Esomeprazole, Oral Capsule

Medically reviewed by University of Illinois-Chicago, Drug Information Group on January 5, 2017Written by University of Illinois-Chicago, Drug Information Group

Important warnings

  • Kidney damage warning: This drug may cause kidney damage. Tell your doctor if you have pain in the side of your back or changes in urination during treatment. These are signs of kidney problems.
  • Severe diarrhea warning: This drug can cause Clostridium difficile-associated diarrhea. This disease may cause mild diarrhea or severe inflammation of your colon. Severe reactions can be fatal (cause death). Call your doctor if you have diarrhea while taking this drug.
  • Long-term use warning: Using this drug for a long time comes with risks. It increases your risk of osteoporosis-related bone breaks in your hip, wrist, or spine. It may also cause inflammation of your stomach lining and low blood levels of magnesium. Taking this drug long-term can also make it harder for your body to absorb vitamin B-12. This can lead to a vitamin B-12 deficiency. Talk to your doctor about how long you can safely take this drug.
  • CLE and SLE warning: Esomeprazole can cause cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). CLE and SLE are autoimmune diseases. Symptoms of CLE can range from a rash on the skin and nose, to a raised, scaly, red or purple rash on certain parts of the body. Symptoms of SLE can include fever, tiredness, weight loss, blood clots, heartburn, and stomach pain. If you have any of these symptoms, call your doctor.

What is esomeprazole?

Esomeprazole is a prescription drug. Some forms are also available over the counter, but this article covers the prescription version only.

Esomeprazole magnesium and esomeprazole strontium come as delayed-release capsules. Esomeprazole magnesium also comes as a liquid suspension. Esomeprazole sodium is available in an intravenous (IV) form, which is only given by a healthcare provider.

Esomeprazole magnesium is available as the brand-name drug Nexium and as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Esomeprazole magnesium may be used as part of a combination therapy. This means you may need to take it with other medications, especially to treat Helicobactor pylori.

Why it's used

Esomeprazole magnesium is used to treat conditions caused by too much acid production in your stomach. These conditions include the following:

  • Heartburn caused by gastroesophageal reflux disease (GERD) and erosive esophagitis. Erosive esophagitis is caused by acid-related damage to the esophagus.
  • Zollinger-Ellison syndrome
  • Helicobactor pylori infections when used in combination with other treatments, such as antibiotics. This infection causes ulcers in part of your intestine.

This drug is also used to prevent stomach ulcers due to the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

How it works

Esomeprazole magnesium belongs to a class of drugs called proton pump inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Esomeprazole decreases the amount of acid your stomach produces. It works by blocking the proton pump in the stomach’s cells. When the proton pump is blocked, your stomach makes less acid.

Esomeprazole side effects

Esomeprazole magnesium oral capsule doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The adult side effects for esomeprazole magnesium are slightly different from the side effects for children.

Adult side effects can include:

  • headache
  • diarrhea
  • nausea
  • flatulence (passing gas)
  • stomach pain
  • constipation
  • dry mouth

Children’s side effects can include the above, plus:

  • regurgitation (burping up food) in babies
  • increased breathing rate in babies

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Severe diarrhea. Symptoms can include:
    • watery stool
    • stomach pain
    • fever that doesn’t go away
  • Bone breaks. Using this drug every day for a long time can increase the risk of osteoporosis-related fractures of your hip, wrist, or spine.
  • Atrophic gastritis (inflammation of the stomach lining). Using this drug every day for a long time can cause this condition. You may or may not have symptoms. If you do, they can include:
    • stomach pain
    • nausea
    • vomiting
    • weight loss
  • Low blood levels of magnesium. Using this drug every day for a long time can cause this side effect. Symptoms can include:
    • seizures
    • dizziness
    • abnormal or fast heart rate
    • jitteriness
    • tremors (jerking movements or shaking)
    • muscle weakness
    • spasms in your hands and feet
    • cramps or muscle aches
    • spasm of your voice box
  • Vitamin B-12 deficiency. Using this drug every day for a long time can make it harder for your body to absorb vitamin B-12. Symptoms can include:
    • nervousness
    • neuritis (inflammation of a nerve). symptoms can include:
      • nerve pain
      • tingling
    • numbness and tingling in your hands and feet
    • poor muscular coordination
    • menstrual bleeding that’s heavier than normal
  • Allergic reaction. Symptoms can include:
    • trouble breathing or swallowing
    • shortness of breath
    • angioedema (swelling of your face, throat, or tongue)
    • itching
    • symptoms of kidney damage, such as:
      • decreased urination
      • flank pain (pain in your side and back)
    • chest tightness
    • paleness or reddening of your face and body
    • panic attack or feeling of impending doom
  • Inflammation in your kidneys. This can happen at any time during treatment with this drug. It may be part of an allergic reaction. If this happens, your doctor will have you stop taking this drug. Symptoms can include:
    • nausea and vomiting
    • diarrhea
    • low blood pressure, which can cause dizziness and fainting
    • decreased urination
    • flank pain (pain in your side and back)
  • Cutaneous lupus erythematosus (CLE). Symptoms can include:
    • rash on the skin and nose
    • raised, red, scaly, red or purple rash on your body
  • Systemic lupus erythematosus (SLE). Symptoms can include:
    • fever
    • tiredness
    • weight loss
    • blood clots
    • heartburn

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Esomeprazole may interact with other medications

Esomeprazole magnesium oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with esomeprazole magnesium are listed below.

