Highlights
- If you have persistent heartburn, your doctor may prescribe esomeprazole (Nexium).
- This medication reduces stomach acid production by blocking specific enzymes in the stomach lining.
- Some of esomeprazole’s long-term side effects can be severe.
- There are 21 major drug interactions esomeprazole users should be aware of in addition to minor and moderate interactions.
If you have heartburn, and it keeps returning after the effects of your antacids wear off, your doctor may prescribe esomeprazole (Nexium). Esomeprazole interferes with stomach acid production. It doesn’t neutralize existing acid; instead, it causes the body to produce less of this essential digestive enzyme.
What Is Esomeprazole and What Is It Used For?
Esomeprazole belongs to a class of medications called proton pump inhibitors, drugs that interfere with the biochemistry of stomach acid production.
FDA-Approved Uses
Esomeprazole is used to treat a range of digestive problems caused by excess stomach acid, including:
- Gastroesophageal reflux disease (GERD). This medication helps relieve symptoms like heartburn, acid regurgitation, and irritation of the esophagus caused by stomach acid.
- Peptic ulcers. Esomeprazole is used in combination with antibiotics to treat internal ulcers, also called peptic ulcers, caused by Helicobacter pylori (H. pylori) infection.
- Zollinger-Ellison syndrome. This medication is also prescribed for rare conditions like Zollinger-Ellison syndrome, where the stomach produces excessive amounts of acid.
Esomeprazole is not an emergency solution for dealing with heartburn. It’s a longer-term treatment option to prevent chronic problems and help already-damaged areas of the digestive tract to heal.
Off-Label Uses of Esomeprazole
Doctors sometimes prescribe esomeprazole for off-label uses, meaning that treatment of these conditions has not been formally approved by the FDA.
These off-label conditions include:
- Stress ulcer prevention. In hospital settings, esomeprazole may be used to prevent stress ulcers in critically ill patients.
- Nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers. It may be used to prevent ulcers in people who have been taking NSAIDs for a long time.
- Functional dyspepsia. Some doctors prescribe esomeprazole for functional dyspepsia, a condition characterized by chronic discomfort in the upper abdomen that is not linked to any specific disease.
- Eosinophilic esophagitis. Esomeprazole may be used to treat eosinophilic esophagitis, an allergic inflammatory condition of the esophagus.
- Laryngopharyngeal reflux: It may also be used to treat symptoms of laryngopharyngeal reflux, where stomach acid flows back into the larynx and pharynx.
- Gastritis. Esomeprazole is sometimes used to manage symptoms of gastritis, an inflammation of the stomach lining that can cause discomfort, indigestion, and ulcers.
- Gastroparesis: Though not a standard treatment, this medication may be used to manage symptoms of gastroparesis, a condition where the stomach empties too slowly.
The History of Esomeprazole
Swedish researchers developed esomeprazole by mirroring the chemical structure of omeprazole.
Astra AB’s research and development specialists discovered omeprazole in the late 1970s. Authorities approved the stomach-acid-reducing drug in 1989, and researchers concluded that esomeprazole was a better proton pump inhibitor than omeprazole.
Following clinical trials, esomeprazole received approval from the FDA in 2001. AstraZeneca marketed the drug under the brand name Nexium. Nexium’s patent in the U.S. expired in May 2014, allowing pharmaceutical companies to make generic versions of the drug.
Nexium’s popularity resulted in overprescription and widespread long-term use. The long-term side effects of the drug prompted lawsuits that created controversy around Nexium. Some medical professionals argue that its long-term side effects may not justify its use. (See What are the Potential Side Effects of Esomeprazole below.)
However, Nexium continues to be the most widely used esomeprazole brand. You may also find this medication under other brand names like Nexpro, Esomezol, and Axagon.
One esomeprazole preparation is available over the counter as Nexium 24HR, marketed as a remedy for frequent heartburn.
How Does Esomeprazole Work?
As a proton pump inhibitor, esomeprazole interferes with stomach acid production by blocking the transport of hydrogen ions to the stomach. It achieves its effects through the parietal cells.
The stomach needs hydrogen ions (protons) to create hydrochloric acid in the stomach. The acid breaks down food and is a key component of the digestive process.
When you ingest an esomeprazole capsule, the active substance reaches the parietal cells in the inner lining of your stomach. It attaches itself to the proton pump enzymes, deactivating them. With only some proton pumps working, the quantity of acid in the stomach drops. With less acid, the pH of the stomach drops as well.
Esomeprazole binds to proton pump enzymes irreversibly. This means its effects are lasting.
