1 What is Nexium?

Brand: Nexium, Amneal, Hanmi

Generic: Esomeprazole strontium

Nexium (generic name esomeprazole) is a drug that is used to relieve several stomach-based complications. It acts as a proton pump inhibitor, reducing the production of stomach acid. Nexium is one of the most widely sold drugs in the world. 

Below are some key points you should know about nexium:

  • Nexium acts as a proton pump inhibitor
  • Proton pump inhibitors are one of the most widely sold medications around the globe
  • Major side effects of Nexium include nausea, headache, and flatulence
  • Nexium can increase your risk of hip fractures
  • Proton pump inhibitors inhibit ATPase transporter
  • Nexium acts as a competitive inhibitor of CYP2C19 enzyme
  • Nexium can sometimes prevent breakdown and absorption of some nutrients
  • The major desired effect of nexium is a marked decrease of stomach hydrochloric production
  • Nexium is mainly used to get rid of gastro-esophageal reflux

How Nexium works

It is a proton pump inhibitor, meaning that it substantially reduces the secretion of stomach acid. The major site of action for this drug is the parietal cells located on the wall of the stomach.

Parietal cells are cells that secrete gastric acid, known as hydrochloric acid, and other intrinsic factors such as vitamin B12.

The drug works through inhibition of hydrogen potassium ATPase which is a transporter responsible for acidifying the stomach.

2 What is Nexium for?

Nexium is mainly used to treat the following complications and conditions.

Peptic ulcer

This is a condition where there is a gap in the stomach lining, intestine or the esophagus.


This is also known as indigestion. It is a condition characterized by nausea, heartburn, upper abdominal fullness and upper abdominal pain.

Zollinger-Ellison syndrome

This is a tumor of the pancreas that overstimulates the production of hydrochloric acid in the stomach.

Gastro-esophageal reflux disease (GERD)

This is a chronic disease that is characterized by damaged mucosa lining in the stomach. Mucosa is damaged by hydrochloric acid coming from the stomach into the esophagus. The main symptoms of this condition include heartburn and nausea. Nexium is used to reduce stomach acid and prevent esophagus damage.

Nexium is also used by patients who are using nonsteroidal anti-inflammatory drugs (NSAIDS). This is due to the ability of NSAIDS to produce excess stomach acid and ulcers. Nexium is used to prevent formation of ulcers in these patients.

There also exist a number of proton pump inhibitors apart from Nexium. They include Prevacid, Zegerid, Protonix, and Aciphex. These drugs are used for milder diseases where Nexium would produce multiple side effects compared to these drugs. However, Nexium is considered by many to be the most effective when used to treat severe stomach conditions.

3 What to know before using

If you are about to start Nexium, speak with your doctor about what you need to know. Inform your healthcare provider for any allergic reactions to these drugs or any other drugs, foods, dyes, preservatives, or animals.

Carefully read the label of non-prescription drugs for any possible allergic reaction or contraindications. Studies in children have not reported any pediatric-specific problems that would limit the utility of esomeprazole injection. Safety and efficacy of this drug in children younger than 1 month of age have not been established.

Studies in the elderly have not reported any geriatric-specific problems that would limit the utility of esomeprazole injection. Adverse effects have been reported in animal studies but studies in pregnant women or animals are still inadequate. Infant risk is still undetermined when taking this drug during breastfeeding.

Discuss with your healthcare professional about the risks and benefits of this drug before breastfeeding. Drugs should not be taken together to prevent any interactions but in necessary cases inquire your healthcare provider regarding the adjustments in dosage or any other necessary precautions to prevent any unwanted side effects.

Inform your healthcare professional if you are taking any other drugs such as:

  • Rilpivirine
  • Atazanavir
  • Bosutinib
  • Cilostazol
  • Citalopram
  • Clopidogrel
  • Dabrafenib
  • Dasatinib
  • Erlotinib
  • Eslicarbazepine
  • Acetate
  • Gefitinib
  • Ketoconazole
  • Ledipasvir
  • Methotrexate
  • Mycophenolate
  • Mofetil
  • Nelfinavir
  • Nilotinib
  • Pazopanib
  • Posaconazole
  • Saquinavir
  • Tacrolimus
  • Thiopental
  • Vismodegib
  • Cranberry
  • Levothyroxine
  • Risedronate
  • Warfarin

Intake of specific food or using alcohol or tobacco with this drug is associated with an increased risk of certain side effects. Your healthcare professional can give you special instructions about the use of food, alcohol, or tobacco.

