Nexium benefit and side effects, risk, danger, safety esomeprazole
December 12 2017 by Ray Sahelian, M.D.

Nexium is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach. Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). Chemically, Nexium is very similar to omeprazole. Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome which all are caused by stomach acid. Nexium, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Nexium was approved by the FDA in 2001.
   Recently research had determined that long term use of Nexium and other PPIs increases the risk for diarrhea and osteoporosis.

The first generic version of the heartburn drug Nexium (esomeprazole) has been approved by the U.S. Food and Drug Administration. The drug helps treat GERD, which stands for gastroesophageal reflux disease. GERD occurs when stomach acid backs into the esophagus, and is commonly known as chronic heartburn or acid reflux.

What conditions is it helpful for?
Nexium is used to treat ulcers, gastroesophageal reflux disease (GERD or heartburn), erosive esophagitis, and other conditions involving excessive stomach acid production.


Curr Med Res Opin. 2015. Rapid resolution of sleep disturbances related to frequent reflux: effect of esomeprazole 20 mg in two randomized, double-blind, controlled trials. To investigate the resolution of heartburn and gastroesophageal reflux disease (GERD)-related sleep disturbances during the first 14 days of treatment with esomeprazole 20 mg compared to placebo in subjects with frequent nighttime heartburn and GERD-related sleep disturbances.. Nexium 20 mg significantly and effectively reduced nighttime heartburn and GERD-related sleep disturbances in the first 2 weeks of treatment compared to placebo, with rapid resolution of sleep disturbances in the first days of treatment.

Who should not take it?
Before taking Nexium, tell your doctor if you have ever had any type of liver disease. You may not be able to take Nexium, or you may require a dosage adjustment or special monitoring.


Nexium, pregnancy and breastfeeding
Nexium is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby, however sometimes information comes our years later that a particular drug is more harmful than initially thought.  Doctors are not sure whether Nexium passes into breast milk. Do not take Nexium without first talking to your doctor if you are breast-feeding a baby.

How to take this medication
It is recommended to take each Nexium dosage with a full glass of water. It should be taken at least one hour before a meal. Do not break or chew the Nexium capsules since they are formulated to release slowly in the body. There are no restrictions on food, beverages, or activities while taking Nexium.
     Recommended adult Nexium dosage for treatment of esophagitis is 20 mg or 40 mg one capsule daily 4 to 8 weeks (unless otherwise directed by your doctor).

What happens if a person misses a Nexium dosage?
This is not a crucial problem, just skip the missed Nexium dosage and take only your next regularly scheduled dosage. Do not take twice as much.

What are the symptoms of Nexium overdose?
Symptoms of an Nexium overdose include drowsiness, shortness of breath, tremor and loss of coordination.

Side effects of Nexium, danger, safety, risk
Nexium began to be used in 2001. It takes many years to find out the full range of side effects of Nexium or other drugs. Serious adverse reactions could be an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives). Other Nexium side effects reported include headache, diarrhea, nausea, flatulence, abdominal pain, or constipation; or dry mouth. Some studies indicate headache is common. The most common Nexium side effects appear to be gastrointestinal. This medication can interfere with the absorption of certain drugs. By preventing high acidity in the stomach, it is theoretically possible that chronic use of this drug may lead to a higher rate of gastrointestinal infections since not enough acid is available to kill germs in the stomach.


Curr Drug Saf. 2011. Hypomagnesaemia / hypokalemia associated with the use of esomeprazole. Low magnesium and potassium levels in the blood.


Nexium medication not safe
Taking a heartburn medication such as AstraZeneca's Nexium increases the risk of diarrhea blamed on the Clostridium difficile bacteria. Nexium reduces gastric acid, allowing for bacteria to multiply in the digestive system. Clostridium is the third-most common type of infectious diarrhea in patients aged 75 and older. Exposure to Clostridium difficile bacteria, which causes infection and inflammation of the intestine, previously occurred mostly during hospital stays, but cases have increasingly been contracted in community settings. While antibiotics formerly blamed for outbreaks of the illness have declined in use, the acid-blocking drugs have become steadily more popular to treat ulcers and conditions such as gastric reflux disease.

Nexium and bone fracture
PPIs may be associated with bone fracture. Prolonged use of proton pump inhibitors such as Nexium, particularly at high doses, is linked to increased risk of hip fracture in the elderly.


Reports and questions from users
I took Nexium everyday for over 9 months. Now i have severe symptoms of IBS. I have major gas, rumbling in the stomach, diarrhea and burping a warm sulfur like taste. I'm assuming the Nexium killed all the healthy bacteria, so I'm getting some probiotics from CVS to take to restore the healthy bacteria.


