Erika Prouty, PharmD, is a professional community pharmacist who aids patients in medication management and pharmacy services in North Adams, Massachusetts.
Nexium (esomeprazole) is a proton pump inhibitor (PPI) available to people with stomach acid-related conditions like gastroesophageal reflux disease (GERD). In addition to treating GERD in adults and children, Nexium can help prevent stomach ulcers caused by medications, infection, and other causes.
Esomeprazole comes in delayed-release capsules, delayed-release granules, tablet form, and powder for oral suspension.
Nexium is available as a prescription medication. However, you can buy Nexium 24HR over the counter (OTC) in a lower dosage form to treat frequent heartburn (two or more days a week). It is also available in generic form.
Drug Availability: Prescription, over the counter
Dosage Form(s): Tablet, capsule, packet
Nexium is indicated to treat or prevent certain conditions caused by the excessive production of stomach acid, specifically:
Adults can use Nexium for:
Nexium can also be used in children and adolescents 1 year to 17 years of age for up to eight weeks to treat GERD. Children ages 1 month to less than 1 year can take Nexium for up to six weeks only to treat GERD with acid-related damage to the esophagus. However, in children less than 1 year old, studies showed it was not more effective than placebo after four weeks of treatment.
OTC Nexium 24HR is indicated for adults with frequent heartburn.
Adults and children as young as 1 month of age can use Nexium. Depending on your treatment goals, you might take Nexium for anywhere from 10 days (for H. pylori eradication therapy) to up to six months (to prevent NSAID-associated ulcers).
Nexium comes in two different forms, each with specific indications and dosing instructions.
Take the delayed-release capsules at least one hour before a meal, usually once a day, in the morning. Swallow the capsules whole; do not chew or crush them.
Children and adults who have trouble swallowing pills can open the capsule and sprinkle the contents over applesauce and consume it that way. This must be taken right after mixing; do not save for later use. Do not mix Nexium with any other food except applesauce. Other types of foods have not been evaluated with Nexium, so it is not known whether they might interfere with the drug’s absorption.
For patients with nasogastric feeding tubes, mix the contents of the Nexium capsule with 50 milliliters (mL) of water and inject it into the tube with a syringe. Specifically, instructions state it should only be administered this way with a catheter-tipped syringe.
You can take Nexium delayed-release granules the same way as Nexium capsules. Mix the granules with water to create a liquid suspension.
The amount of water used to dissolve the granules varies by the dose:
Nexium capsules and granules can be stored safely at room temperature (around 77 degrees F). If traveling, it is OK to expose the drug to temperatures between 59 and 86 degrees F for a short period.
Keep the medicines in a cool, dry drawer or cabinet away from direct sunlight. Store Nexium capsules in their original light-resistant, airtight container. The bathroom is not a good place to keep medications.
If Nexium is delivered via a nasogastric tube, be sure that the drug is fully dissolved before use. To avoid clogging, flush the tube with additional water after the Nexium dose has been delivered.
Nexium and other PPIs are commonly used off-label, meaning they are used to treat other conditions not specified by the FDA.
Off-label uses of esomeprazole include:
See your healthcare provider if your reflux symptoms do not resolve with conservative treatment, such as diet or OTC drugs. Acid reflux can be caused by many things—ranging from indigestion to gastric cancer. Getting a proper diagnosis ensures you receive the right treatment.
You should start to notice an improvement in symptoms two to three days after beginning Nexium, but it can take up to four weeks for it to work properly.
This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
As with all drugs, Nexium may cause side effects. Many of these side effects are mild and will resolve on their own as your body adapts to treatment. On occasion, Nexium can cause serious side effects. However, this usually occurs in people with other medical conditions.
Before starting Nexium, tell your healthcare provider about any medical conditions you have, including liver disease, kidney disease, or mineral and bone disorders like osteoporosis.
Common side effects of Nexium can vary based on your age and may include:
Call your healthcare provider if these symptoms persist or worsen.
Some people taking Nexium have been known to develop acute interstitial nephritis. Acute interstitial nephritis is an inflammatory condition that can impair kidney function and even lead to acute kidney failure. It can occur at any stage of treatment and requires the medication to be stopped immediately. The condition is believed to be caused by a hypersensitive drug reaction.
Nexium may increase the risk of a bacterial infection called Clostridium difficile (C. difficile) in hospitalized patients. C. difficile often spreads through hospitals, causing watery diarrhea, headache, fever, nausea, loss of appetite, and stomach pain. It is unclear why this occurs, but it is thought that PPIs allow C. difficile to thrive by decreasing the stomach acids that help keep the bacteria in check.
