicines like Nelfinavir, Warfarin, Clopidogrel, and Methotrexate. Always inform your doctor about all medicines you are taking.

🤔 Common Patient Concerns

💭 These are the concerns patients most commonly raise

  • Can I take this medicine long-term?
  • Will it affect my kidney function?
  • Can I drive after taking this medicine?
  • Does it interact with my blood pressure medicine?
  • What if I miss a dose?
  • Can I drink alcohol while taking this?
  • Is it safe during pregnancy?
  • Does it cause bone fractures?

🔄 Substitutes for arsoz 40mg injection

View All

Alternative brands with exact same active ingredient:

Medical Note: Always consult your doctor before switching medications.

🛑 Myths vs. Facts

  • Myth: This medicine provides instant relief from heartburn.
    Fact: It reduces acid production over time and may take 1 to 4 days for full effect. It is not for immediate relief.
  • Myth: It is safe to take indefinitely without monitoring.
    Fact: Long-term use requires periodic review and monitoring for side effects like low magnesium and bone fractures.
  • Myth: It can be taken for any stomach pain.
    Fact: It is specifically for acid-related conditions and should only be used as prescribed.

🔄 Alternative Options

Generic Alternatives

  • Esomeprazole 40mg tablet

Brand Alternatives

  • Nexium 40mg tablet
  • Esoz 40mg tablet
  • Emanzen 40mg tablet
  • Esomac 40mg tablet

📊 Comparison with Similar Medicines

[{"medicine":"Esomeprazole 40mg","class":"Proton pump inhibitor","onset":"1 hour","duration":"24 hours","common_use":"GERD, ulcers"},{"medicine":"Omeprazole 40mg","class":"Proton pump inhibitor","onset":"1 hour","duration":"24 hours","common_use":"GERD, ulcers"},{"medicine":"Pantoprazole 40mg","class":"Proton pump inhibitor","onset":"1 hour","duration":"24 hours","common_use":"GERD, ulcers"}]

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