Nexium 24hr side effects

Nexium (esomeprazole) is indicated for the treatment of gastroesophageal reflux disease (GERD)—better known as acid reflux or heartburn. The approval of generic esomeprazole comes following the arrival of over-the-counter Nexium 24HR last year, and could mean even lower prices and more flexibility when it comes to treating GERD.

What is GERD exactly?

Gastroesophageal reflux occurs when the acid in your stomach comes back up through your esophagus and irritates its lining. GERD can be caused by lifestyle factors (including being overweight, smoking, stress, and eating too much at once) as well as various foods—particularly spicy, acidic, and fried or fatty foods, but also caffeine, alcohol, soda, chocolate, and mint flavorings.

When will generic esomeprazole be available?

The manufacturer, Teva Pharmaceuticals, has stated that they have plans to launch esomeprazole in the near future. Previously, another manufacturer, Ranbaxy, had exclusive rights to make the generic, but they recently lost that exclusivity, opening up opportunities for other companies to make generic Nexium available.

How will generic esomeprazole be available?

Same as brand-name Nexium, esomeprazole will be available as a capsule in 20 mg and 40 mg strengths. However, there is still no generic approved for the packets of powder for oral suspension.

How is esomeprazole usually taken?

The typical maintenance dose of esomeprazole is 20 mg or 40 mg ONCE daily.

What are the most common side effects?

Some common side effects of esomeprazole include headache, diarrhea, nausea, gas, stomach pain, sleepiness, constipation, and dry mouth.

What type of medication is esomeprazole and how does it work?
Esomeprazole is considered a proton-pump inhibitor or PPI. PPIs work by turning off some of the pumps in your stomach that create acid.

Esomeprazole, like other PPIs, may take 1 – 4 days for full effect, but relief usually lasts for a full 24 hours.

For more information on how Nexium (esomeprazole) works please see the Nexium website here.

Are there any medications that are similar to Nexium (esomeprazole)?

Yes. These other PPIs are similar to Nexium (esomeprazole):

  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Protonix (pantoprazole)
  • Aciphex (rabeprazole)
  • Dexilant (dexlansoprazole)

Both Prilosec and Prevacid also have over-the-counter (OTC) versions available just like Nexium 24HR. Prilosec is available as Prilosec OTC, and Prevacid is available as Prevacid 24HR.

All but Dexilant are also available as generics at your local pharmacy with a valid prescription from your doctor, though generic Prilosec, Prevacid, and Protonix will have the lowest cash prices.

What if my doctor wants to keep me on brand-name Nexium?

If your doctor would like to keep you on brand-name Nexium you may have two options.

Your first option is to have your doctor write your Nexium prescription as BRAND MEDICALLY NECESSARY. This means that the pharmacy is not permitted to automatically substitute your brand medication, Nexium, for the generic medication, esomeprazole. Be aware though, your insurance may not cover the brand now that the generic is available.

The manufacturer, AztraZeneca, does have a Nexium Savings Card that can help reduce the cost of the medication. If you qualify you may pay as little as $15 per month or $30 for a 90 day supply of brand-name Nexium.

Your second option is to buy Nexium 24HR over-the-counter. Nexium 24HR is the same medication that previously required a prescription. However, Nexium 24HR is only available over-the-counter in the 20 mg capsules, so if you need the 40 mg strength, this option may not work for you.

  • Esomeprazole

    Prescription esomeprazole comes as a delayed-release (releases the medication in the intestine to prevent break-down of the medication by stomach acids) capsule to take by mouth or to open, mix with water, and give through a feeding tube, and as packets of delayed-release (releases the medication in the intestine to prevent break-down of the medication by stomach acids) granules for suspension (to be mixed with water) to take by mouth or give through a feeding tube. Nonprescription (over-the-counter) esomeprazole comes as a delayed-release capsule and tablet to take by mouth. Prescription esomeprazole is usually taken once a day at least 1 hour before a meal. When prescription esomeprazole is used to treat certain conditions in which the stomach makes too much acid, it is taken twice a day. The nonprescription delayed-release capsules and tablets are usually taken once a day in the morning at least 1 hour before eating for 14 days in a row. If needed, additional 14-day treatments may be repeated, not more often than once every 4 months.

    Take esomeprazole at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take esomeprazole exactly as directed. Do not take more or less of it or take it more often than or for a longer period of time than prescribed by your doctor or stated on the package.

    Swallow the capsules whole; do not split, chew, or crush them. If you cannot swallow the capsule, put 1 tablespoon of cool, soft applesauce in an empty bowl. Open one esomeprazole capsule and carefully sprinkle the pellets onto the applesauce. Mix the pellets with the applesauce and swallow the entire tablespoonful of the applesauce and pellet mixture immediately. Do not crush or chew the pellets in the applesauce. Do not save the pellets and applesauce for later use.

    If you are taking the granules for oral suspension, you will need to mix it with water before use. If you are using the 2.5- or 5-mg packet, place 1 teaspoonful (5 mL) of water in a container. If you are using the 10-, 20-, or 40-mg packet, place 1 tablespoonful (15 mL) of water in a container. Add the contents of the powder packet and stir. Wait 2 to 3 minutes to allow the mixture to thicken, and stir the mixture again. Drink the entire mixture within 30 minutes. If any of the mixture is stuck to the container, pour more water into the container, stir and drink all the mixture immediately.

