Nexium (esomeprazole) Cost, Side Effects, Dosage for GERD, Heartburn, Ulcers, and H. Pylori | Sahar Anjomshoaa, PharmD | RxEconsult

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Nexium (esomeprazole) Price, Side Effects, Dosage for GERD, Ulcers, and H. Pylori Category: GI (Ulcers, Crohn's, Ulcerative Colitis) by - October 29, 2014 | Views: 27308 | Likes: 0 | Comment: 0  

Nexium for GERD and Ulcers,

Brand Name: Nexium, Nexium 24HR
Generic Name: Esomeprazole magnesium

Medication Class: Proton pump inhibitor
Similar Drug: Prilosec (omeprazole), Protonix (pantoprazole), Aciphex (rabeprazole), Prevacid (lansoprazole)
Manufacturer: AstraZeneca Pharmaceuticals
FDA Approval Date: October 2006

What is Nexium and its mechanism of action?

Nexium (esomeprazole) belongs to a class of medications called proton pump inhibitor (PPI) and is used for treating ulcers. Esomeprazole, the active chemical in Nexium, has a similar chemical structure as omeprazole - it is the mirror image (enantiomer) of omeprazole. PPIs block the production of gastric acid by proteins (proton pump) in the stomach wall that produce acid. When these proteins are blocked, the production of acid decreases and this allows the stomach and esophageal to heal. PPIs are the most potent inhibitors of acid production.

What is Nexium used for treating?

Nexium is used for:

  • Gastroesophageal reflux disease (GERD)
  • Risk reduction of NSAID-associated gastric ulcer
  • H.pylori eradication to reduce the risk of duodenal ulcer recurrence
  • Zollinger-Ellison syndrome and other pathological hypersecretory conditions
  • Frequent heartburn (Nexium 24 HR OTC)

How effective is Nexium?

GERD: The following results were obtained in a study of 717 patients with more than 6 months history of GERD who were given Nexium 20 mg or 40 mg once daily or placebo for four weeks. 

75% of patients on Nexium 20 mg or 40 mg were symptom free by the end of the trial. In contrast only 30% of patients in the placebo group were symptom free.

Healing of Erosive Esophagitis: In 1,176 patients who received either Nexium 20 mg or omeprazole 20 mg healing rates at weeks 4 and 8 were: 

The healing rate at week 4 was 68.7% for the Nexium 20 mg group compared to 69.5% for patients treated with omeprazole 20 mg.

At week 8, healing rate in the Nexium 20 mg group was 90.6% and in the omeprazole 20 mg group it was 88.3%.

At the end of the trial there was no significant difference between Nexium 20 mg and omeprazole 20 mg in either healing or symptomatic relief of erosive esophagitis.

Risk Reduction of NSAID-associated Gastric Ulcer: 569 patients received Nexium 20 mg or Nexium 40 mg, or placebo for 26 weeks and the following results were obtained. 

95.4% of patients were gastric ulcer free in the Nexium 20 mg compared to 96.7% in the Nexium 40 mg group, and 88.2% in the placebo group.

Nexium 20 mg was equivalent to Nexium 40 mg.

H. pylori eradication in patients with duodenal ulcers: Triple therapy consisting of Nexium/amoxicillin/clarithromycin was evaluated in a study of 191 patients who received either Nexium 40 mg once daily in combination with amoxicillin 1000 mg twice daily and clarithromycin 500 mg twice daily or Nexium 40 mg once daily plus clarithromycin 500 mg twice daily.

The percentage of patients with a healed duodenal ulcer at 4 weeks after a 10 day treatment with Nexium plus amoxicillin and clarithromycin was 77% and 52% with Nexium plus clarithromycin.

Interesting Facts about Nexium

  • Esomeprazole is the enantiomer of omeprazole.
  • An over-the-counter formulation is available.
  • The 20 mg strength is available over the counter.

What are side effects of Nexium?

Most common side effects of Nexium are headache, nausea, flatulence, diarrhea, abdominal pain, dry mouth, and constipation. Low magnesium, growth of candida in the stomach and intestines, Clostridium difficile-associated diarrhea (CDAD), liver failure, and increased risk of osteoporosis related fractures may also occur.

What is the dosage of Nexium and how is it supplied?