Ten months ago I was hospitalized for a bleeding ulcer. Following a heart attack five years ago I was prescribed a daily regimen of 81mg of aspirin which was the cause of the ulcer. I was advised to take 40 mg of of Nexium daily for as long as I was taking aspirin. I have osteoporosis and I understand that Calcium Citrate does not need acid to make it bioavailable. I hope that this is correct. In addition to this what are the long term dangers of continuing to take Nexium and are the risks from long term nexium usage reduced if I switched to 20mg daily.
   Reducing the dosage is likely to reduce the long term risks.


I have been taking 40 mg per day four years ago. About two years ago I have been having balance problems when walking and some kind of fatigue in my lower legs. Can this be a side effect of Nexium ?
   It is possible but there are other reasons for balance problems and especially fatigue. A reliable way to know is to stop the medication to see if the symptoms go away and to restart it to see if the symptoms return.


I have been taking nexium 40 mg for 12 years. I open the capsule and swallow the granules since I cannot swallow pills or capsules. I chew tablets and open capsules. Two months ago I suddenly developed painful edema in my feet, ankles, and lower legs. All radiological and blood tests have been negative.


​I recently had a bad bout of GERD / Hiatal Hernia due to some medication I took for a bad flu virus - which had too much Acetaminophen and guaifenesin. I couldn't breathe, starting having panic attacks and ended up at the ER first and then the doctors office. I was misdiagnosed at the ER with a Virus. I was also given X-rays because my lungs were so tight. Everything was normal. Then I went to my PCP because I was still having issues breathing. Obviously it was my GERD / Hiatal Hernia from the medication I took. The PCP prescribed Nexium 40 MG x 2 per Day for the reflux. I had previously been taking Protonix 40 MG for about 16 yrs. with NO ISSUES. However, it seemed that the Prontonix was NOT working for me during my GERD episode when I had the flu. I actually had stopped taking Protonix for several months, as I know that PPI's are not good to use for a very long time. I was also prescribed Zoloft for the panic attacks. OMG, what a horrid drug. Got a response to it three days later and it caused so many issues. I guess some people cannot take SSRIs. I really don't think I needed GERD was the culprit. Doesn't anyone prescribe Valium for intense moments like these? Allergic reactions are not fun at all. I have so many allergies this can be very dangerous. Went off Zoloft after three days but, kept on with the Nexium for 5 days and I should NOT have. Two 40 MG pills a day? I should have only taken 20 MG. It was horrid - had all of the overdose symptoms you describe on your website. My panic attacks went into full mode and I felt like I was going to die. Went back to the PCP and all my doctor did was prescribe more drugs....he wanted me to take Buspar. I don't have mental issues. I was having a full blown allergic reaction to this drug. How long does it take for the Nexium to leave the body? I'm still having side effects....horrid dry mouth, hard to breathe.....I can breathe through my nose but it feels like I cannot take a full breath - not certain if it's the Hiatal Hernia, shake sometimes, dizzy, cloudy thoughts, can't sleep, weird thoughts, hot and cold etc. My lower ribs in my back hurt and I've been getting spasms. This has increased my anxiety so much that it's been hard to function and stop thinking about breathing. I've been off just for two days. At least I can swallow now. I've lost 13 lbs. in a short time because of this. Should I take N-Acetylcystenine to clear my Liver? Is it safe to take anything after taking these medications? Also, I was so traumatized from these horrid meds that I need something for the anxiety and panic attacks. Would Passion Flower be o.k. to take as well?
   A. Some natural supplements can help with anxiety. The effects of the Nexium should go away within a week or two.


Nexium and drug interactions
It is possible that Nexium may interfere with digoxin (Lanoxin, Lanoxicaps); itraconazole (Sporanox) or ketoconazole (Nizoral); or iron (Feosol, Mol-Iron, Fergon, Femiron, others).


Can I stop using Nexium if I feel better?
Since most drugs have side effects in the long run, if your symptoms were not serious and you feel better, it may be a good idea to stop it if your doctor thinks your condition is fully treated. Sometimes doctors put patients on medicines and do not reevaluate often enough whether the patient still needs the medicines.


How is Nexium available?
Nexium is available is 20 mg and Nexium 40 mg dosage, delayed release. Nexium (esomeprazole magnesium, AstraZeneca) delayed-release capsules were approved in 2006 for use in children ages 12 to 17 for the short-term treatment of gastroesophageal reflux disease (GERD).


