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Nexium 24HR Side Effects

Generic Name: esomeprazole

Note: This page contains side effects data for the generic drug esomeprazole. It is possible that some of the dosage forms included below may not apply to the brand name Nexium 24HR.

For the Consumer

Applies to esomeprazole: oral capsule delayed release, oral packet, oral tablet delayed release

As well as its needed effects, esomeprazole (the active ingredient contained in Nexium 24HR) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking esomeprazole, check with your doctor immediately:

Incidence not known:
  • Blistering, peeling, or loosening of the skin
  • bloating
  • chills
  • constipation
  • cough
  • darkened urine
  • difficulty with swallowing
  • dizziness
  • drowsiness
  • fast heartbeat
  • fever
  • indigestion
  • joint or muscle pain
  • loss of appetite
  • mood or mental changes
  • muscle spasms (tetany) or twitching
  • nausea
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • seizures
  • skin rash, hives, itching
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • tightness in the chest
  • trembling
  • unusual tiredness or weakness
  • vomiting
  • yellow eyes or skin

Minor Side Effects

Some esomeprazole side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Bad, unusual, or unpleasant (after) taste
  • change in taste
Less common:
  • Sleepiness or unusual drowsiness
  • Acne
  • back pain
Incidence not known:
  • Agitation
  • dry mouth
  • excess air or gas in the stomach or intestines
  • full feeling
  • hair loss or thinning of the hair
  • muscular weakness
  • passing gas
  • seeing, hearing, or feeling things that are not there
  • swelling of the breasts or breast soreness in both females and males
  • swelling or inflammation of the mouth
  • swollen joints

For Healthcare Professionals

Applies to esomeprazole: intravenous powder for injection, oral delayed release capsule, oral powder for reconstitution delayed release


The most frequently occurring adverse reactions were headache and diarrhea.
The most frequently reported adverse reactions for patients who received triple therapy for 10 days were diarrhea, taste perversion, and abdominal pain.[Ref]


Common (1% to 10%): Diarrhea, headache, abdominal pain, nausea, vomiting, regurgitation
Uncommon (0.1% to 1%): Abdomen enlargement, bowel irregularity, constipation aggravated, dyspepsia, dysphagia, dysplasia GI, epigastric pain, eructation, esophageal disorder, frequent stools, gastroenteritis, GI hemorrhage, GI symptoms not otherwise specified, hiccup, melena, mouth disorder, pharynx disorder, rectal disorder, serum gastrin increased, tongue disorder, tongue edema, ulcerative stomatitis, vomiting
Frequency not reported: Duodenitis, esophagitis, esophageal stricture, esophageal ulceration, esophageal varices, gastric ulcer, gastritis, hernia, benign polyps or nodules, Barrett's esophagus, and mucosal discoloration
Postmarketing reports: Pancreatitis; stomatitis; microscopic colitis, GI candidiasis, Clostridium difficile associated diarrhea[Ref]


Common (1% to 10%): Increased liver enzymes
Uncommon (0.1% to 1%): Bilirubinemia, hepatic function abnormal, SGOT increased, SGPT increased
Postmarketing reports: Hepatic failure, hepatitis with or without jaundice[Ref]


Common (1% to 10%): Tachypnea (in pediatrics)
Uncommon (0.1% to 1%): Asthma aggravated, coughing, dyspnea, larynx edema, pharyngitis, rhinitis, sinusitis, chest pain, substernal chest pain
Postmarketing reports: Bronchospasm[Ref]


Uncommon (0.1% to 1%): Flushing, hypertension, tachycardia
Frequency not reported: Irregular heartbeat[Ref]


Uncommon (0.1% to 1%): Acne, angioedema, dermatitis, pruritus, pruritus ani, rash, rash erythematous, rash maculo-papular, skin inflammation, sweating increased, urticaria
Frequency not reported: Subacute cutaneous lupus erythematosus
Postmarketing reports: Alopecia, erythema multiforme, hyperhidrosis, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis (some fatal)[Ref]