    The granules and the contents of the prescription delayed-release capsules can both be given through a feeding tube. If you have a feeding tube, ask your doctor or pharmacist how you should take the medication. Follow those directions carefully.

    Do not take nonprescription esomeprazole for immediate relief of heartburn symptoms. It may take 1 to 4 days for you to feel the full benefit of the medication. Call your doctor if your symptoms get worse or do not improve after 14 days or if your symptoms return sooner than 4 months after you finish your treatment. Do not take nonprescription esomeprazole for longer than 14 days or treat yourself with esomeprazole more often than once every 4 months without talking to your doctor.

    Continue to take prescription esomeprazole even if you feel well. Call your doctor if your symptoms worsen or do not improve during this time. Do not stop taking esomeprazole without talking to your doctor.

    Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

    IMPORTANT SAFETY INFORMATION FOR NEXIUM® (esomeprazole magnesium)

    • Symptom relief does not rule out the presence of other serious conditions. Talk with your doctor
    • Talk to your doctor about serious side effects, including:

      – Kidney problems (acute interstitial nephritis) may happen at any time during treatment with NEXIUM. Call your doctor if you have a decrease in the amount that you urinate or if you have blood in your urine

      – NEXIUM may increase your risk of getting severe diarrhea. Call your doctor right away if you have watery stool, stomach pain and fever that does not go away

      – Bone fractures if you take multiple daily doses of NEXIUM for a year or longer

      – Some people who take PPIs, including NEXIUM, develop certain types of lupus or have worsening of the lupus they already have. Call your doctor right away if you have joint pain or rash on your cheeks or arms that gets worse in the sun

      – Low vitamin B12 if you have been on NEXIUM for a long time (more than 3 years)

      – Low magnesium levels if you take NEXIUM (for 3 months or more)

      – Stomach growths (fundic gland polyps), especially if you take PPIs for more than 1 year

    • Tell your doctor about all of the medicines you take, prescription and nonprescription drugs, including clopidogrel, vitamins and herbal supplements. NEXIUM may affect how other medicines work and other medicines may affect how NEXIUM works
    • Do not take NEXIUM if you are allergic to esomeprazole magnesium or any of the ingredients in NEXIUM or are allergic to any other PPI
    • The most common side effects with NEXIUM may include headache, diarrhea, nausea, gas, abdominal pain, constipation, dry mouth and drowsiness
    • In adults 18 and older, the most common side effects with NEXIUM may include headache, diarrhea, nausea, gas, abdominal pain, constipation, and dry mouth
    • In children 1 to 17 years of age, the most common side effects with NEXIUM may include headache, diarrhea, abdominal pain, nausea, and drowsiness

    APPROVED USES FOR NEXIUM® (esomeprazole magnesium)

    NEXIUM is prescribed to treat the symptoms of acid reflux disease, which typically include persistent heartburn on 2 or more days per week, despite treatment and change of diet.

    For many people, NEXIUM is also prescribed to heal damage to the esophagus called erosive esophagitis. This damage may be caused over time from stomach acid wearing away the lining of the esophagus. Only a doctor can diagnose this condition. With NEXIUM, most erosions heal in 4 to 8 weeks. Your results with NEXIUM may vary.

    Please read full Prescribing Information, Medication Guide and Instructions for Use for NEXIUM Packets.

    Nexium® 24HR 20mg Tablets

    Always take this medicine exactly as described in the Consumer
    Medicine Information leaflet or as your doctor or pharmacist have
    told you. Check with your doctor or pharmacist if you are not sure.

    How much to take

    • The recommended dose is one tablet a day.
    • Do not take more than this recommended dose of one tablet (20 mg)
      a day, even if you don’t feel an improvement immediately.
    • You may need to take Nexium® 24HR for a few days before experiencing the full effect.
    • Nexium® 24HR should be taken for at least 7 days and up to 14 days.
    • Tell your pharmacist or doctor if you do not feel better while taking Nexium® 24HR. If symptoms persist or recur within 2 weeks of completing the course, consult your doctor. Further examination may be required.

    Taking this medicine

    • Take Nexium® 24HR at about the same time each day. Keeping a regular time, e.g. in the morning, will help to remind you to take it. Nexium® 24HR can be taken with food or on an empty stomach.
    • Swallow your tablet whole with a glass of water. Do not chew or crush the tablet. If the tablets are chewed or crushed they will not
      work properly.

    Alternative method of taking this medicine

    • Place the tablet in half a glass of non-carbonated water.
      Mineral water or other liquids are not suitable.
    • Gently mix the tablet and water by stirring, taking care not to crush the tablet. Stir until the tablet dissolves into little pellets.
    • Drink the liquid with the pellets immediately, or within 30 minutes.
      Do not chew the pellets. Rinse the glass with half a glass of water and drink.

    If you take more Nexium® 24HR than you should

    If you take more Nexium® 24HR than recommended, Telephone your pharmacist or doctor or the Poisons Information Centre (131126) or go to Accident and Emergency at your nearest hospital immediately if
    you think that you or anyone else may have taken more than the recommended dose. Do this even if there are no signs of discomfort
    and poisoning.

    You should not take Nexium® 24HR for more than 14 days unless directed by your doctor.

