Nexium dosage, forms, and strengths

Nexium is a brand-name stomach acid reducer used to treat heartburn, gastroesophageal reflux disease (GERD), erosive esophagitis, H. pylori infection, and conditions that cause the stomach to secrete too much acid. Healthcare professionals also use it to prevent stomach ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAIDs). Nexium can be purchased over the counter as the brand-name Nexium 24HR, which is used only to treat heartburn. Nexium will require a prescription for other conditions. The active ingredient in Nexium is esomeprazole magnesium, a type of proton pump inhibitor. These drugs block the stomach lining’s ability to secrete acid. In this way, they ease stomach problems like heartburn and GERD caused by stomach acid. They also allow the esophagus or stomach lining to heal ulcers or tissue damage. 

Nexium forms and strengths

Nexium can be taken as a delayed-release capsule or delayed-release granules. Healthcare providers can also give it as an intravenous injection (Nexium I.V.). 

• Delayed release capsule: 20 mg, 40 mg

• Delayed release granules: 2.5 mg packet, 5 mg packet, 10 mg packet, 20 mg packet, 40 mg packet

• Intravenous injection: 40 mg/vial for reconstitution

Granules in both capsules and packets are enteric-coated to resist breakdown by stomach acid.

Nexium dosage for adults

OTC Nexium 24HR is approved to treat heartburn in adults, but treatment is limited to 14 days. Prescription Nexium is FDA-approved to treat GERD, H. pylori infection, and hypersecretory conditions. It’s also FDA-approved to prevent stomach ulcers or peptic ulcer bleeding. Dosages and duration of treatment will vary by condition.

Nexium dosage for heartburn

Over-the-counter Nexium 24HR is FDA-approved to treat adults with heartburn. A single capsule is taken once per day in the morning before eating. Capsules are taken every day for 14 days. Nexium 24HR should not be used for more than two 14-day treatments in four months.

• Standard adult dosage for heartburn: 20 mg capsule taken once per day in the morning for 14 days

Nexium dosage for GERD

Healthcare professionals prescribe Nexium for symptomatic GERD. A single 20 mg capsule is taken once daily, one hour before meals for four weeks. If symptoms persist, the prescriber may add four more weeks to the treatment.

• Standard adult dosage for symptomatic GERD: 20 mg capsule taken once per day, one hour before meals, for four weeks

Nexium dosage for erosive esophagitis

Erosive esophagitis is a medical condition in which the esophagus lining is damaged by stomach acid. Nexium prevents acid reflux and gives the esophageal tissues time to heal. People will take their dose once daily, one hour before a meal. After four to eight weeks of treatment, the prescriber will transition to a smaller daily dose to maintain healing. 

• Standard adult dosage for treatment of erosive esophagitis: 20–40 mg capsule daily

• Standard adult maintenance dosage for erosive esophagitis: 20 mg capsule daily

Nexium dosage for H. pylori infection

Esomeprazole, the active ingredient in Nexium, is part of a triple therapy treatment for Helicobacter pylori (H. pylori) eradication. H. pylori is a bacteria that infects the stomach and can lead to ulcers. Patients will take a dose of Nexium and an antibiotic regimen, commonly the antibiotics amoxicillin and clarithromycin, twice daily for 10 to 14 days.

• Standard adult dosage for treatment of H. pylori eradication: 20-40 mg capsule twice daily with amoxicillin and clarithromycin for 10 to 14 days

Nexium dosage for hypersecretory conditions

Some conditions cause the stomach to secrete too much acid, causing peptic ulcers, pain, and other chronic symptoms. The most common is Zollinger-Ellison syndrome. These are chronic conditions with potentially severe complications so stomach acid reducers may be a lifelong need. Nexium doses are typically much higher for hypersecretory conditions than for other conditions. 

• Starting adult dosage for hypersecretory conditions: 40 mg capsule twice daily

• Standard adult dosage for hypersecretory conditions: 40–120 mg capsule twice daily

Nexium dosage for peptic ulcer prevention

Healthcare professionals use Nexium to prevent ulcers and other gastrointestinal problems in people on NSAID treatment. NSAIDs like aspirin or ibuprofen reduce the stomach’s ability to protect itself from acid, so stomach pain, gastritis, bleeding, and ulcers are possible side effects of NSAID treatment. There are no limits on the duration of Nexium treatment, but the Food and Drug Administration (FDA) advises that it should not be continued beyond six months.

• Standard adult dosage for peptic ulcer prophylaxis: 20–40 mg capsule daily

Nexium dosage for children

Over-the-counter Nexium 24HR is only approved for use in adults. Talk to a healthcare professional before giving Nexium 24HR to any child younger than 18 years of age.

Prescription Nexium is approved for pediatric use in children as young as one month old for erosive esophagitis and as young as one-year-old for symptomatic GERD. Children will take either Nexium capsules or an oral suspension prepared from Nexium granule packets.

Nexium dosage restrictions

People with kidney impairment can be prescribed normal adult doses of Nexium. However, the FDA has recommended that people with severe liver disease (Child-Pugh class C) take no more than 20 mg of Nexium per day. No dosage restrictions are necessary for older adults.

Nexium dosage for pets 

Do not give a pet Nexium. If a pet has abdominal pain or other symptoms of an ulcer, have a veterinarian examine the animal. 

Veterinarians prescribe proton pump inhibitors to treat gastrointestinal ulcers in animals, but the standard medication used is omeprazole. However, some veterinarians may prescribe esomeprazole to dogs and cats. Doses are not standardized but can be administered as a capsule or oral solution once per day. When giving a dose, ensure the dog or cat has not eaten. Intravenous injections of esomeprazole are available if the animal cannot take the drug by mouth.

