Nexium (esomeprazole) is a prescription drug used to treat GERD, ulcers and other stomach acid-related conditions. It belongs to a class of drugs called proton pump inhibitors. Common Nexium side effects include headache and nausea. Serious side effects of Nexium include kidney damage and bone fractures.

Last Modified: November 22, 2021
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Nexium, also known by its generic name esomeprazole, is one of the most widely prescribed drugs for stomach-acid-related conditions in the United States. Americans may know the drug by its nickname, “The Purple Pill.”

Nexium comes in several versions. It premiered as a prescription drug in 1989. Over-the-counter (OTC), generic and store brands followed.

Prescription Nexium
This type of Nexium is only available by prescription and is used to treat more serious acid-related disorders. AstraZeneca manufactures it.
Generic Nexium
Generic Nexium is known as esomeprazole and several companies manufacture it. It comes in prescription and over-the-counter formulas.
OTC Nexium 24HR
The FDA approved OTC Nexium 24HR to treat frequent heartburn. It’s available without a prescription and Pfizer manufactures it.
Store Brand Nexium 24HR
This over-the-counter esomeprazole formula features packaging for the retail outlets that sell it, for example, Walmart or Walgreens. It is the generic form of Nexium 24HR.
Nexium 24hr tablet
Nexium 24HR tablet.

Prevacid and Protonix are two other related drugs in the proton pump inhibitor (PPI) class. These drugs all work similarly to control stomach acid. Esomeprazole, Nexium’s generic name and active ingredient, is almost chemically identical to omeprazole, the active ingredient in Prilosec.

AstraZeneca manufactures prescription versions of both Nexium and Prilosec. Some studies show that esomeprazole is more effective at reducing stomach acid than omeprazole.

What Is Nexium Used to Treat?

Doctors prescribe Nexium to treat serious stomach acid-related conditions in adults and children one year of age and older.

Prescription Nexium may also allow the esophagus to heal in adults with serious GERD, prevent stomach ulcers in people who take NSAIDs or treat and prevent stomach ulcers caused by bacteria.

Nexium Is FDA Approved to Treat:

People with frequent heartburn (two or more days a week) may not need prescription strength esomeprazole and can use OTC Nexium, but it may take one to four days to work effectively.

It isn’t a treatment for sudden heartburn, but it will control acid for up to 24 hours when taken regularly.

How Should I Take Nexium?

Prescription Nexium is available in delayed release capsules or oral suspension. Most people take prescription esomeprazole once a day at least one hour before eating. But if you have a severe condition, your medical provider may recommend you take it twice a day.

Make sure to follow your medical provider’s recommendations. Take the capsules whole and don’t crush or split them. People who cannot swallow the capsule can mix the contents of one capsule into a tablespoon of applesauce. Make sure to eat all of the mixture immediately.

If a person overdoses and is unconscious, has seizures or has trouble breathing, call 911 right away. In case of a suspected overdose, call the poison helpline at 1-800-222-1222 or visit

People taking esomeprazole granules for oral suspension need to mix it with water. Use one teaspoon of water if you are using the 2.5- or 5-mg packet and one tablespoon of water if you are using the 10-, 20- or 40-mg packet.

Mix the packet with the water, allow two to three minutes for the mixture to thicken and stir again. Consume all of the mixture within 30 minutes. Nexium may also be administered through an orogastric or nasogastric tube.

Nexium Side Effects

Most common Nexium side effects are mild. These include: Headache, diarrhea or nausea. Side effects in adults and children may be different.

Generally, most people tolerate the drug well. But Nexium may cause more rare, but serious side effects.

Common Side Effects of Nexium

Common side effects of Nexium occurred in 1% or more of patients in clinical trials. The safety and efficacy of Nexium was tested in more than 15,000 people, according to the drug’s Prescribing Information.

In clinical trials, less than 1% of adults reported dyspepsia, or indigestion. Pediatric side effects can include fast, shallow breathing and vomiting.