    If you forget to take Nexium® 24HR

    If you forget to take a dose, take it as soon as you remember, and then go back to taking it as you would normally. If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Do not take a double dose to make up for the dose that you missed.

    Generic Name: esomeprazole magnesium (oral) (ee so MEP ra zol)
    Brand Names: Nexium

    Medically reviewed by Sanjai Sinha, MD Last updated on Aug 1, 2019.

    • Overview
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    What is Nexium?

    Nexium (esomeprazole magnesium) is a proton pump inhibitor that decreases the amount of acid produced in the stomach.

    Nexium is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions involving excessive stomach acid such as Zollinger-Ellison syndrome. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid).

    Nexium may also be given to prevent gastric ulcer caused by infection with Helicobacter pylori (H. pylori), or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

    Nexium is not for immediate relief of heartburn symptoms.

    Important Information

    Nexium can cause kidney problems. Tell your doctor if you are urinating less than usual, or if you have blood in your urine.

    Diarrhea may be a sign of a new infection. Call your doctor if you have diarrhea that is watery or has blood in it.

    Esomeprazole may cause new or worsening symptoms of lupus. Tell your doctor if you have joint pain and a skin rash on your cheeks or arms that worsens in sunlight.

    You may be more likely to have a broken bone while taking this medicine long term or more than once per day.

    Before taking this medicine

    You should not use Nexium if you are allergic to esomeprazole or to similar medicines such as lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), or rabeprazole (AcipHex).

    Heartburn can mimic early symptoms of a heart attack. Get emergency medical help if you have chest pain that spreads to your jaw or shoulder and you feel anxious or light-headed.

    Tell your doctor if you have ever had:

    • severe liver disease;

    • lupus;

    • osteoporosis or low bone mineral density (osteopenia); or

    • low levels of magnesium in your blood.

    You may be more likely to have a broken bone in your hip, wrist, or spine while taking a proton pump inhibitor long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy.

    Ask a doctor before using this medicine if you are pregnant or breast-feeding.

    How should I take Nexium?

    Use Nexium exactly as directed on the label, or as prescribed by your doctor.

    Take each dose with a full glass (8 ounces) of water.

    Nexium should be taken at least one hour before a meal.

    Do not crush or chew a delayed-release capsule. However to make swallowing easier, you may open the capsule and sprinkle the medicine into a spoonful of pudding or applesauce. Swallow right away without chewing. Do not save the mixture for later use.

    The capsule can be given through a nasogastric (NG) feeding tube. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

    Esomeprazole is usually given for 4 to 8 weeks only. Your doctor may recommend a second course of treatment if you need additional healing time.

    Use this medicine for the full prescribed length of time, even if your symptoms quickly improve.

    Call your doctor if your symptoms do not improve or if they get worse while you are taking this medicine.

    This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using esomeprazole.

    Some conditions are treated with a combination of esomeprazole and antibiotics. Use all medications as directed.

    Store at room temperature away from moisture and heat.

    What happens if I miss a dose?

    Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

    What happens if I overdose?

    Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

    What should I avoid while taking Nexium?

    This medicine can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

    Nexium side effects

    Get emergency medical help if you have signs of an allergic reaction ro Nexium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

    Call your doctor at once if you have:

    • severe stomach pain, diarrhea that is watery or bloody;

    • seizure (convulsions);

    • kidney problems – urinating more or less than usual, blood in your urine, swelling, rapid weight gain;

    • low magnesium – dizziness, fast or irregular heart rate, tremors (shaking) or jerking muscle movements, feeling jittery, muscle cramps, muscle spasms in your hands and feet, cough or choking feeling; or

    • new or worsening symptoms of lupus – joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.

    Taking esomeprazole long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk.

    If you use esomeprazole for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.

    Common Nexium side effects may include:

    • headache, drowsiness;

    • mild diarrhea;

    • nausea, stomach pain, gas, constipation; or

    • dry mouth.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    What other drugs will affect Nexium?

    Tell your doctor about all your current medicines. Many drugs can affect esomeprazole, especially:

    This list is not complete and many other drugs may interact with esomeprazole. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

    Further information

    Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Nexium only for the indication prescribed.

    Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

    Copyright 1996-2020 Cerner Multum, Inc. Version: 15.04.

    Related questions

    • What is the difference between Nexium and Prilosec?

    Medical Disclaimer

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    • Nexium (Esomeprazole Delayed-Release Capsules)
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    • Nexium Oral (Advanced Reading)

    Other brands: Nexium 24HR

    Professional resources

    • Nexium (FDA)
    • … +2 more

    Other Formulations

    • Nexium I.V.

    Related treatment guides

    • Erosive Esophagitis
    • Barrett’s Esophagus
    • Duodenal Ulcer Prophylaxis
    • GERD
    • … +4 more

    How does this medication work? What will it do for me?

    Esomeprazole belongs to the family of medications known as proton pump inhibitors (PPIs). In adults and children, it is used to treat conditions such as reflux esophagitis (tissue damage caused by stomach contents flowing back up the esophagus) and symptoms of gastroesophageal reflux disease (GERD) in people with reflux esophagitis. It is also used to treat nonerosive reflux disease (NERD; heartburn and regurgitation not related to tissue damage) in children and adults. When combined with other medications, esomeprazole is used to treat duodenal ulcers that are caused by bacteria known as H. pylori.