How to take Nexium

Nexium is usually taken for a limited time, but doses must be taken daily. 

• Your doctor will tell you how much medicine to use. Do not use more than directed.

• Take all the medicine in your prescription, even if you feel better after a few days.

• Take this medicine at least 1 hour before a meal.

• Antacids can be taken with Nexium.

• If a dose is missed, take it as soon as it’s remembered unless it’s almost time for the next dose. If so, skip the missed dose and take the next dose as scheduled. Do not take extra medicine to make up for a missed dose.

• This medication comes with a medication guide. Please read it before taking the first dose.

• Store Nexium and Nexium 24HR in a closed container out of the reach of children at room temperature, away from heat, moisture, and direct light.

Nexium 24HR

• Follow the package instructions when taking this medicine. Keep the package so that you don’t lose the instructions and warnings.

• Swallow the capsule whole. Do not crush or chew it.

• Do not take this medicine for longer than 14 days.

Delayed-release capsules

• Swallow the capsule whole. Do not crush or chew it. 

• If you cannot swallow the capsule, open up the capsule, and pour the contents into 1 tablespoon of applesauce. Stir the mixture well and swallow it right away. Do not chew. Throw away any remaining mixture.

Granules

• Mix the contents of a 2.5 mg or 5 mg packet with 1 teaspoon (5 mL) of water and stir well. 

• Mix the contents of a 10 mg, 20 mg, or 40 mg packet with 1 tablespoon (15 mL) of water and stir well.

• After mixing the contents with water, let the mixture thicken for 2 to 3 minutes. Stir once more.

• Drink the solution within 30 minutes

• Add more water to any leftover medicine and drink it right away.

Feeding tube

• Nexium capsules can be used to prepare a solution for use in a nasogastric feeding tube.

• First, open the capsule, remove the plunger from a 60 mL catheter-tipped syringe, and pour the capsule's contents into the syringe. 

• Pour 50 mL of water into the syringe. 

• Place the plunger back into the syringe and shake well for 15 seconds. 

• Make sure no medicine is stuck in the tip of the syringe. 

• Inject the medicine into the gastric tube right away.

• Use water to rinse any leftover medicine through the tube.

Nexium dosage FAQs

How long can you take Nexium?

Nexium and other stomach acid reducers are only intended for limited use, usually two to eight weeks. Long-term use of stomach acid reducers increases the risk for vitamin B12 deficiency, Clostridium difficile diarrhea, low magnesium, and stomach polyps.

Can you overdose on Nexium?

Do not take too much Nexium. An overdose can cause symptoms such as sleepiness, confusion, blurred vision, and fast heartbeats. There is no treatment to reverse esomeprazole toxicity, but healthcare professionals can manage the symptoms. Call a poison control center or get medical treatment if too much Nexium is taken.

What interacts with Nexium?

Esomeprazole and other PPIs are contraindicated for concomitant use with any drugs that contain the HIV/AIDS drug rilpivirine.

Nexium interferes with the body’s ability to absorb some drugs, so these drugs are less effective. This is especially important for medications like the anticancer drug Tarceva (erlotinib), the organ transplant drug mycophenolate mofetil, and the antifungal drugs ketoconazole and itraconazole.

Esomeprazole can also speed up the body’s breakdown of other drugs in the bloodstream. These drugs will be less effective as a result. For some drugs, that may be critical, such as the blood thinner clopidogrel or the HIV/AIDS drugs atazanavir and Viracept (nelfinavir). 

Esomeprazole also slows down the breakdown of some drugs in the bloodstream, increasing the risk of possible serious side effects. These include the anticoagulants warfarin and cilostazol, the antiarrhythmic digoxin, tacrolimus, methotrexate, diazepam, and the antiviral drug saquinavir.

Some drugs called CYP2C19 or CYP3A4 Inducers speed up the body’s breakdown of esomeprazole, so Nexium will be less effective at reducing stomach acid. These drugs include rifampin, St. John’s wort, and ritonavir.

Some drugs, such as the antifungal drug voriconazole, decrease the body’s ability to metabolize esomeprazole, so there’s an increased risk of Nexium side effects like headache, flatulence, constipation, and dry mouth. People on high-dose Nexium may need a dose reduction to avoid drug interactions.

What happens when you mix Nexium and alcohol?

Alcohol and Nexium do not affect one another. However, alcohol stimulates stomach acid secretion, so drinking will partly offset the benefits of taking Nexium.

Is it safe to take Nexium during pregnancy?

There is no known risk to the baby or the pregnancy if Nexium is taken during pregnancy. Animal studies show a possible risk to the fetus, but clinical trials did not test the drug in pregnant women.

Is it safe to take Nexium while breastfeeding?

Although a small amount of esomeprazole is present in human breast milk, healthcare professionals do not believe taking Nexium while breastfeeding will produce adverse reactions in a nursing infant.

Sources

• Drugs used to treat gastrointestinal ulcers in monogastric animals, Merck Veterinary Manual Professional Version

• Nexium 24HR drug label information, NIH National Library of Medicine

• Nexium drug summary, Prescriber’s Digital Reference

• Nexium esomeprazole magnesium delayed release drug information, NIH National Library of Medicine

• Nexium I.V. esomeprazole sodium injection, NIH National Library of Medicine

• What is Nexium: uses, warnings, interactions & FAQs, SingleCare