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Nexium: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on April 4, 2023.

1. How it works

  • Nexium is a brand (trade) name for esomeprazole, an acid-suppressing agent that may be used to treat conditions associated with excessive stomach acid production, such as gastroesophageal reflux (GERD) and stomach ulcers.
  • Nexium (esomeprazole) reduces the production of stomach acid by irreversibly blocking the actions of an enzyme responsible for acid production, called H+/K+ ATPase (also known as the gastric proton pump). The proton pump is located in the parietal cells of the stomach wall. Both baseline gastric acid secretion and stimulated gastric acid secretion are affected.
  • This allows damaged tissue in the esophagus, stomach, and duodenum to heal.
  • Nexium belongs to the class of medicines known as proton pump inhibitors (PPIs).

2. Upsides

  • Effective at healing erosive esophagitis (a severe inflammation of the lining of the esophagus- the tube that carries food from the mouth to the stomach), and relieving symptoms of gastroesophageal reflux disease (also known as heartburn).
  • May be taken at the same time as NSAIDs to reduce the risk of NSAID-associated gastric ulcers in those people on continuous NSAID therapy.
  • May be used in conjunction with amoxicillin and clarithromycin in people with Helicobacter pylori infection and duodenal ulcer disease.
  • Usually given for 4 to 8 weeks only, although a second course may be given for those who need additional healing time. May be used long-term in people with certain conditions.
  • Useful in the treatment of hypersecretory conditions such as Zollinger-Ellison syndrome.
  • The dosage of Nexium does not need adjusting in people with kidney disease.
  • Available orally as a delayed-release capsule and delayed-release granules.
  • Also available as an IV preparation for the short-term treatment of GERD with erosive esophagitis in adults and pediatric patients aged 1 month to 17 years when oral Nexium is not possible or appropriate.
  • Nexium is available as a generic under the name esomeprazole.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, diarrhea or constipation, flatulence, nausea, abdominal pain, dry mouth, or drowsiness.
  • May also interfere with some laboratory tests.
  • In some people, Nexium may cause drowsiness and affect your ability to drive. Do not drive or operate machinery until you know how Nexium affects you.
  • May mask the symptoms of gastric malignancy. Further investigations should be carried out in people who have a suboptimal response to Nexium or an early symptomatic relapse once therapy has been discontinued. Endoscopy should be performed on seniors before the administration of Nexium.
  • A dosage of 20mg Nexium should not be exceeded in people with severe liver disease.
  • May not be suitable for everybody including those with significant liver disease, osteoporosis, osteopenia (low bone mineral density), or low levels of magnesium in their blood.
  • PPIs (including Nexium) have been associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine. The risk is higher in those who take high dosages for prolonged periods or who are aged 50 and older.
  • Has also been associated with other conditions such as lupus erythematosus, fundic gland polyps, and magnesium deficiency.
  • Prolonged treatment (greater than 24-36 months) may cause vitamin B12 deficiency. The risk is greater in women, people aged less than 30, and with higher dosages.
  • Administration of PPIs (such as Nexium), has been associated with acute interstitial nephritis, a severe inflammation of the kidneys. May occur on medication initiation or at any point of therapy. Symptoms include fever, rash, and generalized aches and pains. Discontinue Nexium and seek medical advice.
  • Has been associated with a greater risk of Clostridium difficile-associated diarrhea. See your doctor if you develop diarrhea that does not improve.
  • Nexium should not be given with clopidogrel because it can reduce the activity of clopidogrel. Nexium may also interact with several other medications, particularly those that induce the CYP2C19 or CYP3A4 hepatic enzymes such as St. John's Wort or rifampin. Nexium can also interact with methotrexate or reduce the absorption of drugs that are dependent on a certain gastric pH for their absorption.
  • Usually, only up to 8 weeks of treatment is recommended. Controlled studies have not investigated use beyond 6 months; however, Nexium has been used long-term for the treatment of hypersecretory conditions such as Zollinger-Ellison syndrome.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Nexium effectively heals inflamed tissue in the gastrointestinal tract and relieves symptoms of heartburn. Nexium is available orally and as an IV preparation that may be used in adults and children aged 1 month to 17 years as an alternative to oral therapy.

5. Tips

  • Take each dose at least one hour before food and with a full glass of water.
  • Do not crush or chew delayed-release capsules. Swallow whole or carefully open the capsule and sprinkle the contents onto pudding or a spoonful of applesauce. Swallow right away without chewing.
  • Take exactly as directed by your doctor. Talk to your doctor if your symptoms appear to be getting worse.
  • Heartburn often causes similar symptoms to those of a heart attack - seek emergency medical attention if you have chest pain or a heavy feeling in your chest, or pain that spreads up your neck or down your arm.
  • See your doctor if you develop any unexplained fever, rash (particularly one that gets worse after you have been in the sun), new or worsening joint pain, persistent diarrhea, or generalized aches and pains.
  • Also, see your doctor if you develop any muscle cramps, spasms, or weakness; jitteriness; abnormal heartbeat; dizziness; seizures; or any other symptoms of concern.
  • Do not take Nexium if you are allergic to other proton pump inhibitors.
  • May sometimes cause unusual results with medical tests.

6. Response and effectiveness

  • Peak concentrations of Nexium occur within one to four hours of an oral dose. However, it may take several days of dosing before the maximum effect of Nexium is reached. One dose of Nexium will provide an effect for up to 24 hours.

7. Interactions

Medicines that interact with Nexium may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Nexium. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Nexium include:

  • antidepressants, such as clomipramine, escitalopram, imipramine, St John's wort, or trimipramine
  • antifungals, such as fluconazole, itraconazole, ketoconazole, or voriconazole
  • attention deficit hyperactivity disorder (ADHD) medications (eg, dextroamphetamine, dexmethylphenidate, lisdexamfetamine, methylphenidate)
  • bisphosphonates, such as alendronate, etidronate, or risedronate
  • cancer treatments, such as bosutinib, dabrafenib, dasatinib, erlotinib, or pazopanib
  • epilepsy medications, such as carbamazepine, fosphenytoin, phenobarbital, or phenytoin
  • hepatitis medications, such as boceprevir, ledipasvir, sofosbuvir, and telaprevir
  • HIV medications (eg, atazanavir, indinavir, ritonavir, or saquinavir)
  • iron supplements, such as ferrous fumarate, ferrous gluconate, or ferrous sulfate
  • multivitamins
  • nitrates (eg, amyl nitrate, isosorbide dinitrate, isosorbide mononitrate, or nitroglycerin)
  • proton pump inhibitors (eg, lansoprazole, omeprazole, pantoprazole)
  • quinidine
  • statins, such as atorvastatin, lovastatin, or simvastatin
  • warfarin
  • others, such as cilostazol, cisapride, clopidogrel, dabigatran, delavirdine, diazepam, digoxin, enzalutamide, mesalamine, methotrexate, moclobemide, mycophenolate mofetil, rifampin, or tacrolimus.

Note that this list is not all-inclusive and includes only common medications that may interact with Nexium. You should refer to the prescribing information for Nexium for a complete list of interactions.


Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Nexium only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2023 Revision date: April 4, 2023.