    Esomeprazole can be used to treat or reduce the risk of stomach ulcers due to medications known as NSAIDs (e.g., ibuprofen, naproxen, ketorolac) that irritate the stomach. It is also used to treat conditions associated with the overproduction of stomach acid, including Zollinger-Ellison syndrome.

    Esomeprazole works by reducing the amount of acid the stomach produces.

    This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

    Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

    Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

    What form(s) does this medication come in?

    Tablets
    20 mg
    Each light pink, oblong, and biconvex, delayed-release tablet, engraved with “20 mg” on one side and “A” over “EH” on the other side, contains 20 mg of esomeprazole. Nonmedicinal ingredients: cellulose microcrystalline, crospovidone, glyceryl monostearate, hydroxypropyl cellulose, hypromellose, iron oxide, magnesium stearate, methacrylic acid ethylacrylate copolymer, polyethylene glycol, polysorbate, sodium stearyl fumarate, sugar spheres, synthetic paraffin, talc, titanium dioxide, and triethyl citrate.

    40 mg
    Each pink, oblong, and biconvex, delayed-release tablet, engraved with “40 mg” on one side and “A” over “EI” on the other side, contains 40 mg of esomeprazole. Nonmedicinal ingredients: cellulose microcrystalline, crospovidone, glyceryl monostearate, hydroxypropyl cellulose, hypromellose, iron oxide, magnesium stearate, methacrylic acid ethylacrylate copolymer, polyethylene glycol, polysorbate, sodium stearyl fumarate, sugar spheres, synthetic paraffin, talc, titanium dioxide, and triethyl citrate.

    Sachet (granules) for oral suspension
    Each sachet of fine pale yellow (may also be brownish) delayed release granules contains 10 mg of esomeprazole. Nonmedicinal ingredients: dextrose, crospovidone, citric acid, glycerol monostearate, hypromellose, hydroxypropyl cellulose, iron oxide, magnesium stearate, methacrylic acid copolymer type C, polysorbate, sugar spheres, talc, triethyl citrate, and xanthan gum.

    How should I use this medication?

    The recommended dose of esomeprazole to treat reflux esophagitis and symptoms of GERD is 40 mg once daily for 4 to 8 weeks. After 8 weeks, treatment may be continued at a dose of 20 mg once daily for an additional 4 weeks.

    To treat NERD or heartburn, the recommended dose is 20 mg taken once daily for 2 to 4 weeks. After this, esomeprazole may be taken at a dose of 20 mg once daily as needed to control symptoms.

    To treat stomach ulcers associated with NSAID use, the dose is 20 mg once daily for 4 to 8 weeks. To prevent such ulcers, the dose is 20 mg once daily.

    To treat duodenal ulcers caused by H. pylori in adults, the dose of esomeprazole is 20 mg twice daily taken with amoxicillin 1,000 mg twice daily and clarithromycin 500 mg twice daily – all for 7 days.

    For children 12 months to 11 years of age, the recommended dose of esomeprazole to treat reflux esophagitis is 10 mg to 20 mg (depending on the child’s weight) once daily for 8 weeks. For NERD (heartburn and reflux), the recommended dose is 10 mg once daily for up to 8 weeks.

    For children 11 to 17 years of age, the recommended dose of esomeprazole to treat reflux esophagitis is 20 mg to 40 mg once daily for 4 to 8 weeks. For NERD (heartburn and reflux), the recommended dose is 20 mg once daily for 2 to 4 weeks.

    Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

    Esomeprazole tablets can be taken with or without food. They should be swallowed whole – do not crush or chew them. Alternatively, the tablet may be stirred into half a glass of noncarbonated water until it disintegrates. Drink the liquid containing the small pellets of medication immediately, or within 30 minutes. To ensure you get the full dose of the medication, rinse the glass with more water and drink it.

    The sachets of esomeprazole contain granules for oral suspension. Pour all the granules of one sachet into a glass containing one tablespoon (15 mL) of water, stir, and leave for a few minutes to allow the mixture to thicken. Stir again and drink it within 30 minutes. To ensure you get the full dose of the medication, rinse the glass with more water and drink it.

    It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

    Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

    Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

    Who should NOT take this medication?

    Do not take this medication if you:

    • are allergic to esomeprazole or any ingredients of the medication
    • are taking the medication rilpivirine

    What side effects are possible with this medication?

    Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

    The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

    The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

    Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

    • changed sense of taste
    • diarrhea
    • dizziness
    • drowsiness
    • dry mouth
    • headache
    • increased sweating
    • nausea
    • sore mouth
    • spinning sensation
    • swelling ankles, feet, and hands
    • trouble sleeping

    Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

    Check with your doctor as soon as possible if any of the following side effects occur:

    • blurred vision
    • confusion
    • diarrhea (watery and severe; may also be bloody)
    • feeling of burning or tingling
    • sensitivity to the sun
    • shortness of breath
    • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
    • signs of electrolyte imbalance (e.g., muscle pain or cramps, weakness, irregular heart beat)
    • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
    • skin reactions (such as rash, itching, or hives)
    • sore joints

    Stop taking the medication and seek immediate medical attention if any of the following occur:

    • severe skin problems (blisters, ulcers or lesions)
    • signs of a severe allergic reaction such as hives; difficulty breathing; or swelling of the tongue, face, mouth, or throat

    Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

    Are there any other precautions or warnings for this medication?

    Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

    Bone health: Studies suggest that the use of esomeprazole, like other PPIs, may be related to an increase risk of fractures, particularly for people who take this medication for a year or longer. The lowest dose of this medication to control the symptoms, taken for the shortest period of time, is less likely to cause these problems.

    Diarrhea: When gastric acid is decreased, the number of bacteria normally in the digestive system increases. Occasionally, this can cause serious infection in the digestive tract. If you experience watery, foul-smelling bowel movements after starting to take esomeprazole, contact your doctor as soon as possible.

    Fluid and electrolyte balance: Esomeprazole may cause the levels of electrolytes such as potassium, magnesium, and calcium in the blood to change while taking this medication. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible.

    Liver function: The liver is partially responsible for removing esomeprazole from the body. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

    Methotrexate interaction: Esomeprazole, like other medications in this group, may interact with methotrexate when the two medications are used at the same time. This combination may lead to higher than expected amounts of methotrexate in the body and can cause serious side effects, including kidney damage, irregular heartbeat, anemia, or infection. If you take esomeprazole and are also going to receive a dose of methotrexate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

    More serious conditions of the stomach and intestines: If you experience symptoms of a more serious condition of the stomach and intestines (e.g., trouble swallowing, unplanned weight loss, persistent vomiting, vomiting blood, or black stools) while taking this medication, contact your doctor immediately.

    Vitamin B12: Long-term use of esomeprazole may lead to vitamin B12 deficiency. If you are a vegetarian or have low vitamin B12 levels, discuss with your doctor whether any special monitoring is required.

    Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

    Breast-feeding: It is not known if esomeprazole passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

    Children: The safety and effectiveness of using this medication have not been established for children less than 1 year of age.

    What other drugs could interact with this medication?

    There may be an interaction between esomeprazole and any of the following:

    • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
    • “azole” antifungals (e.g., fluconazole, itraconazole, ketoconazole, voriconazole)
    • bisphosphonates (e.g., alendronate, etidronate, risedronate)
    • carbamazepine
    • cisapride
    • citalopram
    • clobazam
    • clopidogrel
    • clomipramine
    • dabigatran
    • delavirdine
    • dexmethylphenidate
    • dextroamphetamine
    • diazepam
    • escitalopram
    • enzalutamide
    • fosphenytoin
    • hepatitis C antiviral medications (e.g., boceprevir, ledipasvir, sofosbuvir, telaprevir)
    • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
    • imipramine
    • iron supplements (e.g., ferrous sulfate, ferrous fumarate)
    • mesalamine
    • methotrexate
    • methylphenidate
    • moclobemide
    • multiple vitamins with minerals
    • mycophenolate
    • other proton pump inhibitors (e.g., omeprazole, lansoprazole, pantoprazole)
    • pentamidine
    • phenobarbital
    • phenytoin
    • certain protein kinase inhibitors (e.g., bosutinib, dabrafenib, dasatinib, erlotinib, pazopanib)
    • quinidine
    • rifampin
    • riociguat
    • St. John’s wort
    • “statin” cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
    • stiripentol
    • tacrolimus
    • trimipramine
    • warfarin

    If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

    • stop taking one of the medications,
    • change one of the medications to another,
    • change how you are taking one or both of the medications, or
    • leave everything as is.

    An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

    Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

    All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Nexium

    PMC

    Case report

    A 61-year-old female was admitted to The First Affiliated Hospital of Bengbu Medical College (Bengbu, Anhui, China) on May 4, 2015 as a result of experiencing a whole-body rash for 10 days, diarrhea for 7 days, and unconsciousness and oliguria for 1 day. The patient had been diagnosed with hyperthyroidism 30 years ago, but was not administered a formal treatment or monitored. The patient had been experiencing arthritic pain for >1 month and had received an intra-articular injection and oral administration of non-steroidal anti-inflammatory drugs (NSAIDs), but the exact drug was unknown. The patient was prescribed 20 mg twice daily and orally of omeprazole enteric-coated tablets (ECT; Kaikaii Yuansheng Pharmaceutical Co., Ltd, Xinyang, China) to treat the stomach discomfort caused by these NSAIDs. However, the patient developed a whole-body rash 7 days after omeprazole administration, which was 10 days before admission. This rash did not disappear following anti-allergy treatment at a local clinic on April 24, 2015 (Fig. 1). The patient also experienced diarrhea >10 times a day, and nausea and vomiting from 7 days prior to admission. The patient’s diarrhea was treated with an infusion of unknown drugs 2 days prior to admission at the local Suzhou Municiple Hospital on May 2, 2015 but demonstrated no marked improvement in symptoms. The patient developed a high fever reaching 40°C, 1 day prior to admission, and was transferred the Intensive Care Unit (ICU) to continue treatment for low blood pressure and oliguria. The patient was treated with 20 mg norepinephrine (Wuhan Yuanda Pharmaceutical Co., Ltd, Wuhan, China) intravenously once per day to treat low blood pressure, and furosemide injection (40 mg) was administered intravenously once per day to cure oliguria. Norepinephrine activates the alpha receptor, then induces the small artery and vein blood vessel to contract and thus increases the blood pressure. The patient lost consciousness and her condition did not improve following treatment for allergies and a fluid infusion of 20 mg norepinephrine was pumped into the blood intravenously once per day in order to increase blood pressure. Norepinephrine activates the α-receptor, then induces the small artery and small vein blood vessel to contract and finally increases the blood pressure.

