Esomeprazole: uses, dosing, side effects & brands

Esomeprazole is a proton pump inhibitor sold in the U.S. under 4 brand and generic names, for duodenal ulcer, esophagitis and gastroesophageal reflux. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.

By the pharmaranks editorial teamReviewed against the FDA (openFDA label, NDC Directory & Enforcement) sourcesUpdated Jul 24, 2026How we research

Key facts

Drug class: Proton Pump Inhibitor
Treats (across its forms): Duodenal Ulcer, Esophagitis and Gastroesophageal Reflux
Available as: Capsule, delayed release · Powder, delayed release · Tablet · Powder, extended release · Injectable · Powder
Sold as: 4 products — Nexium, Nexium 24hr and Esomeprazole Magnesium, and others
Prescription?: Both Rx and OTC forms
Generic available?: Yes
What the pharmacy pays: about $178 for a 30-count supply — not your price

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How Nexium is dosed

From the FDA label for Nexium (application NDA022101). Other esomeprazole products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.

Population Recommended Adult (2.1) and Pediatric Dosage (2.2) Healing of EE (1 year and older) EE due to Acid-Mediated GERD (1 month to less than 1 year) Adults 20 mg or 40 mg A maximum dosage of 20 mg once daily is recommended for patients with severe liver impairment (Child-Pugh Class C). once daily for 4 to 8 weeks; some patients may require an additional 4 to 8 weeks 12 years to 17 years 20 mg or 40 mg once daily for 4 to 8 weeks 1 month to 11 years see full prescribing information for weight-based dosing and duration of treatment ( 2.2 ) Maintenance of Healing of EE Adults 20 mg once daily. Controlled studies do not extend beyond 6 months Treatment of Symptomatic GERD Adults 20 mg once daily once daily for 4 weeks some patients may require an additional 4 weeks 12 years to 17 years 20 mg once daily for 4 weeks 1 year to 11 years 10 mg once daily for up to 8 weeks Risk Reduction of NSAID-Associated Gastric Ulcer Adults 20 mg or 40 mg once daily for up to 6 months Controlled studies do not extend beyond 6 months. H. pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence Adults NEXIUM 40 mg once daily for 10 days Amoxicillin 1000 mg twice daily for 10 days Refer to the amoxicillin and clarithromycin prescribing information for dosage adjustments in elderly and renally-impaired patients. Clarithromycin 500 mg twice daily for 10 days Pathological Hypersecretory…

Everything below is the FDA label for Nexium (capsule, delayed release, powder, delayed release). Esomeprazole is also sold as tablet, powder, extended release, injectable and powder, and those are different medicines to take — follow the label for the one you were prescribed.

Nexium side effects

The following serious adverse reactions are described below and elsewhere in labeling: • Acute Tubulointerstitial Nephritis [see Warnings and Precautions (5.2) ] • Clostridium difficile-Associated Diarrhea [see Warnings and Precautions (5.3) ] • Bone Fracture [see Warnings and Precautions (5.4) ] • Severe Cutaneous Adverse Reactions [see Warnings and Precautions (5.5) ] • Cutaneous and Systemic Lupus Erythematosus [see Warnings and Precautions (5.6) ] • Cyanocobalamin (Vitamin B-12) Deficiency [see Warnings and Precautions (5.8) ] • Hypomagnesemia and Mineral Metabolism [see Warnings and Precautions (5.9) ] • Fundic Gland Polyps [see Warnings and Precautions (5.13) ] Most common adverse reactions (6.1) : • Adults (≥ 18 years) ( > 1%) are: headache, diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth. • Pediatrics (1 to 17 years) ( > 2%) are: headache, diarrhea, abdominal pain, nausea, and somnolence. • Pediatrics (1 month to less than 1 year) (>1%) are: abdominal pain, regurgitation, tachypnea, and increased ALT. To report SUSPECTED ADVERSE REACTIONS, contact AstraZeneca at 1-800-236-9933 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical…

