Nexium (esomeprazole) is a medicine used to treat GERD, ulcers and other stomach acid-related conditions. It belongs to a class of drugs called proton pump inhibitors. Nexium side effects include headaches, constipation and nausea, and it may lead to kidney damage and bone fractures

Last Modified: March 28, 2024
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What Is Nexium?

Nexium is part of a class of drugs called proton pump inhibitors (PPIs). It is one of the most widely used medications in the United States for stomach acid-related conditions. Many people refer to it as “the purple pill.”

Nexium comes in four versions:
  • Prescription Nexium: AstraZeneca manufactures this formulation that treats serious acid-related disorders.
  • Generic Nexium: Several drugmakers manufacture esomeprazole, or generic Nexium. It is available in prescription and over the counter formulations.
  • OTC Nexium 24HR: The U.S. Food and Drug Administration (FDA) approved this over-the-counter version of Nexium to treat chronic heartburn. Pfizer manufactures it.
  • Store Brand Nexium 24HR: This generic version of 24HR esomeprazole is sold under the in-house brands of certain retailers, including Walmart and Walgreens.
Nexium 24hr tablet
Nexium 24HR tablet.

Esomeprazole is the active ingredient in all versions of Nexium. Its chemical composition is almost identical to that of omeprazole, the active ingredient in Prilosec. Some studies show esomeprazole is slightly more effective at controlling stomach acid than omeprazole.

What Is Nexium Used to Treat?

Nexium treats serious stomach acid-related conditions in adults and children older than one year of age. Prescription Nexium also may allow the esophagus to heal in adults with serious GERD, prevent stomach ulcers in people who take NSAIDs and treat, as well as prevent, stomach ulcers that bacteria can cause.

The FDA approved Nexium to treat:

People who experience heartburn more than two days a week can take OTC Nexium to relieve their symptoms. The medication is not a treatment for sudden heartburn, but it can help control acid problems for up to 24 hours when taken regularly. It may take up to four days for the drug to take effect.

How Should I Take Nexium?

Most people with a Nexium prescription can take it once a day, although some people can take two doses a day. Over-the-counter versions of the drug should be taken once a day for up to 14 days every four months. The best time to take Nexium is at least one hour before eating.

Take Nexium capsules whole. Don’t crush or split pills. If you cannot swallow a whole capsule, you can mix the contents into a tablespoon of applesauce and eat that.

For Nexium in oral suspension form, you must mix it with water before you can take it:
  • Mix 2.5 mg or 5 mg packets of granules with one teaspoon of water.
  • Mix 10 mg, 20 mg or 40 mg packets with one tablespoon of water.

Give a mixture two to three minutes to thicken, then drink all the liquid within 30 minutes.

You can also take Nexium through an orogastric or nasogastric tube. If this is how you take it, get specific directions from your healthcare provider and follow them.

Nexium Overdose

You can overdose on Nexium if you ingest large quantities at one time. Don’t take more than 80 mg per day (the maximum recommended dose) unless a healthcare professional directs you to do so.

If someone you know overdoses on Nexium or falls unconscious after taking it, has seizures or has difficulty breathing, call 911 for emergency treatment. You can also call the poison helpline at 1-800-222-1222 or visit for more information on how to avoid serious complications.

Side Effects of Nexium

The most common Nexium side effects include headache and nausea. Serious side effects include kidney damage and bone fractures. Thousands of people have filed Nexium lawsuits after they took Nexium and later developed kidney disease. According to lawsuits, AstraZeneca knew the drug could cause kidney problems but failed to warn the public.

Common side effects of Nexium include:
  • Abdominal pain
  • Constipation
  • Decreased appetite
  • Diarrhea
  • Dry mouth or an unusual taste in the mouth
  • Flatulence
  • Headache
  • Nausea

Infants who take Nexium may experience abnormal liver enzymes, rapid breathing and regurgitation. Children who take Nexium may get drowsy.

Nexium may cause other side effects beyond those listed here. Contact your doctor if you experience after-effects that interfere with your quality of life or that do not go away.

Serious Side Effects of Nexium

While most people tolerate Nexium well, some people experience severe side effects from the medication.

Less common side effects include:
  • Acne
  • Allergic reactions
  • Blisters, peeling skin, hives, rashes or polyps
  • Changes in urination frequency or bloody urine
  • Difficulty breathing or irregular heartbeat
  • Dizziness, lightheadedness or excessive tiredness
  • Elevated liver enzymes, irregular blood cell count or vitamin B-12 deficiency
  • Fever
  • Hoarseness or difficulty swallowing
  • Jaundice, or yellowing of the skin and eyes
  • Severe diarrhea or bloody stool
  • Severe nausea or loss of appetite
  • Swelling, joint pain, muscle cramps or weakness
  • Uncontrollable shaking, jitteriness or seizures

Nexium increases the risk of developing cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). People with either disease may see their condition worsen if they take Nexium.

