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Overview: Esomeprazole is used for heartburn, acid reflux, and other conditions where you have too much acid in your stomach. It works by reducing how much acid your stomach makes and usually takes a few days to fully work. Common side effects include headache, diarrhea or constipation, nausea, gas, stomach pain, and dry mouth. Other side effects are possible, especially if this medicine is taken long term. Contact your health care provider right away if you are peeing less than usual, have watery diarrhea that does not go away, a skin rash, dizziness, or unusual joint pain.

Uses

What is esomeprazole used for?

Esomeprazole is used to treat heartburn and certain other conditions caused by too much acid in the stomach.

Esomeprazole may also be used for other conditions as determined by your health care provider.

How does esomeprazole work (mechanism of action)?

Esomeprazole works by reducing the amount of acid your stomach makes.

How is esomeprazole supplied (dosage forms)?

Brands and other names

  • Nexium
  • Nexium 24HR

Dosage forms and strengths

  • 20 mg, 40 mg delayed-release oral capsules
  • 20 mg delayed-release oral tablets
  • 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg packets of delayed-release granules (powder) for oral suspension

Esomeprazole is also available in injectable forms.

How should I store esomeprazole?

Esomeprazole should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of esomeprazole?

The most common side effects of esomeprazole are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Headache
  • Diarrhea
  • Nausea
  • Gas
  • Stomach pain
  • Constipation
  • Dry mouth
  • Injection site reaction (esomeprazole IV)
  • Dizziness (esomeprazole IV)

There may be other side effects of esomeprazole that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of esomeprazole?

While less common, the most serious side effects of esomeprazole are described below, along with what to do if they happen.

Kidney Problems. A type of kidney problem called acute tubulointerstitial nephritis can happen at any time during treatment with esomeprazole. If you notice a decrease in the amount of your urine or see blood in your urine, call your health care provider right away. 

Antibiotic-Related Diarrhea. An overgrowth of germs called Clostridioides difficile, or “C. diff,” can happen in your gut during treatment with esomeprazole. Call your health care provider right away if you have any of the following symptoms.

  • Watery diarrhea
  • Diarrhea that does not go away
  • Blood in your stool (poop)
  • Severe stomach cramps
  • Fever that starts after you start or finish the medicine

Severe Skin Reactions. Esomeprazole can cause severe skin reactions, such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), that can lead to death if not treated. If you get a rash, stop esomeprazole and call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful skin that looks burned and peels off
  • Flat rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms including fever, chills, and muscle aches

Severe Allergic Reaction called DRESS. Esomeprazole can cause a specific type of allergic reaction called DRESS. DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It is also sometimes called multi-organ hypersensitivity. This is a reaction that can affect multiple parts of the body including your liver, kidneys, and heart. Stop using the medicine and get help right away if you have any of the following symptoms of this serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Shortness of breath, trouble swallowing, or throat tightness
  • Swelling in your feet, ankles, or legs
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain
  • Dark-colored pee
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Lupus. Some medicines, such as esomeprazole, can cause certain types of lupus or cause worsening of lupus you already have. Lupus is an autoimmune disorder where your immune cells attack other cells or organs in your body. Tell your provider right away if you have new or worsening joint pain or a rash on your arms or cheeks.

Low Vitamin B-12. Esomeprazole can cause you to absorb less vitamin B-12 than usual, which can cause low vitamin B-12 levels. You have a higher risk of this if you take esomeprazole for a long time (3 years or longer). Stop using esomeprazole and call your health care provider if you have any of the following symptoms.

  • Sore tongue
  • Weakness 
  • Tingling or numbness in your hands or feet

Low Magnesium. Esomeprazole can cause low magnesium levels, also known as hypomagnesemia, which can be serious. Decreased magnesium levels can cause seizures or heart rhythm problems. You have a higher risk if you take esomeprazole for a long time or take other medicines that also cause low magnesium. Stop using esomeprazole and call your health care provider if you have any of the following symptoms.

  • Changes in your heart rate or rhythm, such as fast or skipping heartbeat
  • Muscle spasms
  • Seizures 

Warnings & Precautions

Who should not use esomeprazole?

Allergies to Ingredients. People who are allergic to any of the following should not use esomeprazole.

  • Nexium
  • Nexium 24 HR
  • Nexium IV
  • Esomeprazole
  • Any other medicine known as a proton pump inhibitor
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific esomeprazole products they stock.

Drug Interactions. Esomeprazole should not be taken while you are using certain other medicines. Before taking esomeprazole, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about esomeprazole before using it?

If esomeprazole was prescribed to you by a health care provider, use it as prescribed. If you are using over-the-counter esomeprazole, follow the instructions that come with the product.

Do not share esomeprazole that was prescribed for you by a health care provider with other people, even if they have the same condition as you. It may harm them.

Keep esomeprazole out of the reach of children.

Do not chew, cut, or crush esomeprazole.

Antacids may be taken with esomeprazole if needed.

Esomeprazole should not be used for immediate relief of heartburn. It may take 1 to 4 days for the medicine to fully work.

If you are having trouble swallowing the esomeprazole capsule, you may open them and sprinkle the contents on 1 tablespoon of applesauce. Swallow the applesauce right away. Do not mix it with any other food.

Use an accurate measuring device to measure the amount of water needed to mix your esomeprazole oral liquid dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist what measuring device to use.

What should I tell my health care provider before using esomeprazole?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if esomeprazole is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Low blood potassium level (hypokalemia)
  • Low blood magnesium level (hypomagnesemia)
  • Low blood calcium level (hypocalcemia)
  • Liver problems

Other Medicines and Supplements. Esomeprazole may interact with other medicines and supplements. Before using esomeprazole, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how esomeprazole could affect pregnancy or harm a fetus. Tell your health care provider if you are or plan to become pregnant. Your health care provider will let you know if you should take esomeprazole while you are pregnant or trying to get pregnant. 

Breastfeeding. Esomeprazole passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should take esomeprazole while breastfeeding.

Interactions

Does esomeprazole interact with foods or drinks?

Esomeprazole should be taken on an empty stomach. Avoid taking esomeprazole within 1 hour before meals.

It is unknown if drinking alcohol will affect esomeprazole.

Does esomeprazole interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using esomeprazole.

  • Clopidogrel (Plavix) or cilostazol (Pletal), which are antiplatelet medicines used to prevent blood clots
  • Citalopram, which is a medicine used to treat depression
  • Methotrexate (Trexall and others)
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Warfarin, which is a blood thinner
  • Certain antiretroviral medicines, such as rilpivirine (Edurant), nelfinavir (Viracept), or saquinavir (Invirase), which are used for HIV or AIDS
  • St. John’s Wort, which is a supplement that may be used for depression
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis

Some other medicines may alter the blood levels of esomeprazole, and vice versa. Esomeprazole may also affect the absorption of some other medicines. Tell your health care provider about all medicines that you take or have recently taken. Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

This may not be a complete list of medicines that can interact with esomeprazole. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much esomeprazole?

If you or someone else has used too much esomeprazole, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of esomeprazole?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.