Nexium is available as:

20 and 40 mg delayed-release capsules

Delayed-release suspension 2.5, 5, 10, 20 and 40 mg

20, 40 mg vial of freeze-dried powder for intravenous infusion

20 mg capsules (Nexium 24HR OTC formulation)

Nexium granules are coated to prevent destruction by stomach acid. Chewing or crushing Nexium may cause Nexium to be destroyed by stomach acid before it is absorbed. Nexium should be swallowed whole and taken 1 hour before food. Patients who have difficulty in swallowing may open the contents and mix with 1 tablespoon of applesauce.

Suspensions should be mixed with 15 ml of water, leave 2-3 minutes to thicken and drink within 30 minutes.

For intravenous infusion, first reconstitute then administer over 10 to 30 minutes.


  • GERD for adults: 20 mg or 40 mg once daily for 4 to 8 weeks
  • GERD for pediatrics 12 to 17 years: 20 mg or 40 mg once daily for up to 8 weeks
  • GERD for pediatrics 1 to 11 years: 10 mg or 20 mg once daily for up to 8 weeks
  • GERD 1 month to less than 1 year: 2.5 mg, 5 mg, or 10 mg (based on weight) once daily for up to 6 weeks
  • Risk Reduction of NSAID-associated Gastric Ulcer: 20 mg or 40 mg once daily for up to 6 months
  • H.pylori Eradication: 40 mg once daily for 10 days plus clarithromycin and amoxicillin
  • Zollinger-Elison Syndrome: 40 mg twice daily
  • Heartburn: 20 mg once daily for 14 days; may repeat a 14 day course after 4 months

What are Nexium drug interactions?

Interference with Antiretroviral therapy (e.g., atazanavir, nelfinavir, saquinavir): Combining Nexium with antiretroviral medications can affect therapeutic levels of these medications and increase or decrease their concentration.

Absorption of drugs affected by gastric acidity (e.g., ketoconazole, atazanavir, iron salts, erlotinib): Nexium may interfere with the absorption of these drugs due to inhibition of gastric acid secretion, thus decreasing their efficacy.

Tacrolimus: Combining Nexium with tacrolimus may increase blood levels of tacrolimus.

Combination therapy with Clarithromycin and amoxicillin: Co-administration of these medications would result an increase in plasma level of Nexium. 

Avoid combining clopidogrel with Nexium. Nexium reduces the effect of clopidogrel by blocking the conversion of clopidogrel to its active form. 

What are warnings and precautions for Nexium?

Atrophic Gastritis (chronic inflammation of stomach): Caution should be advised for patients on long-term use of Nexium

Clostridium difficile associated diarrhea: Long-term use of Nexium is associated with diarrhea especially in hospitalized patients. PPIs should be discontinued until diarrhea improves.

Interaction with Clopidogrel (Plavix): Avoid combining clopidogrel with Nexium. Nexium reduces the effect of clopidogrel by blocking the conversion of clopidogrel to its active form. Use alternative antiplatelets or PPIs. 

Bone Fracture: Long-term use of PPIs is associated with increased risk of bone fracture. Patient should use the lowest dose and for only as long as needed.

Hypomagnesemia: It occurs after a long-term use of PPIs and it can cause serious adverse reactions such as seizures and abnormal heart beats. Monitoring magnesium levels is recommended.

Concomitant use of Nexium with St.John’s Wart or Rifampin: Due to the function of liver enzyme, concomitant use of these medications is not recommended since they decrease the concentration of Nexium.

Concomitant use of Nexium with methotrexate: PPIs prolong serum levels of methotrexate leading to toxicity. Avoid combining Nexium with methotrexate. 

Pregnancy: Safety during pregnancy has not been established. 

Nursing Mothers: Small amounts of Nexium are excreted in human milk.

What is the cost of Nexium?

The wholesale price for 30 capsules of Nexium 20 mg is $236.74 and the retail price is $251.00.

The OTC price of 12 capsules of Nexium 24Hr is $12.99. 

How to obtain prescription cost assistance for Nexium?

Obtain prescription assistance at AZ & Me Prescription Saving Program. Nexium coupons are also available.  


Nexium Prescribing Information, AstraZeneca Pharmaceutical LP. March 2014

RedBook Online, Nexium, Truven Health Analytics, Inc.; 2014


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