Inform your healthcare provider for any other medical problems such as diarrhea, hypomagnesemia, osteoporosis, or liver disease.

Interactions of Nexium with other drugs

Before starting Nexium, you should first tell your doctor if you have any allergies and also disclose all other medications you are taking. These medications should include recreational or illegal drugs, over-the-counter drugs, prescribed drugs, vitamins, and herbal or dietary supplements.

These medications could potentially affect the way Nexium works by either reacting or affecting absorption and bioavailability.

For example, Nexium should not be taken together with diazepam, as it increases the concentration of diazepam in the blood, causing other side effects such as confusion and convulsions.

Since nexium decreases the amount of gastric acid, it can also decrease the absorption of antifungal drugs such as ketoconazole and then increase the absorption of drugs such as digoxin, causing toxicity.

Nexium can also decrease blood levels of nelfinavir and atazanavir and increase levels of saquinavir. You should therefore avoid using these drugs together with Nexium.

You should also avoid using the following medications with Nexium:

  • Iron supplements
  • Blood thinners such as aspirin
  • Some antifungals
  • Cilostazol
  • Some HIV medications

4 How should I take Nexium?

You should take Nexium exactly as your doctor or pharmacist prescribed. You should not take smaller or larger amounts or for a longer period than usual. You should always follow all directions on the prescription label.

Here are some things you should know about how to take Nexium:

  • Take each dose as prescribed and with one glass of pure water
  • Take Nexium for 4 to 8 weeks only. In case you need a second course of treatment, your doctor may recommend another dose for complete healing
  • You should take Nexium at least one hour before main meals
  • You should not crush, break, chew, or open delayed-release capsules. Swallow it whole as intended. Breaking or chewing means the drug will be released all at once, making it less effective.
  • In case you have problems with swallowing, open the capsule and then sprinkle the drug in a spoonful of applesauce or pudding to make it easier to swallow. After that, swallow the drug immediately without chewing. Do not save anything for later use after you open the capsule.

Nexium can also be administered through nasogastric feeding tube. In this way, you should open the capsule and then sprinkle the drug into a 60ml syringe. Mix the drug with 50ml of water. Place the plunger into the syringe and then shake well to mix. Make sure no drug granules stick on the tip of the syringe. Attach the syringe to a nasogastric tube and the push the plunger to deliver the drug and empty the tube. Lastly, flush the feeding tube with water to wash the remaining nexium.

Also keep in mind:

  • Your symptoms may improve before the medicine is over. Make sure you take all Nexium for the full prescribed time
  • You should call your doctor in case your symptoms get worse or do not improve even after using Nexium
  • Since Nexium can cause unusual results with some clinical tests, keep your doctor updated with all medicines you are taking

Nexium dosage

The average prescription depending on the strength of dosage is listed below. However, your doctor may prescribe a different dose for you. Always follow your doctor's instructions precisely.

  • Children aged 1-11 years: 10-20mg daily
  • Adults (above 12 years): 20-40mg one time daily for 2 months
  • Treatment of Zollinger-Ellison syndrome: 40mg 2 times daily
  • Treatment for H. pylori: 40 mg one time daily along with antibiotics such as Amoxicot, Amoxil, Biomax and clarithromycin for 10 days

Over-the-counter Nexium

Nexium is now available over-the-counter in 20mg capsules. It is recommended for patients not to use this medication for more than 2 weeks in a row unless directed by a physician.

OTC Nexium with yellow stripes should be taken at least one hour before any meal. You are required to swallow the whole capsule without chewing or crushing. Patients who have problems with swallowing should open the capsule and then mix with applesauce or as directed by the physician.

Missed dose of nexium

In case you miss a dose of Nexium, take it soon as you remember. Avoid “doubling up” to compensate for the missed dose. Taking double the dose can cause overreaction, with serious side effects.

Overdose of Nexium

If you happen to overdose on Nexium, you should immediately call poison control or your doctor for immediate attention.

Overdose of Nexium can result in the following complications:

  • Nausea
  • Blurred or poor vision
  • Confusion
  • Fast heartbeat
  • Sweating
  • Convulsion
  • Dry mouth
  • Excessive drowsiness

5 Precautions to take

Before using Nexium, there are some precautions you must take. Regular visits should be made to your healthcare provider to track your progress and to monitor the effectiveness of the drug. Unwanted effects can be screened using blood tests.

Check with your doctor if your condition does not improve, or if it becomes worse. Seek medical attention immediately if you experience symptoms of anaphylaxis such as rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this drug.