    Skin rashes on the patient.

    The patient was then transferred to the ICU department of The First Affiliated Hospital of Bengbu Medical College on May 4, 2015 for further treatment as described below. A tracheal intubation with mechanical ventilation was performed due to the patient’s loss of consciousness and dyspnea. Blood gas analysis revealed severe metabolic acidosis and electrolyte disturbance of pH 6.86, PaCO2 41 mmHg, PaO2 120 mmHg, HCO3− 7.1 mmol/l, BE− 26.1 mmol/l, Na+ 134.7 mmol/l, K+ 2.26 mmol/l and Ca2+ 0.93 mmol/l. Fluid infusion, correcting acid-base disturbance (by sodium bicarbonate injection) and other treatment, including calcium and potassium supplements, calcium gluconate injection (Yunan Baiyao Group Co., Ltd., Kunming, China) and potassium chloride injection (Hebei Kelun Pharmaceutical Group Co., Ltd., Xiantao, China). Admission examination results were as follows: Temperature, 37°C; pulse, 117 times/min; respire, 34 times/min; blood pressure, 106/56 mmHg; and Glasgow score, 3 (19,20). The patient maintained a whole-body rash and did not respond to loud noise or physical stimuli, but did respond to pain stimulation induced by piercing with a needle, meaning that the central nervous system functioned normally. The patient’s pupils measured 1 mm and did not react to light. The patient’s breath sounded rough and rale upon lung auscultation as determined by a stethoscope, but was not obviously dry. Electrocardiogram monitoring (model DASH5000; GE Healthcare Life Sciences, Chalfont, UK) showed a regular sinus rhythm (heart rate, 117 beats/min) and no cardiac murmur. The abdomen was soft and the patient demonstrated no presence of pain when it was pressed. The liver and spleen were small enough to feel by doctors, implying that their function is normal, and bowel movement sounds could be heard. No obvious edema was observed in the four limbs, but the patient presented with oliguria. A routine blood test indicated that the patient’s white blood cell (WBC) count had increased, and neutrophils (NEUTs) were not measured (WBC, 32.67×109 cells/l; hemoglobin, 127 g/l; hematocrit, 34%; platelet, 386×109 platelets/l). The results led to the following symptom identification: i) Allergic shock; ii) pulmonary infection and respiratory failure; iii) acute kidney injury; iv) metabolic acidosis; v) electrolyte disturbance, hypokalemia and hypocalcemia; vi) hyperthyroidism; and vii) diarrhea.

    The patient was administered 500 ml glucose and sodium chloride injection and 500 ml polygeline injection both intravenously. A total of 20 mg norepinephrine was also administered intravenously by a drip once per day in order to maintain blood pressure. 2.25 g piperacillin sodium (Haerbin Pharmaceutical Group Co., Ltd, Haerbin, China) and tazobactam sodium (Haerbin Pharmaceutical Group Co., Ltd) were both administered intravenously three time per day for antibiotic treatment upon admission to the ICU of The First Affiliated Hospital of Bengbu Medical College on May 4th. In addition, blood filtration was performed for acute kidney injury, 3.0 g calcium gluconate injection once daily and 6.0 g 10% potassium chloride injection once daily were administered to treat electrolyte disturbance, hypokalemia and hypocalcemia. Furthermore, 6.0 g montmorillonite powder (Hunan Fangsheng Pharmaceutical Group Co., Ltd., Changsha, China) was injected through the nose three times a day and 2.0 g triple viable Bifidobacterium lactobacillus (Shanghai Xinyi Pharmaceutical Group Co., Ltd., Shanghai, China) were administered through the npse three times a day in order to treat diarrhea and regulate intestinal flora. Loperamide hydrochloride (Xian Janssen Pharmaceutical Ltd., Hefei, China) capsules at 4.0 g were administered through the nose once per day to inhibit intestinal motility, as the patient was experiencing diarrhea >10 times a day. Furthermore, an injection of 80 mg methylprednisolone sodium succinate (Belgium Pharmacia The Upjohn Company, Shanghai, China) was administered intravenously once per day and 80 mg compound ammonium glycyrrhetate S (Jincheng Haisi Pharmaceutical Group Co., Ltd., Jincheng, China) was administered intravenously once per day for anti-allergy treatment. The patient was diagnosed with diarrhea, allergic shock caused by omeprazole, and omeprazole enteric-coated tablet-induced rash following a consultation between the Departments of Pharmacy and Gastroenterology on May 5th. Blood gas analysis on May 7th demonstrated a blood pH 7.48, PaCO2 35.5 mmHg, PaO2 61.5 mmHg, BE 2.9 mmol/l, Na+ 142.3 mmol/l, K+ 3.42 mol/l and LAC 2.3 mmol/l. The patient’s metabolic acidosis had been treated, but lactic acid levels remained high, which highlighted that there remained an obstruction to circulatory function, and a poor oxygenation index of ~100 mmHg. A routine blood test on May 7th returned the following results: WBC, 9.49×109 cells/l; NEUT, 84.1%; red blood cell count, 3.79×1012 cells/l; hemoglobin, 119.00 g/l; hematocrit, 0.33; and platelet count, 72×109 platelets/l. The routine blood test and body temperature (37.0°C) revealed a significant attenuation of the infection; a sputum smear revealed dysbacteriosis, and diarrhea, and the patient was administered norvancomycin by a nasal tube. On May 8th, the patient demonstrated marked deflorescence and a normal urine output, which indicated a significant improvement in kidney function. The patient stopped experiencing diarrhea on May 13th, after which her condition began to stabilize. Genetic screening revealed that the patient had a poor metabolism of omeprazole. Therefore, the severe adverse reactions (omeprazole enteric-coated tablet-induced rash, diarrhea and allergic shock) experienced by the patient were hypothesized to be caused by the accumulation of omeprazole metabolites in vivo. Informed consent was obtained from the patient’s family.