Who shouldn’t take Nexium

NEXIUM is contraindicated in patients with known hypersensitivity to substituted benzimidazoles or to any component of the formulation. Hypersensitivity reactions may include anaphylaxis, anaphylactic shock, angioedema, bronchospasm, acute tubulointerstitial nephritis, and urticaria [see Warnings and Precautions (5.2) , Adverse Reactions (6.2) ]. • For information about contraindications of amoxicillin and clarithromycin, indicated in combination with NEXIUM for H. pylori eradication to reduce the risk of duodenal ulcer recurrence, refer to the Contraindications section of the respective prescribing information. • Proton pump inhibitors (PPIs), including NEXIUM, are contraindicated in patients receiving rilpivirine-containing products [see Drug Interactions (7) ] . • Known hypersensitivity to substituted benzimidazoles or any component of the formulation. ( 4 ) • Patients receiving rilpivirine-containing products. ( 4 , 7 ) • Refer to the Contraindications section of the prescribing information for amoxicillin and clarithromycin, when administered in combination with NEXIUM. ( 4 )

Nexium drug interactions

Tables 3 and 4 include drugs with clinically important drug interactions and interaction with diagnostics when administered concomitantly with esomeprazole and instructions for preventing or managing them. Consult the labeling of concomitantly used drugs to obtain further information about interactions with PPIs. Table 3: Clinically Relevant Interactions Affecting Drugs Co-Administered with Esomeprazole and Interaction with Diagnostics Antiretrovirals Clinical Impact: The effect of PPIs on antiretroviral drugs is variable. The clinical importance and the mechanisms behind these interactions are not always known. • Decreased exposure of some antiretroviral drugs (e.g., rilpivirine atazanavir, and nelfinavir) when used concomitantly with esomeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology (12.3) ] . • Increased exposure of other antiretroviral drugs (e.g., saquinavir) when used concomitantly with esomeprazole may increase toxicity [see Clinical Pharmacology (12.3) ] . • There are other antiretroviral drugs which do not result in clinically relevant interactions with esomeprazole. Intervention: Rilpivirine-containing products: Concomitant use with NEXIUM is contraindicated [see Contraindications (4) ] . Atazanavir: See prescribing information for atazanavir for dosing information. Nelfinavir: Avoid concomitant use with NEXIUM. See prescribing information for nelfinavir. Saquinavir: See the prescribing information for saquinavir for monitoring of potential saquinavir-related toxicities. Other antiretrovirals: See prescribing information for specific antiretroviral drugs Warfarin Clinical Impact: Increased INR and prothrombin time in patients receiving PPIs, including esomeprazole, and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Intervention: Monitor INR and prothrombin time and adjust the dose of warfarin, if needed, to maintain the target INR range. Methotrexate Clinical Impact: Concomitant use of esomeprazole with methotrexate (primarily at high dose) may elevate and prolong serum concentrations of methotrexate and/or its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities. No formal drug interaction studies of high-dose methotrexate with PPIs have been conducted [see Warnings and Precautions (5.12) ] . Intervention: A temporary withdrawal of NEXIUM may be considered in some patients receiving high-dose methotrexate. 2C19 Substrates (e.g., clopidogrel, citalopram, cilostazol) Clopidogrel Clinical Impact: Concomitant use of esomeprazole 40 mg resulted in reduced plasma concentrations of the active metabolite of clopidogrel and a reduction in platelet inhibition [see Clinical Pharmacology (12.3) ] . There are no adequate combination studies of a lower dose of esomeprazole or a higher dose of clopidogrel in comparison with the approved dose of clopidogrel. Intervention: Avoid concomitant use with NEXIUM Consider use of alternative anti-platelet therapy [see Warnings and Precautions (5.7) ] . Citalopram Clinical Impact: Increased exposure of citalopram leading to an increased risk of QT prolongation [see Clinical Pharmacology (12.3) ]. Intervention: Limit the dose of citalopram to a maximum of 20 mg per day. See prescribing information