Nexium for children
In 2008,  Nexium drug was approved by the FDA for treating excess stomach acid in children aged 1 to 11 years.
The FDA approved Nexium, Astra's top seller and the world's second-biggest prescription medicine, in two forms -- a delayed response capsule and a liquid. Nexium was approved in a dose of 10 milligrams, or 20 milligrams daily, for children aged between 1 and 11 -- half the dosage for patients aged 12 to 17.
   Comments: Long term safety of Nexium in children is not clearly understood.



Nexium ads on TV claim that it relieves heartburn and esophagitis. The ads mention that headache, diarrhea, and abdominal pain are Nexium side effects. The phone number is listed as 800-purplepill. The website is purple pill dot com.


Q. Are there natural alternatives to Nexium?
   A. I am not aware of a natural source of a proton pump inhibitor, but there are some supplements used for ulcer that are worth a try.

Q. My fiance was diagnosed with Barretts Esophagus in 2006. Since then his specialist has prescribed him with 80mg of Nexium a day. Recently my fiance has been feeling very ill with Nexium side effects. Major headaches, diarrhea, nausea, dizziness and tightness in his throat, making it difficult to swallow. Then we went to visit the specialist last week for an Upper GI to see what the problem was. Thankfully his Barretts is gone, but the doctor said to keep taking the same dosage of Nexium. My fiance still could not function normally, so he on his own stopped taking the Nexium and started to eat foods with low levels of acid and started to feel much better. His father died of cancer in the esophagus.

   A. Thanks for sharing this Nexium side effect experience with us. We are surprised about Barrett's esophagus syndrome being gone, we wonder if the initial diagnosis was correct.

Q. What was it you said about the unwanted side effects of Nexium? That it take years to know what all of these side effects will be? Well, now were paying the bill for that asinine method of determining the safety of a drug. I'm referring to the article in The New York Times, December 27, 2006 "Study Finds a Link Between Some Heartburn Drugs and Hip Injuries in People Over 50". You Medicos should know that about the human system. You can't take from one part of the human system without paying back to another. Were you getting paid from Astra Zenica pharma that makes Nexium for touting the benefits?
   A. Many times in my life I have made a quick judgment about someone without first understanding them in a fuller way. You may wish to spend more time on my website reading a number of different pages and you will realize your last statement in your email was quite off the mark.


Q. I believe I suffered an overdose of Nexium medication. I have been diagnosed with oscillopsia, ataxia, severe difficulty swallowing, I have a swollen membrane in the inner ear, frequent headaches and my blood platelet count is now 88. My doctor has said this was all caused by a virus of unknown origin, yet, when my blood was tested, I showed no signs of a virus or a bacterial infection. He then diagnosed opsoclonus myoclonus ataxia, had me COMPLETELY tested for that, and according to the tests, I'm fine. I have no brain issues (CT scan and MRI), I have no genetic disorders, no cancers, I am a perfectly healthy 44 year old woman other than the obvious issues. Is there any type of test or testing that would prove Nexium is what has caused this? If so, do you know if there is any way to fix me?
   A. Sorry, this is outside of my range of knowledge.


Q. I am a neurologist and the individual above needs a full neurological work up, but certainly should be checked for Whipple's disease and remote effect of neural crest tumors. I hope you can pass on this information to her so she can see a competent neurologist.


Q. I read your page regarding Nexium usage, but something I haven't been able to find information on is long term Nexium use. I've been taking Nexium everyday for the past 3 years, since I was diagnosed with a hiatal hernia. If I go off it for a week, my stomach hurts, I have diarrhea, and can eat hardly anything, but I am afraid to keep taking the drug indefinitely. My father died of stomach and esophageal cancer, so the whole issue scares me. Do you have any information regarding my concern about long term safety or side effects of Nexium medication use?
   A. Not enough long term human research with Nexium is available to know the full extent of Nexium side effects. Until we learn more, the best option is to take occasional breaks as tolerated and to use the lowest dosage that works. Taking occasional breaks may reduce potential long term Nexium side effects.


Q. Is it true that long term use of Nexium can cause pernicious anemia due to malabsorption of vitamin B12?
   A. Yes, it is possible that Nexium drug use can lead to reduced absorption of protein bound vitamin B12 but taking vitamin B12 supplements should not be a problem.


Q. I have been taking Nexium drug for 8 years or more. I really can't recall how long. I had either irritable bowel syndrome or acid reflux my throat hurt and this seemed to do the trick. I take 40 mg per day every day. Now I can drink orange juice and coffee and hot sauce with no effects. None of these were possible before. I do have an occasional migraine maybe 3 times a year not more and they could be stress. I am a 49 year old male and have never broken a bone although very active all my life. I only drink about 24 oz of milk a day due to being recently diabetic. Am I in danger of osteoporosis at this age? Do I need to limit my use although my doctor has never indicated to do so? How can I help the medical profession understand long term use of this drug?
   A. Osteoporosis usually occurs later in life and is more likely in women than in men. Sometime in the next few years your doctor may order a bone density test if he or she feels you need it due to being on Nexium medication for many years. Research regarding Nexium and osteoporosis is still in its early stages.