What Formulas Are Available for Esomeprazole?
Esomeprazole is mainly a prescription medication, though Nexium 24HR is available over the counter as a remedy for frequent heartburn.
Prescription esomeprazole is available in three forms: esomeprazole magnesium, esomeprazole strontium, and esomeprazole sodium.
- Esomeprazole magnesium. This is the most commonly used form of esomeprazole and is widely available. It’s the form used in Nexium.
- Esomeprazole strontium. This formulation is less commonly used and is generally considered to be interchangeable with esomeprazole magnesium for most indications. However, it has a longer duration of action, which may affect dosing schedules.
- Esomeprazole sodium. This is only available as an intravenous solution and must be administered in a hospital setting.
Esomeprazole is available in several formulations:
- Tablet. Nexium is available only as tablets.
- Capsule. Esomeprazole magnesium and esomeprazole strontium are available in capsule forms. These capsules release their contents only in the acidic section of the digestive tract. Capsules are also used for people who receive continuous enteral nutrition (tube feedings).
- Sprinkle capsule. This medication is available in a delayed-release sprinkle capsule form, commonly known as “omeprazole sprinkle capsules,” or Zegerid OTC.
- Liquid. Patients who can’t swallow tablets or capsules can get esomeprazole magnesium in liquid suspension form.
- Intravenous. As discussed above, only esomeprazole sodium is available in intravenous form. Only a qualified healthcare provider can administer the drug in this form.
Esomeprazole Dosage and Administration
Doctors use esomeprazole to treat many gastrointestinal conditions. They know how to set the dosage. Regardless of the circumstances, never set your own dose or take esomeprazole and other proton pump inhibitors without a prescription.
Adult Dosage for GERD
GERD treatment with esomeprazole is generally a four-week course. If your GERD persists after a four-week treatment, your doctor may decide to repeat the therapy.
For GERD, doctors usually prescribe 20 milligrams of esomeprazole magnesium per day, orally. Some doctors may prescribe 24.65 milligrams of esomeprazole strontium instead.
If erosive esophagitis accompanies GERD, you may receive 20 to 40 milligrams of esomeprazole sodium in intravenous injection form to facilitate healing.
Adult Dosage for Erosive Esophagitis
If you suffer from this condition, your doctor may prescribe 20 to 40 milligrams of esomeprazole magnesium or 24.65 to 49.3 milligrams of esomeprazole strontium per day, orally.
After the initial therapy lasting four to eight weeks, erosive esophagitis patients may go on a maintenance dose of 20 milligrams of esomeprazole magnesium or 24.65 milligrams of esomeprazole strontium per day, orally.
Adult Dosage for H. pylori
Hpylori therapy is a complex treatment, and esomeprazole is just one of its components. To defeat the infection in adults, doctors will generally prescribe 40 milligrams of esomeprazole magnesium in combination with clarithromycin and amoxicillin. The duration of the therapy is generally ten days.
Sometimes, instead of 40 milligrams of esomeprazole magnesium, doctors may prescribe 49.3 milligrams of esomeprazole strontium once a day orally, also for ten days.
Adult Dose for Gastric Ulcer Resulting From NSAIDs
Long-term use of NSAIDs can cause the development of ulcers. Doctors will typically prescribe 20 to 40 milligrams of oral esomeprazole magnesium per day to treat them. Alternatively, they may give patients 24.65 to 49.3 milligrams of esomeprazole strontium per day.
Gastric ulcer therapy with esomeprazole typically lasts for six months.
Adult Dose for Zollinger-Ellison Syndrome
The usual dose for adults suffering from this condition is 20 to 40 milligrams of esomeprazole magnesium per day or 24.65 to 49.3 milligrams of esomeprazole strontium per day.
However, higher doses aren’t uncommon. Some doctors may prescribe doses of 240 milligrams per day. The management of this condition requires long-term treatment, and your doctor will set and adjust your dosage according to your personal medical history.
Adult Dose for Pathological Hypersecretory Conditions
If your stomach produces too much acid due to an underlying condition, esomeprazole can help. For this condition, doctors usually prescribe 40 milligrams of esomeprazole magnesium twice a day. They may alternatively prescribe 49.3 milligrams of esomeprazole strontium twice a day.
Doctors may always adjust the dosage based on your health condition and specific circumstances.
Adult Dose for Duodenal Ulcer and Gastric Ulcer
The duodenum is the part of the digestive system between the stomach and the small intestine. Like the stomach, it can develop sores due to excess acid. Doctors can use esomeprazole to treat this condition.