Common side effects of Nexium include:
  • Abdominal pain
  • Abnormal liver enzymes (in infants)
  • Abnormal rapid breathing (in infants)
  • Constipation
  • Diarrhea
  • Drowsiness or sleepiness (in children)
  • Dry mouth
  • Flatulence
  • Headache
  • Nausea
  • Regurgitation (in infants)

Nexium may cause other side effects than those listed here. If you experience side effects that are bothersome or don’t go away, contact your medical provider right away.

Serious Side Effects of Nexium

While most people tolerate Nexium well, it can cause serious side effects in some people. These include bone fractures, autoimmune issues and kidney problems.
Most of these side effects are rare. Make sure to talk to your doctor right away if you experience any of the following side effects.

Serious Nexium side effects may include:
  • Blisters or peeling skin
  • Blood in the urine
  • Bloody or watery stool
  • Difficulty breathing or swallowing
  • Dizziness
  • Elevated liver enzymes
  • Excessive tiredness
  • Fever
  • Hives
  • Hoarseness
  • Hypersensitivity reactions (swelling, rashes, difficulty breathing)
  • Increased or decreased urination
  • Increased risk of bone fracture
  • Increased risk of cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) or worsening of existing disease
  • Irregular blood cell count
  • Irregular heartbeat
  • Itching
  • Jitteriness
  • Joint pain
  • Lightheadedness
  • Muscle cramps or weakness
  • Nausea or loss of appetite
  • Rash
  • Seizures
  • Severe abdominal pain
  • Severe diarrhea with watery stools, stomach pain, or fever that does not go away
  • Stomach polyps
  • Uncontrollable shaking
  • Vitamin B-12 deficiency

These serious side effects have been reported with Nexium through clinical studies listed on the drug’s label. People have reported other serious side effects after Nexium was released on the market.

Reported post-approval side effects include: Blurred vision, hepatitis and autoimmune issues. Because these are voluntary reports, scientists can’t determine how often they happen or if they are definitively linked to Nexium. Read the drug’s label for a complete list of postmarketing side effects.

Side Effects of Long-Term Nexium Use

When people use Nexium short-term, its potential side effects are relatively mild. But studies have linked Nexium and other PPIs to several long-term health dangers, including kidney damage. Some people who suffered kidney problems have filed proton pump inhibitor lawsuits claiming drug makers didn’t properly warn them of the risk.

At least one study showed long-term use of Nexium and other PPIs could also increase the risk of death. Not all these possible Nexium side effects show up in the medicine’s label.

Nexium should be used for the shortest time period at the smallest effective dose. The FDA warns that patients should never take Nexium 24HR for more than 14 days at a time. And they should never take more than three 14-day courses in a year.

Chronic Kidney Disease & Damage
Several studies have linked long-term use of PPIs such as Nexium to chronic kidney disease (CKD) and acute kidney injury (AKI). The damage may be permanent. One 2021 study in Hospital Pharmacy found people with CKD who discontinued PPIs didn’t see much positive change after one year.
Stroke Risk
Some studies show an increased risk of ischemic stroke with PPI use. However, other studies don’t show an increased stroke risk. For example, in one study researchers linked PPI use to a 21 percent increased stroke risk. A 2021 study in Frontiers in Cardiovascular Medicine showed an increased risk of stroke and myocardial infarction in people who took PPIs.
Cardiovascular Disease
Long-term use of PPIs including esomeprazole has been linked to cardiovascular disease. One 2021 study in Mayo Clinic Proceedings found long-term PPI use was associated with twice the risk of cardiovascular disease and heart failure.
Gastric Cancer
Some studies have found that PPIs may double the risk of gastric cancer in some patients. But according to a 2021 study in Gut, although PPIs may increase the risk of gastric cancer compared to H2 blockers the risk is low.

Make sure to speak to your medical provider about whether the benefits of taking Nexium long-term outweigh the risk of these serious side effects.

Some studies have shown intermittent use of PPIs instead of continuous long-term use may have some benefits and fewer risks.

Side Effects of Nexium Withdrawal

People who have been using Nexium for a long time may suffer serious Nexium withdrawal symptoms when they stop taking it. Symptoms include heartburn, indigestion and regurgitation.