Uncommon (0.1% to 1%): Goiter[Ref]


Uncommon (0.1% to 1%): Abnormal urine, albuminuria, dysuria, hematuria, micturition frequency, polyuria, impotence, vaginitis, cystitis, fungal infection, moniliasis, genital moniliasis, dysmenorrhea, menstrual disorder
Postmarketing reports: Gynecomastia[Ref]


Uncommon (0.1% to 1%): Anemia, anemia hypochromic, cervical lymphadenopathy, epistaxis, leukocytosis, leukopenia, thrombocytopenia
Postmarketing reports: Agranulocytosis, pancytopenia[Ref]


Uncommon (0.1% to 1%): Allergic reaction
Postmarketing reports: Anaphylactic reaction/shock[Ref]


Uncommon (0.1% to 1%): Glycosuria, hyperuricemia, hyponatremia, increased alkaline
phosphatase, thirst, vitamin B12 deficiency, weight increase, weight decrease, appetite increased, anorexia
Postmarketing reports: Hypomagnesemia, with or without hypocalcemia and/or hypokalemia[Ref]


Uncommon (0.1% to 1%): Arthralgia, arthritis aggravated, arthropathy, cramps, fibromyalgia syndrome, hernia, polymyalgia rheumatic, back pain, fracture of the hip, wrist or spine
Postmarketing reports: Muscular weakness, myalgia, bone fracture[Ref]

An increased risk of hip fracture has been reported in a cohort study. The risk was significantly increased among patients prescribed long-term high PPIs.[Ref]

Nervous system

Uncommon (0.1% to 1%):Dizziness, hypertonia, nervousness, hypoesthesia, migraine, migraine aggravated, paresthesia, somnolence, tremor, visual field defect, parosmia, taste loss, taste perversion
Postmarketing reports: Hepatic encephalopathy, taste disturbance[Ref]


Uncommon (0.1% to 1%): Conjunctivitis, abnormal vision
Postmarketing reports: Blurred vision[Ref]


Uncommon (0.1% to 1%): Earache, tinnitus, facial edema, peripheral edema, fatigue, fever, flu-like disorder, generalized edema, leg edema, malaise, pain, rigors, fatigue, asthenia, vertigo, otitis media[Ref]


Uncommon (0.1% to 1%): Depression aggravated, apathy, confusion, insomnia, sleep disorder
Postmarketing reports: Aggression, agitation, depression, hallucination[Ref]


Very rare (less than 0.01%): Interstitial nephritis concomitantly with renal failure
Postmarketing reports: Interstitial nephritis[Ref]


1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. "Product Information. Esomeprazole Strontium (esomeprazole)." Amneal Pharmaceuticals, Glasgow, KY.

3. Cerner Multum, Inc. "Australian Product Information." O 0

4. "Product Information. Nexium (esomeprazole)" Astra-Zeneca Pharmaceuticals, Wilmington, DE.

5. "Product Information. NexIUM I.V. (esomeprazole)." Astra-Zeneca Pharmaceuticals, Wilmington, DE.

6. Mennecier D, Ceppa F, Gidenne S, Vergeau B "Hyponatremia with consciousness disturbance associated with esomeprazole." Ann Pharmacother 39 (2005): 774-5

7. Yang YX, Lewis JD, Epstein S, Metz DC "Long-term proton pump inhibitor therapy and risk of hip fracture." JAMA 296 (2006): 2947-53

8. Rosenshein B, Flockhart DA, Ho H "Induction of Testosterone Metabolism by Esomeprazole in a CYP2C19*2 Heterozygote." Am J Med Sci 327 (2004): 289-293

9. Geevasinga N, Kairaitis L, Rangan GK, Coleman PL "Acute interstitial nephritis secondary to esomeprazole." Med J Aust 182 (2005): 235-6

It is possible that some side effects of Nexium 24HR may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.