for citalopram. Cilostazol Clinical Impact: Increased exposure of cilostazol and one of its active metabolites (3,4-dihydro-cilostazol) [see Clinical Pharmacology (12.3) ]. Intervention: Consider reducing the dose of cilostazol to 50 mg twice daily. See prescribing information for cilostazol. Digoxin Clinical Impact: Potential for increased exposure of digoxin [see Clinical Pharmacology (12.3) ]. Intervention: Monitor digoxin concentrations and adjust the dose, if needed, to maintain therapeutic drug concentrations. See prescribing information for digoxin. Combination Therapy with Clarithromycin and Amoxicillin Clinical Impact: Concomitant administration of clarithromycin with other drugs can lead to serious adverse reactions, including potentially fatal arrhythmias, and are contraindicated. Amoxicillin also has drug interactions. Intervention: See Contraindications, Warnings and Precautions in prescribing information for clarithromycin. See Drug Interactions in prescribing information for amoxicillin. Drugs Dependent on Gastric pH for Absorption (e.g., iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole/itraconazole) Clinical Impact: Esomeprazole can reduce the absorption of other drugs due to its effect on reducing intragastric acidity Intervention: Mycophenolate mofetil (MMF): Co-administration of omeprazole, of which esomeprazole is an enantiomer, in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the active metabolite, mycophenolic acid (MPA), possibly due to a decrease in MMF solubility at an increased gastric pH. The clinical relevance of reduced MPA exposure on organ rejection has not been established in transplant patients receiving NEXIUM and MMF. Use NEXIUM with caution in transplant patients receiving MMF [ see Clinical Pharmacology (12.3) ]. See the prescribing information for other drugs dependent on gastric pH for absorption. Tacrolimus Clinical Impact: Potentially increased exposure of tacrolimus, especially in transplant patients who are intermediate or poor metabolizers of CYP2C19. Intervention: Monitor tacrolimus whole blood concentrations and consider reducing the dose, if needed, to maintain therapeutic drug concentrations. See prescribing information for tacrolimus. Interactions with Investigations of Neuroendocrine Tumors Clinical Impact: Serum chromogranin A (CgA) levels increase secondary to PPI-induced decreases in gastric acidity. The increased CgA level may cause false positive results in diagnostic investigations for neuroendocrine tumors [see Warnings and Precautions (5.11) , Clinical Pharmacology (12.2) ]. Intervention: Discontinue NEXIUM at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high. If serial tests are performed (e.g. for monitoring), the same commercial laboratory should be used for testing, as reference ranges between tests may vary. Interaction with Secretin Stimulation Test Clinical Impact: Hyper-response in gastrin secretion in response to secretin stimulation test, falsely suggesting gastrinoma. Intervention: Discontinue NEXIUM 4 weeks prior to testing [see Clinical Pharmacology (12.2) ] False Positive Urine Tests for THC Clinical Impact: There have been reports of false positive urine screening test for tetrahydrocannabinol (THC) in patients receiving PPIs. Intervention: An alternative confirmatory method should be considered to verify positive results. Table 4: Clinically Relevant Interactions Affecting Esomeprazole When Co-Administered with Other Drugs CYP2C19 or CYP3A4 Inducers Clinical Impact: Decreased exposure of esomeprazole when used concomitantly with strong inducers [see Clinical Pharmacology (12.3) ]. Intervention: St. John’s Wort, rifampin : Avoid concomitant use with [see Warnings and Precautions (5.10) ]. Ritonavir-containing products : see prescribing information for specific drugs Voriconazole Clinical Impact: Increased exposure of esomeprazole [see Clinical Pharmacology (12.3) ]. Intervention: Dose adjustment of NEXIUM is not normally required. However, in patients with Zollinger-Ellison syndrome, who may require higher doses, dosage adjustment may be considered. See prescribing information for voriconazole. See full prescribing information for a list of clinically important drug interactions. ( 7 )

Every esomeprazole product we track (4)

Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.