I stumbled upon the website when I was looking at Nexium alternatives and was wondering if you have any info on H. Pylori, gastritis treatment with supplements and herbs, and diet? I didn't see it on your website but if you could refer me to a trusted source, I would appreciate it. To add to the info on Nexium use and side effects that you have: I had terrible side effects, besides diahrrea at 40 mg a day which where prescribed to treat astrophic gastritis, even when reduced to 20 mg had a very suppressed, flat mood: very disabling, hard to function. My GI said it is not common but occurs in small percentage of patients. I tried B supplements and it works a little better but not well enough. When evaluating the benefits of taking Nexium, I didn't feel it was benefiting me enough for me to continue taking them especially that my symptoms are not as disabling as when I take the drug. Thanks so much. great info on the web and if you get a chance to forward me some info on H. Pylori, it would be much appreciated! Keep up the good work, it is always refreshing to see MD who is not completely closed to the alternatives.
    See helicobacter pylori for information on natural therapy.


I was hoping to ask a fast question. I have been eating medjool dates and date rolls for the past two months almost daily. All of a sudden when I eat them I get massive stomach cramps that won't go away unless I take copius amounts of acidophilus. Could it be the magnesium held in these is starting to bother me or some other property held within? They did not bother me at all the first 6 weeks of consuming them. My Dr. put me on Nexium but I would think it doubtful that these dates could have caused some kind of ulcer. I eat other food normally with no problem. I hope you can help give an opinion.
    It is not possible to know without doing a full history and medical examination and review of routine tests, but it is unlikely that the magnesium is causing problems. Dates are high in fructose.


I have been taking Nexium for four months for GERD; it works wonderfully, but the side effects, including depression and joint pain are too much to handle. Since going off it, my acid reflux is better than before, but still bothers me sometime. Of course my favorite foods are coffee, red wine, chocolate and garlic; that probably doesn't help. I'm a sixty-seven year old man of normal weight and in otherwise great health. Do you have any suggestions for herbal alternatives?
    See the article on this site regarding GERD.


I have a question about the prolonged use of Nexium. Here is the background on me: I’m a 56-year old female in good health. About a year ago I started having problems swallowing. It wasn’t a classic example of GERD exactly; it was more that food would not go down easily. I frequently found myself choking or coughing until the food would go down. This of course lead to my seeing a GI who ordered an esophagram followed by an endoscopy — both were done last November. The endoscopy revealed Barret’s esophagus and also a superficial ulcer in my stomach. I was put on Nexium, 40 mg and told to come back for a repeat endoscopy in February, 2010 which I did. The second procedure revealed that the Barrett’s esophagus / ulcer was fully healed as well as the stomach ulcer. My dosage was reduced to 20 mg. I feel fine and have no repeats/issues with food not going down, with digestion, or with any of the side effects mentioned (diarrhea, tiredness, headache, etc.). In fact, I feel quite good! My doctor said to come back in a year for another endoscopy and to re-evaluate my need for nexium. Questions: I’d like to know if I should continue with the nexium, as proscribed, or if it is possible to take it less frequently, or perhaps not at all? This is the only medication I have ever taken on a regular basis my entire life. I have no other chronic ailments or issues. My doctor says I will probably be taking this medication for the rest of my life. Is this a fair assessment? For the record, my father also suffers from heartburn and gastric reflux. He is 85. Is this a condition I most likely inherited? I believe my grandmother, his mother, also had ulcers and digestive issues. I’d appreciate your feedback.
   This is not a decision I can make for you since I am not your physician but you could take a look at the pages on this site on Barrett's and ulcer.


I am 41 years old and I have been taking Nexium for over 20 years (20mg per day) to threat my gastroesophageal reflux disease. After my last visit to the doctor he told me that the lining of my esophagus has no more irritation and it seems to be recovered. Therefore I tried to reduce it and use some alternative medicaments. The first two three days was ok I could manage some disturb by taking some natural pill like ‘’NeoBianacid (Aboca)’’ .After 2 weeks the frequency of reflux disturbs increased and the effect of natural pills is limited to 30 40 minutes.


I was very happy to have come across your page on Nexium which has been very informative in my learning of gastro-intestinal medications. I understand that it can be prescribed for laryngal issues caused by reflux. I was curious to know, in your clinical experience, if very infrequent occurences of reflux justifies the use of this medication.
   A. Since it has potential side effects when used long term, my preference is to not use it unless it is very necessary.