Usually, the solution is esomeprazole sodium, administered through IV infusion. The typical starting dose is 80 milligrams administered over 30 minutes. For maintenance, doctors may administer 8 milligrams per hour for 72 hours. Only healthcare professionals can administer this medication, typically in a hospital setting.
Following IV therapy, doctors usually prescribe an oral medication-based treatment.
Children’s Dose for GERD
Children up to 11 years old generally receive 10 milligrams of esomeprazole magnesium once a day. The typical duration of a therapy is eight weeks.
Children between 11 and 17 may receive 20 milligrams of oral esomeprazole magnesium per day.
Esomeprazole sodium IV infusion therapy can also be used for children, but doctors only use it as a short-term solution for GERD.
Children’s Dose for Erosive Esophagitis
For toddlers less than one year old, doctors may prescribe 2.5 to 10 milligrams of oral esomeprazole magnesium per day, depending on body weight. This therapy may last up to six weeks.
For children between ages 1 and 11, the usual dose for this condition is 10 to 20 milligrams of oral esomeprazole magnesium per day, depending on body weight.
The therapy may last from four to eight weeks. Doctors don’t yet know how children react to higher doses of esomeprazole.
How Should I Take Esomeprazole?
The following guidelines are important to follow, no matter which form of esomeprazole you’re taking.
- Take with food and at the same time every day. Food may interfere with the absorption of esomeprazole. When esomeprazole is given to patients receiving tube feedings, the feeding should be interrupted for at least one hour before and one hour after the dose of esomeprazole. This will make it easier for your body to absorb the medication.
- Take only as directed. Always take esomeprazole as prescribed by your doctor. These are potent drugs, and patients should not take any liberties with them. Your doctor knows exactly how much you need and how much of the drug your body can handle.
- Don’t extend treatment on your own. Once you complete your treatment, don’t begin a second round. If you fail to improve or your symptoms get worse, contact your doctor.
- Never chew film-coated tablets or delayed-release capsules. The coating and the capsule play important roles in these medications — they ensure the active substance is released only in the targeted section of the digestive tract.
- Don’t discontinue the medication unless your doctor tells you to. Esomeprazole may improve your symptoms quickly. Continue taking the medication even if you feel well.
- If you’re taking an antibiotic, complete the full course. Doctors often prescribe an antibiotic along with esomeprazole for conditions like H. pylori. Always complete the full course of the treatment your doctor prescribes.
- Be sure your providers know you’re taking esomeprazole. Be aware that esomeprazole can affect some medical test results, so your doctors need to know that you’re taking it.
What Precautions Should I Take With Esomeprazole?
- Allergy information: Inform your doctor and pharmacist about any allergies you have to esomeprazole or related medications. Request a list of ingredients in esomeprazole capsules or powder from your pharmacist.
- Medication interactions: Discuss all medications you’re currently taking or plan to take with your doctor and pharmacist before starting esomeprazole. Consult them before making any changes to your medication regimen.
- Additional supplements: Share with your healthcare providers what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Your medication doses may need adjustment.
- Nonprescription interactions: Certain nonprescription or herbal products like iron supplements and St. John’s wort may interact with esomeprazole. Consult your healthcare provider before starting these medications.
- Nonprescription usage: If you’re considering nonprescription esomeprazole, inform your doctor about any long-term heartburn symptoms or other concerning symptoms like chest pain, unexplained weight loss, or bloody vomit.
- Health history: Tell your doctor if you have or have had issues with low levels of magnesium, calcium, or potassium, hypoparathyroidism, low vitamin B12 levels, osteoporosis, autoimmune diseases, or liver disease.
- Pregnancy and breastfeeding: Notify your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. Contact your doctor if you become pregnant while taking esomeprazole.
- Age considerations: If you are 70 or older, discuss the risks and benefits of taking esomeprazole with your doctor. Follow the recommended usage duration.
What Are the Potential Side Effects of Esomeprazole?
Like any medication, esomeprazole can cause side effects. These can range from mild to severe.
Potentially Severe Side Effects
The more severe side effects of the drug are relatively rare, but they usually require immediate medical attention. These include:
- Kidney problems. Symptoms may include changes in urination, blood in urine, and swelling in the extremities.
- Clostridium difficile (C. difficile)-associated diarrhea. Severe diarrhea that may be associated with an underlying infection.
- Bone fractures. Long-term use or high doses have been linked to an increased risk of bone fractures.
- Low magnesium levels. Symptoms may include seizures, dizziness, irregular heartbeat, or muscle spasms.
- Atrophic gastritis. Long-term use can lead to inflammation of the stomach lining.
