Nexium (Esomeprazole) Capsules for Acid Reflux
Nexium is an oral proton pump inhibitor containing esomeprazole, the S-enantiomer of omeprazole. It is used in adults and children for gastro-oesophageal reflux disease, peptic ulcer disease, NSAID-induced ulcer prophylaxis and Helicobacter pylori eradication.
- Active ingredients
- Esomeprazole
- Manufacturer
- AstraZeneca
- Dosage forms
- delayed-release capsule, delayed-release tablet, oral suspension
- Available dosages
- 20mg, 40mg
- Category
- Gastrointestinal Medications
What is it?
Nexium is the original brand of esomeprazole, marketed by AstraZeneca since its approval in 2001. It is supplied as delayed-release capsules, delayed-release tablets, oral suspension and parenteral solution. Nexium is dispensed both with and without prescription depending on dose and country, and is one of the most prescribed proton pump inhibitors globally. Multiple authorised generics are now widely available.
Active ingredients
Each capsule contains esomeprazole (as the magnesium trihydrate) as the sole active ingredient at 20mg or 40mg. Esomeprazole is the pure S-enantiomer of omeprazole, with more consistent metabolism than the racemic parent compound and higher bioavailability after multiple doses.
Forms and dosages
Nexium is administered orally once daily, ideally 30-60 minutes before a meal. According to the prescribing information, the usual adult dose is 20mg or 40mg once daily for GORD, peptic ulcer healing or H. pylori eradication regimens. Capsules should be swallowed whole with water or opened and the granules sprinkled on soft food in patients with swallowing difficulties. Dose reduction is required in severe hepatic impairment.
Indications
Nexium is approved in adults and children for the treatment of gastro-oesophageal reflux disease, including erosive oesophagitis healing and maintenance of healing, peptic ulcer disease, prevention of NSAID-induced ulcers, Zollinger-Ellison syndrome and as part of triple-therapy regimens for Helicobacter pylori eradication. According to clinical guidelines, the lowest effective dose for the shortest necessary duration should be used, with periodic reassessment of long-term therapy.
How it works
Esomeprazole is a substituted benzimidazole prodrug that is activated in the acidic environment of the gastric parietal cell, where it irreversibly inhibits the H+/K+-ATPase enzyme — the proton pump responsible for the final step in gastric acid secretion. Acid secretion gradually returns after discontinuation as new pumps are synthesised. The S-enantiomer has more consistent metabolism than racemic omeprazole.
Frequently asked questions
How is Nexium different from Prilosec? ▾
Nexium contains esomeprazole, the pure S-enantiomer of omeprazole, while Prilosec contains racemic omeprazole (R and S enantiomers). The S form has more consistent metabolism with higher bioavailability after multiple doses, particularly in CYP2C19 extensive metabolisers. Clinical efficacy is broadly comparable at equivalent doses, although Nexium may produce slightly faster healing in erosive oesophagitis. Choice between the two is made by the prescriber.
When should Nexium be taken? ▾
Nexium is most effective when taken approximately 30 to 60 minutes before a meal, ideally before breakfast, because the proton pumps are most active during meals. According to the prescribing information, capsules should be swallowed whole with water, although they can be opened and the granules sprinkled on soft food in patients with swallowing difficulties. The granules must not be crushed or chewed.
Does Nexium interact with clopidogrel? ▾
Esomeprazole is a CYP2C19 inhibitor, and CYP2C19 is responsible for activating the antiplatelet prodrug clopidogrel. Pharmacokinetic studies have shown reduced active metabolite concentrations and antiplatelet effect when these two drugs are co-administered. According to the prescribing information and several regulatory communications, the combination should be avoided when possible; alternative proton pump inhibitors such as pantoprazole are preferred in patients on clopidogrel.
Can Nexium be taken long-term? ▾
Nexium is commonly used for prolonged periods in chronic GORD, Barrett's oesophagus and peptic ulcer prophylaxis with NSAIDs. Long-term use has been associated with potential reductions in vitamin B12 and magnesium absorption, an increased risk of bone fractures and possible enteric infections. According to international guidelines, long-term proton pump inhibitor therapy should be regularly reassessed, with the lowest effective dose used.
What are the main contraindications for Nexium? ▾
Nexium is contraindicated in known hypersensitivity to esomeprazole, omeprazole or substituted benzimidazoles, and in concurrent use with rilpivirine. Caution is required in severe hepatic impairment, in long-term use with monitoring of magnesium and bone density, and during pregnancy and breastfeeding. According to the prescribing information, the medical history must be reviewed by a clinician before any prescription.
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The information on this website is provided for reference and educational purposes only. It does not replace consultation with a qualified healthcare professional.