    How Acid-Blocking Medications can Cause Food Allergies

    Numerous studies and FDA warnings are beginning to highlight that nutrient deficiencies of things like vitamin B12, iron, vitamin C, calcium, and magnesium often occur when people take acid blocking medications for long periods of time. But few people are talking about another side-effect of not breaking your food down: food reactions.

    Food Allergies and Low Stomach Acid

    It is estimated that over 70% of the body’s entire concentration of immune cells are found in the intestinal tract. These cells are designed to survey the contents of the intestines for possible foreign invaders like harmful bacteria or viruses. They often do this by recognizing certain amino acid sequences in the proteins of the substances that are traveling through. Just like we remember people by their facial features or personality traits, immune cells recognize organisms by their sequence of amino acids in their proteins. If there are amino acid combinations that look like harmful bacteria, fungi, viruses, or parasites, the immune cells will launch an “attack” against the foreign invader and call for reinforcements.

    When proteins from our foods are properly digested, they are literally broken down into tiny fragments that contain 1, 2, or 3 amino acids. These substances are too small for the immune cells to mistake for a harmful organism and therefore they do not stimulate an immune response. If there is not adequate acid in the stomach, proteins are not broken down well. This leaves the protein fragments in a size and shape that can be mistaken for an invader and cause an immune reaction.

    As Dr. Eva Untersmayr states in an article from Clinical Reviews in Allergy and Clinical Immunology, “Despite being considered a pleasure by most persons, food intake might also represent a health hazard in situations of altered metabolism or if food proteins are recognized as potentially harmful by the immune system.”

    To test this theory, Dr. Untersmayer set up some experiments in petri dishes to see how important gastric acid’s role was in lessening the allergenic capacity of foods. She found that proteins from cod fish lost their ability to bind to IgE antibodies within one minute of exposure to acids that were below a pH of 2.5. When the pH was raised slightly to a 2.75 (less acidic) that completely changed. In just that slight variation of acidity, the proteins became 10,000 times more likely to bind to IgE antibodies (meaning they became allergenic).

    But does this theory hold up to scrutiny when we look at actual patients that take acid-blocking medications?

    Dr. Untersmayr compared adults before and after a 3 month course of acid-blocking medication, she found that 10% of the subjects had an increase in existing IgE mediated allergies and 15% developed new allergies to foods like milk, potato, celery, carrots, apple, orange, wheat, and rye flour. “Thus, the relative risk to develop food-specific IgE after anti-acid therapy was 10.5.”

    In other words, her subjects were 10.5 times more likely to develop food allergies when they are on acid blocking medications!

    Babies and Children are More at Risk for Food Allergies

    Is this the same for kids? Yes. A study in Pediatric Allergy and Immunology in 2013 examined what happened to children varying in age from 0-18 when they were on acid blocking medication for one year. When researchers compared 4724 children that were not on medications with another 4724 set of age-matched children that were on gastric blocking medications, they found a 367% increase in allergies in the medicated group.

    If your baby has colic, the best option to reduce or eliminate symptoms is to have the breastfeeding mother do an Elimination Diet. If you are breastfeeding, there are many things you can do to get to the root of your infant’s digestive issues. Removing the offending foods from your diet as well as adding in gut-healing nutrients can do wonders.

    How to Heal after using Acid-Blocking Medications:

    1. Amino Acids.

    A healthy stomach will produce acid to break apart proteins so amino acids can be absorbed in the small intestines. When proteins are not broken down properly, amino acids are not absorbed properly. I find that many people are amino acid-deficient after being on these medications because of how they inhibit protein digestion. Slow cooked meats and bone broths are one option for increasing very digestible sources of amino acids, and so are amino acid supplements. The following amino acids have been shown to decrease muscle wasting and improve lean muscle mass for individuals that are deficient in protein:

    Amino Acid Complex is a broad-spectrum amino acid supplement that was developed to decrease muscle wasting in cancer patients undergoing chemotherapy. It was later discovered to be effective at improving heart and mitochondrial function. There is actual research on this amino acid combination jump-starting mitochondrial function (you need to have good mitochondrial function so you can produce enough stomach acid). Purchase Amino Acid Complex in our online Store.