Esomeprazole products
#	Drug	Rating	Type	Form	Generic?	Pharmacy pays
1	Nexium	70/100	Prescription	Capsule	No data	—	View →
2	Nexium 24hr	70/100	Over-the-counter	Capsule	No data	—	View →
3	Esomeprazole Magnesium	66/100	Prescription	Capsule	No data	—	View →
4	Esomeprazole Sodium	Not yet rated	Prescription	Injectable	Generic	$178	View →

What esomeprazole pills look like

Imprint codes, colour and shape from the FDA’s labelling data. Match the imprint on your pill — or search any imprint.

Esomeprazole pill imprints
Imprint	Strength	Colour	Shape	Maker
186;20mg	20 mg	white	capsule	—
186;20mg	20 mg	white	capsule	—
RG;50	20 mg	pink	capsule	—
L898	20 mg	blue	capsule	—
A108;40mg	40 mg	blue	capsule	—

Combination products containing esomeprazole

A combination is a different drug — different dosing, different warnings. It is listed here so you can find it, not so you can substitute it.

Vimovo

Esomeprazole recalls

From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.

Can you crush or split esomeprazole?

At least one esomeprazoleproduct is labelled to be swallowed whole — crushing an extended-release tablet releases the whole day’s dose at once. Which applies depends on the form you were given.

What each esomeprazole label says about crushing, splitting and chewing

How long does esomeprazole take to work?

“It may take 1 to 4 days for you to feel the full benefit of the medication.” — MedlinePlus, U.S. National Library of Medicine.

What the NIH says about how quickly esomeprazole works

How long esomeprazole keeps

No esomeprazole label we read sets a separate limit for after opening, but they do specify how it must be stored — and the stability behind any date assumes those conditions.

Does esomeprazole expire? The in-use limits and storage rules from its labels

Esomeprazole and breastfeeding

From LactMed, the US National Library of Medicine’s Drugs and Lactation Database — quoted, not rewritten.

Esomeprazole is the S-enantiomer of the proton-pump inhibitor, omeprazole. Limited information indicates that maternal doses of 10 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.

Full LactMed record for esomeprazole: levels in milk, effects in breastfed infants, and the drugs it would consider instead

National Institute of Child Health and Human Development, record revised May 15, 2022. LactMed states its information is not a substitute for professional judgement.

What people report to the FDA about esomeprazole

The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 18,789 reports naming esomeprazole, and the FDA flagged 80% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:

nausea1,880 reports
diarrhoea1,470 reports
fatigue1,467 reports
headache1,448 reports
dyspnoea1,317 reports
arthralgia1,255 reports
malaise1,065 reports
chronic kidney disease895 reports

Read these as a signal, not a rate. A report does not mean esomeprazole caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.

Source: openFDA drug/event (FAERS), retrieved July 25, 2026.

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Frequently asked questions

What is Nexium?

The active ingredient in NEXIUM ® (esomeprazole magnesium) delayed-release capsules for oral administration and NEXIUM (esomeprazole magnesium) for delayed-release oral suspension is bis(5-methoxy-2-[(S)-[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-1 H -benzimidazole-1-yl) magnesium trihydrate, a PPI. Esomeprazole is the S-isomer of omeprazole, which is a mixture of the S- and R- isomers. (Initial U.S. approval of esomeprazole magnesium: 2001).

What kind of drug is esomeprazole?

The FDA classifies esomeprazole as a proton pump inhibitor. Proton pump inhibitors block the H+/K+ ATPase 'proton pump' in the stomach's acid-making cells, the final step in producing stomach acid. By binding this pump, they sharply and lastingly cut acid output, easing heartburn and helping ulcers heal. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.

Can you take esomeprazole with other medicines?

It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run esomeprazole against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.

What brand names is esomeprazole sold under?

We track 4 esomeprazole-containing products in the U.S.: Nexium, Nexium 24hr, Esomeprazole Magnesium and Esomeprazole Sodium. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.

What forms does esomeprazole come in?

Across the brands we track, esomeprazole is currently marketed as capsule, delayed release, powder, delayed release, tablet, powder, extended release, injectable and powder, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.

Is there a generic esomeprazole?

Yes. Our catalog lists 2 generic esomeprazole products alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.

Has esomeprazole been recalled?