Intubated patients often receive PPIs like Nexium to prevent gastric ulcers. Despite their benefits, the drugs may increase the risk of pneumonia. This is because any pathogenic bacteria that form in the gut can potentially move to the lungs.
Severe drug allergies with Nexium, such as hypersensitive reactions and anaphylaxis, are rare.
These include symptoms of anaphylaxis or anaphylactic shock, such as:
Contact your healthcare provider right away if you have serious side effects after using Nexium. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.
PPIs like Nexium can increase the risk of bone fractures, particularly with long-term use in older adults. PPIs are thought to be linked to an increased risk of osteoporosis. However, studies are conflicting on the actual odds of this occurring.
Talk with your healthcare provider about ways to prevent bone mineral loss and fracture, including the use of vitamin D or calcium supplements.
On rare occasions, PPIs like Nexium can cause a severe drop in blood magnesium levels, an event called hypomagnesemia. Hypomagnesemia tends to occur after a year of use but may start as early as three months. Although hypomagnesemia often has no symptoms, it can sometimes cause cramps and spasms, abnormal heart rhythms (arrhythmia), and seizures.
Hypomagnesemia is typically treated with magnesium supplements and immediately discontinuing the PPI.
Nexium may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088)
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
Esomeprazole is broken down by the liver and passed from the body mainly in the stool. Because of this, patients with impaired liver function are less able to break down the drug and need a lower dose to avoid liver toxicity and injury.
If you have severe liver impairment—classified as Child-Pugh Class C—you should take no more than 20 mg of Nexium per day to prevent these potentially serious complications. Your healthcare provider should administer liver function tests (LFTs) routinely to monitor for any signs of hepatotoxicity (liver poisoning).
There is no evidence to suggest that Nexium cannot be used during pregnancy. However, animal studies have reported a potential for fetal defects. No well-controlled studies in humans are available, but there has been no evidence of birth defects in humans. Animal studies suggest that Nexium may cause bone malformation if taken at 34 times the recommended dose.
If you are pregnant or considering getting pregnant, speak with your healthcare provider to fully weigh the treatment benefits and potential risks. The same applies if breastfeeding. Nexium may pass through breast milk in small quantities.
If you miss a dose of Nexium, take it as soon as you remember. If it is almost time for your next dose, skip the initial dose and continue as normal. Never double up doses.
Accidentally taking more than the recommended dose of Nexium (for example, two 40-mg doses in a 24-hour period) probably won’t cause you any harm.
However, a deliberate overdose of up to 2,400 mg—60 times the maximum dose in adults—has been known to cause many of the same symptoms commonly associated with Nexium, but more severely.
Symptoms of a Nexium overdose include:
Treatment of a Nexium overdose is based on the symptoms. There are no antidotes for a PPI overdose, and procedures like hemodialysis cannot clear the drug from the bloodstream.
If you think you or someone else may have overdosed on Nexium (esomeprazole), call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking esomeprazole, call 911 immediately.
It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood, urine, and other laboratory tests may be needed to check for unwanted effects. If your condition does not improve, or if it becomes worse, check with your doctor.
This medicine is sometimes given together with amoxicillin (Amoxil®) and clarithromycin (Biaxin®) to treat ulcers caused by H. pylori infection. Be sure you understand the risks and proper use of any other medicines your doctor prescribes.
Check with your doctor right away if you have a change in frequency of urination or amount of urine, blood in the urine, fever, joint pain, loss of appetite, nausea, skin rash, swelling of the body, feet, or ankles, unusual tiredness or weakness, or unusual weight gain after using this medicine. These could be symptoms of a serious kidney problem called acute tubulointerstitial nephritis.
Taking this medicine for a long time may make it harder for your body to absorb vitamin B12. Tell your doctor if you have concerns about vitamin B12 deficiency.
This medicine may cause diarrhea, and in some cases it can be severe. Do not take any medicine to treat diarrhea without first checking with your doctor. Check with your doctor right away if you have a watery stool that does not go away, stomach pain, and fever with this medicine.
This medicine may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, use high doses, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.
This medicine may cause hypomagnesemia (low magnesium in the blood). This is more likely to occur if you are using this medicine for more than one year, or if you are using it together with digoxin (Lanoxin®) or certain diuretics (water pills). Check with your doctor right away if you have convulsions (seizures), a fast, racing, or uneven heartbeat, muscle spasms (tetany), tremors, or unusual tiredness or weakness.