- Anaphylactic reactions. Severe allergic reactions are rare but can be life-threatening.
Other Side Effects of Esomeprazole
The most commonly reported reactions to this medication are changes in taste and an unpleasant aftertaste. Drugs.com lists many side effects to this medication that are either less common or whose frequency is unknown. Please refer to esomeprazole side effects for the complete list.
Everyone reacts differently to medication, and no one will experience all side effects of a drug. In many cases, more common, less-severe side effects may resolve as your body adjusts to the medication.
If you experience any new or unusual symptoms that make you uncomfortable, talk to your doctor right away.
What Should I Avoid When Taking Esomeprazole?
When taking esomeprazole long term, avoid situations where you may expose yourself to strong physical shocks. This medication may turn your bones brittle, making them more likely to fracture.
Avoid rough physical activities
If you happen to get diarrhea while using esomeprazole, don’t take anti-diarrheal medication — call your doctor instead.
What Should I Do If I Miss a Dose of Esomeprazole?
If you forget to take a dose of Nexium, take it as soon as you remember it. If it’s almost time to take your next dose, skip it. Never take two doses to make up for a missed one.
What Should I Do If I Overdose on Esomeprazole?
If you overdose on esomeprazole, seek medical attention immediately. Call the Poison Help Line at 1-800-222-1222
Contraindications
Some people should not take esomeprazole. Others should use it with caution under close medical supervision.
Keep in mind that these lists are general guidelines. In special cases, doctors may feel the benefits of taking a particular medication outweigh the risks, so if you are in one of these groups, talk to your doctor about your personal situation.
Who Should Not Take Esomeprazole?
As a general guideline, you shouldn’t take esomeprazole if you have:
- A known hypersensitivity. If you are highly sensitive or allergic to esomeprazole, other proton pump inhibitors, or any of the inactive ingredients in the medication, don’t take omeprazole. Hypersensitivity reactions may include rash, itching, difficulty breathing, and swelling of the face, lips, tongue, or throat.
- A history of acute interstitial nephritis. This kidney condition has been associated with proton pump inhibitor use.
- If you take a medication that has a known interaction with esomeprazole. Some medications have a known interaction with esomeprazole, such as certain antiretrovirals, anticoagulants, or anti-cancer medications.
- Are taking clopidogrel. Esomeprazole can interfere with the effectiveness of this antiplatelet medication.
If you belong to one of these groups, consult a healthcare provider about your personal risks.
Who Should Take Esomeprazole With Caution?
- People with liver disorders. Esomeprazole is metabolized in the liver, and those with liver dysfunction may require dosage adjustments.
- Individuals at risk for osteoporosis or bone fractures. Long-term use of esomeprazole has been associated with an increased risk of bone fractures.
- Patients with low magnesium levels. Long-term use can lead to hypomagnesemia, which may require monitoring and supplementation.
- Those taking certain other medications. Esomeprazole can interact with a variety of other drugs, including certain antiretrovirals, anticoagulants, and anti-cancer medications. (See Potential Drug Interactions below.)
- Pregnant or breastfeeding women. While esomeprazole is generally considered safe during pregnancy and breastfeeding, it’s best to consult a healthcare provider.
- Elderly patients. Older adults may be more sensitive to the effects of esomeprazole and may require dosage adjustments.
Are There Any Other Potential Drug Interactions With Esomeprazole?
According to Drugs.com, a total of 197 drugs and supplements can interact with this medication. Of these, 21 are considered major.
Major Interactions
Potential major interactions include:
-
- Heart medicines like digoxin
- Medicines for peripheral arterial disease, such as cilostazol
- Antifungal medicines, like itraconazole, ketoconazole, posaconazole, and voriconazole
- Methotrexate
- HIV medicines
- Epilepsy medicines like phenytoin
- Antibiotics like rifampicin
- Blood thinners, such as clopidogrel and warfarin
These interactions can cause a variety of side effects, including:
- Increased levels of esomeprazole in the blood, which can increase the risk of side effects
- Decreased levels of other medications in the blood, which can make them less effective
- Increased toxicity of other medications in the blood
Other Interactions
There are also 142 moderate and 34 minor potential interactions reported for this medication. For a quick way to find out if a medication you take is on the list, you can search for it using the Drugs.com Drug Interactions Checker.
Be sure to search for the specific formulation of esomeprazole you’re taking, as the interactions vary among the formulations.
Note that no list of potential drug interactions is complete, so let your provider know if you experience any new or unusual symptoms after taking this medication.
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Please note that this information is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication.