Nexium or PPI withdrawal is called rebound acid hypersecretion (RAH). RAH occurs after a person stops taking a PPI and the stomach secretes more acid than it used to before the patient began taking Nexium. People who suffer from RAH may start using PPIs again to avoid symptoms.

Gradually lowering the Nexium dose over time instead of suddenly stopping treatment may help avoid RAH, according to a 2019 article published by New Zealand Medicines and Medical Devices Safety Authority. Using other non-PPI medicines, such as H2 blockers or antacids, may help manage symptoms.

Precautions Before Taking Nexium

Nexium may not be safe or effective for everyone. Make sure you discuss the risks and benefits of the medicine with your medical provider before taking it.

If you need to, schedule an appointment with your medical provider. This will allow you to ask questions about Nexium and other PPIs as well as give your medical provider a complete list of your medications and discuss your medical history.

Before taking Nexium, tell your medical provider:
  • About any medications you are allergic to, especially if you are allergic to any ingredient in esomeprazole or other PPIs.
  • If you are taking blood thinners, HIV medications, supplements, methotrexate, antifungal drugs or other medications that may react with Nexium. You may have to adjust your levels of medication.
  • If you are taking vitamins or supplements, including St. John’s Wort. You may have to stop taking some of them while taking Nexium.
  • If you are pregnant or plan to become pregnant.
  • If you have autoimmune disease, liver disease, low vitamin B-12 levels, low magnesium or osteoporosis.

If you have taken over-the-counter Nexium for longer and you continue to suffer serious heartburn or chest pain, wheezing, abdominal pain, bloody stools, unexplained weight loss, vomiting and other serious symptoms. You may have a more serious condition that OTC Nexium cannot treat.

Your doctor may run some tests to determine if you have another illness or recommend taking prescription Nexium.

Nexium Drug Interactions

Nexium drug interactions can affect how it or another drug performs. For example, some studies suggest taking PPIs with aspirin may weaken the effect of aspirin. This is important for people with heart problems who may take PPIs and low dose aspirin.

Researchers in one study in the European Journal of Hospital Pharmacy looked at the medical records of 1,288 elderly patients who used multiple prescription medications. They found esomeprazole was prescribed about 65% of the time with at least one of 18 drugs that could cause a potentially severe drug interaction.

To avoid drug interactions, patients should tell their doctor what drugs and supplements they are taking before using Nexium. Refer to the drug’s prescribing information for a list of potential drug interactions.

When to Stop Taking Nexium

Patients shouldn’t stop taking prescription Nexium before talking to their medical provider. Stopping medication suddenly may lead to Nexium withdrawal symptoms and could make existing 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, such as an allergic reaction, seek emergency medical help immediately.

If you want to stop taking Nexium, discuss your treatment goals with your doctor. Review the medicines you are currently taking and check to see if any are still necessary. Ask your doctor whether there are alternatives to taking PPIs, such as H2 blockers, antacids or lifestyle changes. Keep in mind that you may need to see your doctor several times to reduce your dose.

FDA Warnings About Nexium

Since 2010, the FDA has released several warnings about Nexium side effects. These side effects or contraindications have been added to the warnings and precautions section of Nexium’s drug label.

Past warnings have included: Bone fractures, low magnesium levels, clostridium difficile-associated diarrhea, vitamin B12 deficiency, acute interstitial nephritis, potential fetal harm, and the risk of new or worsening lupus.

Most recently, the drug’s label was changed in October 2020 to warn that people taking rilpivirine-containing products shouldn’t take Nexium. In November 2020, a warning was added about reports of acute tubulointerstitial nephritis (a type of kidney damage) in patients taking PPIs.

Is Nexium Safe?

In general, Nexium is tolerated well by most patients and side effects are mild. All medications have a risk of side effects, so no medication can be 100% safe for all people. While there is a risk of side effects, the benefits outweigh the risk for some patients.

Speak to your doctor about whether Nexium is safe for you. This may be based on the medications you are taking, your preexisting conditions and whether or not the benefit you may get from the medicine outweighs potential risks.

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