    L-Glutamine is known to soothe the intestinal tract. In fact, it is the primary fuel for the intestinal cells! Glutamine also plays a roll in maintaining lean muscle mass. It is the most abundant amino acid in the human body and commonly used by athletes. Purchase L-Glutamine in our online Store.

    2. Do an Elimination Diet.

    Do you suffer from bowel flare-ups, skin problems, brain fog, insomnia, mood issues, muscle and joint pain, or migraines after being on your meds for 6 months or longer? Remember that acid-blocking medications cause low stomach acid, which then in turn allows for large, undigested food particles to reach the immune system. Food reactions cause a myriad of different symptoms.

    If you are reacting to foods, it is going to be difficult to heal your body unless you remove those offending foods for a while. Our Elimination Diet has helped thousands of people identify what foods work and don’t work for their bodies. In the process, they have been able to let go of GERD, dyspepsia, joint pain, headaches, skin problems, mood issues, and more!

    Have you read our book The Elimination Diet? As a companion to our book, we have an Elimination Diet Support Program that will guide you through the Diet. to learn when our next group program begins (though you can join at any time).

    3. Talk To Your Doctor.

    Acid blocking medications may be necessary if you have a serious medical condition like stomach ulcers or Barret’s esophagus. However, there have been numerous articles recently warning about the overuse of these medications for dyspepsia and GERD. They list numerous negative effects with the long-term use of acid blocking medications. Above and beyond food reactions, there have been warnings issued about an increase of bacterial infections (SIBO, c. difficile), magnesium deficiencies, fractures, community acquired pneumonia, vitamin B12 deficiencies, and more. If you have not discussed these with your doctor, now may be a good time to do so. Here are a few quotes and study links to help you communicate with your practitioner:

    “…for most patients the adverse effects of PPIs outweigh the benefits. Reducing the unnecessary use of these medications will require action by both physicians and patients. As physicians, we should offer treatments other than PPIs for functional dyspepsia, prescribe short courses of PPI treatment (after disclosure of possible risks and benefits), and consider a trial of discontinuing PPI therapy in patients who are asymptomatic.” – JAMA Internal Medicine 2010 http://archinte.jamanetwork.com/article.aspx?articleid=415861

    “Moreover, emerging data illustrate the potential risks associated with long-term PPI therapy including variations in bioavailability of common medications, vitamin B12 deficiency, Clostridium difficile-associated diarrhea, community-acquired pneumonia, and hip fracture. For these reasons, it is imperative to use the lowest dose of drug necessary to achieve desired therapeutic goals.” – Am J Gastroenterol 2009 http://www.ncbi.nlm.nih.gov/pubmed/19262544

    “The authors concluded that PPIs are associated with a 29% increased risk of fracture, including 31% increased risk of hip fracture and a 54% increased risk of vertebral fracture. These findings were robust and were consistent across all types of studies, for both low- and high-quality studies, for both long-term use (defined as greater than 1 year) and any use, and for both usual doses and high doses.” – Ann Fam Med. 2011

    4. Use The GERD Supplement Protocol.

    Using this GERD supplement protocol is often more effective than using PPIs. In fact, it has helped hundreds of my clients heal from debilitating digestive issues. In this 2006 study, 176 GERD subjects were put on a supplement protocol and compared with 175 GERD subjects that were administered 20 mg of omeprazole (Prilosec®). At the end of 40 days, 100 percent of the patients in the supplement group reported relief of symptoms compared to 66 percent of the medication group. And here is where it gets fun. Once the initial 40-day trial ended, the researchers took the people who did not respond to the medication and gave them the supplements. All of 60 of them…100%…had resolution of their symptoms on the supplement protocol. Check out our GERD supplement package that contains these key nutrients for healing.

    GENERIC NAME: ESOMEPRAZOLE DELAYED-RELEASE CAPSULE – ORAL (ES-oh-MEP-ra-zole)

    BRAND NAME(S): Nexium

    Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage

    USES: Esomeprazole is used to treat certain stomach and esophagus problems (such as acid reflux, ulcers). It works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn, difficulty swallowing, and persistent cough. This medication helps heal acid damage to the stomach and esophagus, helps prevent ulcers, and may help prevent cancer of the esophagus. Esomeprazole belongs to a class of drugs known as proton pump inhibitors (PPIs).

    HOW TO USE: Read the Medication Guide and the Patient Information Leaflet if available from your pharmacist before you start taking esomeprazole and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually once daily, at least 1 hour before a meal. Dosage and length of treatment are based on your medical condition and response to treatment.Do not crush or chew this medication. Swallow the capsules whole. If you have difficulty swallowing this medication whole, you may open the capsule and sprinkle the contents into a tablespoon of unheated applesauce. Swallow the applesauce mixture right away without chewing it. Do not prepare the mixture ahead of time for later use. Doing so may destroy the drug.If needed, antacids may be taken along with this medication. If you are also taking sucralfate, take esomeprazole at least 30 minutes before sucralfate.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Continue to take this medication for the prescribed length of treatment even if you are feeling better.Tell your doctor if your condition persists or worsens.

    SIDE EFFECTS: See also Precautions section.Headache or abdominal pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: symptoms of a low magnesium blood level (such as unusually fast/slow/irregular heartbeat, persistent muscle spasms, seizures).This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of bacteria. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, fever, blood/mucus in your stool.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

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