The drug also increases the likelihood of developing bone fractures.

Some people who took Nexium reported blurred vision, hepatitis and autoimmune issues after taking it. People reported these side effects outside the scope of clinical trials, so scientists can’t verify a link to the drug.

Talk to your doctor immediately if you experience any of these serious side effects after taking Nexium.

Precautions Before Taking Nexium

Nexium may not be safe and helpful for everyone. Consult your doctor about Nexium before taking an over-the-counter version of the medication if you have any conditions or take medications that may result in adverse interactions.

Before taking Nexium, tell your doctors:

  • If you have allergies to any medications or medication ingredients, especially if they’re in esomeprazole or other PPIs.
  • If you take blood thinners, methotrexate, HIV medications, antifungal drugs or any other medications that may interact with Nexium.
  • If you take vitamins or supplements, including St. John’s Wort.
  • If you have an autoimmune disease, liver disease, low magnesium or vitamin B-12 levels or osteoporosis.
  • If you’re pregnant or if you plan to become pregnant.
  • If you took OTC Nexium for more than 14 days and are experiencing bloody stools, severe heartburn, nausea, vomiting or unexplained weight loss. (You may have a more serious condition that Nexium can’t treat.)

Ask about Nexium and other PPIs and about how your medical history might impact their effectiveness for you.

Nexium Drug Interactions

Drug interactions can affect how Nexium and other medications perform. Some studies suggest taking PPIs with aspirin may weaken aspirin’s effectiveness.

A study in the European Journal of Hospital Pharmacy examined medical records of 1,288 elderly people who had multiple drug prescriptions. In that group, 65% of people who had an esomeprazole prescription also had a prescription for at least one of 18 other medications that could cause a severe negative interaction.

A 2022 medical literature review published in Expert Opinion on Drug Metabolism & Toxicology also found that esomeprazole may strongly inhibit the cytochrome CYP2C19. This may reduce your body’s ability to metabolize certain medications, including antidepressants, antifungals, antiplatelet drugs and anticancer compounds.

To avoid problematic drug interactions with Nexium, tell your doctor about all the medications you take before you start a dose of Nexium. You can find a list of potential drug interactions on Nexium’s prescribing information.

When to Stop Taking Nexium

You should not stop taking prescription Nexium without speaking to your medical provider. Stopping your medication suddenly may lead to Nexium withdrawal symptoms and could make your stomach problems worse.

Many Nexium side effects are mild and may go away after your body gets used to the medication. If you experience a serious side effect like an allergic reaction, seek emergency medical help immediately.

If you want to stop taking Nexium, discuss your treatment goals with your doctor. Ask about alternatives to PPIs that might help you, such as H2 blockers, antacids or lifestyle changes. You may need to see your doctor several times to taper your Nexium dose before stopping it entirely.

FDA Warnings About Nexium

The FDA released several warnings about Nexium’s side effects and contraindications, which were added to the warnings and precautions section of Nexium’s drug label.

Among the most recent:

  • In November 2021, the FDA sent a letter to AstraZeneca advising that labeling information include risks of hypocalcemia (calcium deficiency) and hypokalemia (low potassium) in patients treated with PPIs for at least three months, severe adverse skin reactions and drug-induced hypersensitivity syndrome (that can impact organs).
  • In October 2021, the FDA issued a warning following reports of erectile dysfunction in people taking PPIs, including Nexium and generic esomeprazole. It took no regulatory action.
  • In November 2020, the FDA cautioned people about acute tubulointerstitial nephritis (a type of kidney damage) developing for people who take PPIs.
  • In October 2020, drugmakers changed Nexium’s drug label to state that people taking products containing rilpivirine (an HIV antiviral medication) should not take Nexium at the same time.

Past warnings about Nexium have included potential increased risks of low magnesium levels, vitamin B12 deficiency, and clostridium difficile-associated diarrhea. Warnings about rare, but serious possible increased risks have included bone fractures, acute interstitial nephritis, new or worsening lupus and potential fetal harm.

Is Nexium Safe?

Most people who take Nexium tolerate it well and experience mild side effects, if any. Like all medications, it carries some risks. For some, the benefits of taking it outweigh these risks.

Talk to your doctors about whether Nexium is safe for you. They can evaluate your pre-existing health conditions and any recent changes to your health and weigh those against your current medications.

Please seek the advice of a medical professional before making health care decisions.