The FDA's Enforcement database lists 3 recall records whose product description mentions esomeprazole. The most recent: Esomeprazole Magnesium for Delayed-Release Oral Suspension (May 13, 2025). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.

How long does it take for esomeprazole to work?

Esomeprazole isn't a rescue antacid. You may notice some relief the first day, but its full acid-blocking effect takes 1-4 days of once-daily dosing, taken about an hour before eating. Healing erosive esophagitis or ulcers runs weeks. If you need instant relief from a flare, an antacid acts in minutes; esomeprazole works gradually to prevent heartburn from returning.

What are the common side effects of esomeprazole?

Headache, diarrhea, nausea, gas, abdominal pain, constipation, and dry mouth are the reactions reported in the FDA label's adult trials, and for most people they are mild and settle over the first week or two. One dosing detail changes both how well it works and how you feel: esomeprazole should be taken at least 1 hour before a meal. Proton pump inhibitors only shut down pumps that are actively working, so a capsule swallowed after dinner or at bedtime on an empty stomach does substantially less than the same capsule taken an hour before breakfast.

What are the serious risks of long-term esomeprazole?

The FDA label attaches most of them to duration rather than dose. Low magnesium has been reported after at least three months of treatment, in most cases after a year, and can cause tetany, seizures, and arrhythmias — symptoms include muscle cramps, tremor, jitteriness, and palpitations. Vitamin B12 malabsorption is flagged for daily use longer than about 3 years. Osteoporosis-related fractures of the hip, wrist, or spine appear in observational studies of high-dose (multiple daily doses) and long-term (a year or longer) therapy. Fundic gland polyps become more likely beyond one year. The label's consistent instruction is to use the lowest dose for the shortest duration appropriate — so if you have been refilling it for years without a review, that review is overdue. Do not stop abruptly on your own if you are being treated for a healing ulcer or Barrett's esophagus; symptoms commonly return after stopping, and a step-down plan works better than a hard stop.

When should I call a doctor about esomeprazole?

Call promptly for: watery or bloody diarrhea that does not improve, especially with fever or cramping (C. difficile-associated diarrhea is a labeled risk); decreased urination, swelling, blood in urine, fatigue, nausea, or fever and rash, which can signal acute tubulointerstitial nephritis — the label notes this can begin at any point in therapy, even years in; a rash on sun-exposed skin, joint pain, or fatigue (cutaneous or systemic lupus erythematosus, mostly cutaneous, reported weeks to years after starting); or muscle cramps, spasms, an irregular heartbeat, or seizure (low magnesium). Go to the ER for a painful spreading rash with blisters or peeling, or mouth, eye, and genital sores — SJS, TEN, DRESS, and AGEP are all in the label's severe cutaneous reaction warning, which directs that the drug be stopped at the first sign. Separately, heartburn that improves on a PPI does not rule out stomach cancer; the label says a symptomatic response does not preclude gastric malignancy, so trouble swallowing, vomiting blood, black stools, or unintended weight loss need investigation, not another refill.

What drugs interact with esomeprazole?

Two are absolute or near-absolute. Rilpivirine-containing HIV products are contraindicated with esomeprazole and every other PPI. And the label says to avoid concomitant use of esomeprazole with clopidogrel (Plavix): clopidogrel is a prodrug that needs CYP2C19 to become active, esomeprazole inhibits that enzyme, and 40 mg esomeprazole reduces clopidogrel's pharmacological activity — the label directs consideration of alternative antiplatelet therapy. Also on the list: avoid St. John's wort and rifampin, which lower esomeprazole levels; high-dose methotrexate, where PPIs can raise and prolong methotrexate levels enough to cause toxicity; and chromogranin A testing for neuroendocrine tumors, which requires stopping the PPI at least 14 days beforehand. Because acid is needed to absorb them, drugs such as atazanavir, certain antifungals, and some iron salts can be affected too.

Cite this page

APA: pharmaranks. (2026, July 24). Esomeprazole: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/esomeprazole
MLA: “Esomeprazole: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/esomeprazole.

We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.

Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.

Read the full FDA label for esomeprazole on DailyMed (NIH) ↗.