Speak with your doctor immediately if you exhibit symptoms of atrophic gastritis such as burning feeling in the chest or stomach, indigestion, stomach upset, or tenderness in the stomach area.

Speak with your doctor immediately if you have symptoms of acute interstitial nephritis such as fever, joint pain, skin rash, swelling of the body, feet, or ankles, or unusual weight gain after receiving this drug.

Speak with your doctor immediately if you have watery diarrhea that does not go away, stomach pain, and a fever while receiving this drug.

For patients 50 years of age, receiving high doses or prolonged doses of this drug may increase the risk of fractures of the hip, wrist, and spine.

Prolonged use of this drug for more than 1 year or using it with digoxin or diuretics may cause hypomagnesemia, which manifests as convulsions, fast, racing, or uneven heartbeat, muscle spasms, tremors, or unusual tiredness or weakness.

Always let any of your doctors or specialists know that you are taking this drug as it may affect the results of certain medical tests. Consult with your healthcare professional before taking any other prescription or non-prescription drugs and herbal or vitamin supplements.

Nexium warnings

People with history or a family line of liver disease should first inform their doctor before starting Nexium.

You should let your doctor know if you have any of the following complications:

You should also consider the following precautions before taking Nexium:

  • Before using Nexium, let your doctor know your medical history, mainly if you have a heart or liver disease
  • Before taking the drug, you should tell your doctor if you are allergic to the drug's ingredients or other similar drugs such as omeprazole and lansomeprazole. Nexium may contain inactive ingredients that can cause an allergic reaction.
  • Before taking over-the-counter Nexium, you should first consult with your doctor if you have signs such as stomach pain, heartburn for about 3 months, pain when swallowing, frequent chest pain, black stools, and frequent wheezing.
  • Some signs and symptoms may suggest a more serious condition. You should first seek medical advice before taking Nexium if you have: jaw/arm/shoulder pain, sweating, lightheadedness, unexpected weight loss, dizziness, and breath shortness.
  • Nexium may increase your risk of developing bone fractures, especially when used for a long time, and in higher doses. You should therefore talk to your doctor about how you can prevent bone fractures. This might include use of calcium and vitamin D supplements.
  • When pregnant, you should use Nexium as directed by your doctor, and monitor your condition frequently. You should also discuss its benefits and risks with your doctor before usage.
  • Consult with your doctor before breast-feeding while taking Nexium.

6 Nexium side effects

Just like any other type of medications, you are likely to experience some side effects when using Nexium. Some side effects are common and less severe, some are rare and more severe, and others are long term side effects. 

Common but mild side effects

Rare but severe side effects

  • Acne
  • Severe allergic conditions
  • Fever/chills
  • Change in heart rhythm
  • Back and chest pain
  • Dark colored urine
  • Yellow coloration of the skin and eyes (Jaundice)
  • Severe pain in the stomach
  • Extreme tiredness and muscle weakness (fatigue)
  • Chronic sore throat
  • Abnormal bruising and bleeding
  • Prickly and tingling experience (paresthesia)
  • Cough
  • Mental and mood changes
  • Seizures
  • Muscle twitching
  • Skin rash
  • Sores and white spots on the lips or in the mouth
  • Red and irritated eyes

Long term side effects

When you use Nexium for a long time, you are at a higher risk of facing some long term side effects.

They include the following.

Hip fracture

Nexium can alter calcium absorption which can cause weakening of bones. Long term usage of Nexium may also affect bone recycling by inhabitation of proton pumps which are used during bone production and remodeling.

Kidney damage

According to recent studies, prolonged usage of Nexium has been found to correlate with chronic kidney disease.

Nutritional deficit

Some scientific studies suggest that, because stomach acid is used in food breakdown, nutritional deficit may occur if production of the acid is inhibited. Some recent studies have also shown interference with the absorption of iron, vitamin B12, and calcium. The mechanism in which these factors interact is not well understood.

Clostridium defficile-related diarrhea

Some scientific evidence shows that usage of Nexium and other proton pump inhibitors can cause an increase in the rate of Clostridium difficile-based diarrhea.


Benign polyps on the fundic glands can develop as a result of long term usage of Nexium and other proton pump inhibitors. However, Nexium is not associated with gastric cancer.


According to some scientific studies, there is about 30% probability of developing hospital-acquired pneumonia for patients who are prescribed esomeprazole.

Systemic lupus erythematosus

This is a chronic inflammatory disease that can usually occur after long term use of Nexium or other proton pump inhibitors. This condition occurs when the body attacks its own cells.

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