Cutaneous or systemic lupus erythematosus may occur or gets worse in lupus patients and are taking PPI. Call your doctor right away if you or your child have a joint pain or skin rash on your cheeks or arms that gets worse when exposed in the sun.
This medicine may increase your risk for fundic gland polyps (abnormal tissue growth in the upper part of your stomach). This is more likely if you are using this medicine for more than 1 year. Talk to your doctor if you have concerns.
Do not stop using this medicine without first checking with your doctor.
Make sure any doctor or dentist who treats you knows that you or your child are using this medicine. This medicine may affect the results of certain medical tests.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription (eg, clopidogrel, atazanavir, nelfinavir, Plavix®, Reyataz®, Viracept®) or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
You should not use Nexium if you have a known severe hypersensitivity to any PPI. This includes having experienced allergy-induced bronchospasm, urticaria (hives), angioedema (deep tissue swelling), acute interstitial nephritis, or anaphylaxis.
Nexium has several drug-drug interactions, some of which are more significant than others.
You can avoid some of these interactions by separating the doses by several hours. Others may require a dose adjustment, a drug substitution, or the temporary discontinuation of one of the drugs.
To avoid interactions, always tell your healthcare team about any drugs you take, including prescription, OTC, herbal, nutritional, or recreational drugs.
Nexium is one form of esomeprazole, called esomeprazole magnesium. Another form, called esomeprazole strontium, has a similar mechanism of action but is available by prescription only and is not used in children.
There is also an intravenous (IV) form, called Nexium IV (esomeprazole sodium), that is injected into a vein of adults or children who cannot take the medication by mouth or have a bleeding ulcer caused by endoscopy.
Beyond Nexium, there are five other PPIs approved for use by the FDA:
Like Nexium, Prevacid and Prilosec are both available over the counter. There is also a drug called Zegerid that combines omeprazole with sodium bicarbonate to better relieve heartburn symptoms.
Although all PPIs work in similar ways, Nexium has the longest drug half-life overall. This means that it stays in your system longer than some of the other PPIs. It has also proven to be better than other PPIs at suppressing stomach acid.
On the downside, taking Nexium with food decreases the amount of the drug your body absorbs compared with a drug like Dexilant, which is why you should take Nexium on an empty stomach. Dexilant has fewer side effects but is more costly than any of the other.
Nexium is a proton pump inhibitor (PPI) that blocks the production of stomach acid. This action helps treat or prevent stomach acid-related conditions like gastroesophageal reflux disease (GERD), peptic ulcer, H. pylori infection, and erosive esophagitis.
Nexium works by blocking an enzyme called H+/K+ ATPase, also known as the gastric proton pump. The enzyme, which is found within cells lining the stomach, is responsible for acidifying the gut and activating a digestive enzyme called pepsin. By blocking H+/K+ ATPase, acid production is suppressed, and inflamed or injured tissues have the chance to heal.
Nexium is sometimes used in combination therapy to get rid of H. pylori. The treatment typically consists of a PPI plus two or more antibiotic drugs and occasionally bismuth. The role of the PPI is to suppress stomach acids to reduce the risk of ulcers. At the same time, the antibiotics work to kill the bacteria.
Although Nexium has distinctive benefits (including a longer duration of action), there is little evidence that one PPI is inherently “better” than the other in treating GERD, peptic ulcer disease, or other stomach–acid-related problems.
Although PPIs and H2 receptor blockers like Pepcid (famotidine) both decrease the production of stomach acid, PPIs are considered stronger and faster once in the body for a few days. Even so, H2 blockers have their place in treatment as they can reduce nocturnal acids that contribute to peptic ulcers. They also appear safer to use in intubated patients in intensive care units.
People with GERD, H. pylori, chronic gastritis, and other similar conditions will often describe how debilitating the symptoms can be, affecting not only their health but their general well-being. PPIs like Nexium can go a long way toward improving these symptoms and may, in some cases, even resolve them.
Despite these benefits, PPIs are not intended to be a permanent form of therapy. There are risks associated with long-term use, including bone mineral loss and kidney function impairment (increasing the risk of chronic kidney disease)
This is why medications alone are not the only solution to conditions like GERD.
The following lifestyle strategies can improve your symptoms:
Remain in the care of a gastroenterologist if your condition is persistent, severe, or impacting your quality of life. The healthcare provider can monitor for side effects and adjust the treatment plan when needed to better ensure long-term control of your symptoms.
Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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