Drugs you should not use with esomeprazole

Do not take these drugs with esomeprazole. Doing so can cause dangerous effects in your body. Examples of these drugs include:

  • Clopidogrel. Esomeprazole can block clopidogrel from working in your body. If you need to take esomeprazole, your doctor may consider a different anti-platelet drug.

Interactions that increase your risk of side effects

  • Side effects from other drugs: Taking esomeprazole magnesium with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
    • Diazepam. Esomeprazole magnesium can cause diazepam to build up in your body. This can cause more side effects from diazepam.
    • Warfarin. Esomeprazole magnesium can increase the blood-thinning effect of warfarin. This can increase your international normalized ratio (INR) test results and prothrombin time. This interaction can increase bleeding and be fatal (cause death). If you need to take these drugs together, your doctor will watch you closely and may adjust your warfarin dosage.
    • Cilostazol. Esomeprazole magnesium can slow the breakdown of this drug. This can increase the levels of cilostazol in your body. If you need to take these drugs together, your doctor will decrease your dosage of cilostazol.
    • Digoxin. Esomeprazole magnesium can increase the levels of digoxin in your body. Your doctor may check your digoxin blood levels and adjust your digoxin dosage if needed.
    • Methotrexate. Esomeprazole magnesium can increase the levels of methotrexate in your body. This may cause dangerous side effects. These side effects can include nausea, vomiting, headache, fatigue, and liver and kidney damage. If you need to take a high dose of methotrexate, your doctor may have you stop taking esomeprazole for a short time.
    • Saquinavir. Esomeprazole magnesium may increase the levels of saquinavir in your body. This may cause more side effects from saquinavir. These may include fatigue, confusion, stomach and back pain, nausea, vomiting, and liver damage. Your doctor may watch you more closely and decrease your dosage of saquinavir if needed.
    • Tacrolimus. Esomeprazole magnesium can increase the levels of tacrolimus in your body. This may cause high blood pressure and kidney damage. Your doctor may check your tacrolimus levels and adjust your dosage if needed.
  • Side effects from esomeprazole magnesium: Taking esomeprazole magnesium with certain medications raises your risk of side effects from esomeprazole. This is because the amount of esomeprazole in your body is increased. Examples of these drugs include:
    • Voriconazole. Voriconazole can double the levels of esomeprazole magnesium in your body. Your doctor may decrease your dose of esomeprazole. They may be more likely to lower your dosage if you have Zollinger-Ellison’s syndrome and take a high dosage.
    • Clarithromycin

Interactions that can make your drugs less effective

  • When other drugs are less effective: When certain drugs are used with esomeprazole magnesium, they may not work as well. This is because the amount of these drugs in your body may be decreased. Examples of these drugs include:
    • Certain antiretrovirals, such as atazanavir and nelfinavir. Esomeprazole magnesium may keep you from absorbing these drugs well. This means that they won’t work to treat your virus. You shouldn’t take esomeprazole with these drugs.
    • Mycophenolate mofetil. Esomeprazole magnesium may change the balance of your stomach acid. This may decrease how well you absorb mycophenolate mofetil. It isn’t known how this will affect your transplant. Ask your doctor whether it’s safe for you to use these drugs together.
  • When esomeprazole magnesium is less effective: When esomeprazole magnesium is used with certain drugs, it may not work as well to treat your condition. This is because the amount of esomeprazole in your body may be decreased. Examples of these drugs include:
    • St. John’s wort. You shouldn’t use these drugs together.
    • Rifampin. You shouldn’t use these drugs together.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Esomeprazole warnings

This drug comes with several warnings.

Allergy warning

Esomeprazole magnesium can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing or swallowing
  • shortness of breath
  • swelling of your face, throat, or tongue
  • itching
  • kidney damage, with symptoms such as:
    • decreased urination
    • flank pain (pain in your side and back)
  • chest tightness
  • paleness or reddening of your face and body
  • panic attack or feeling of impending doom

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interactions warning

Taking this drug with food can decrease the amount of esomeprazole magnesium in your body. You should take this drug at least one hour before meals.

Warnings for people with certain health conditions

For people with severe liver problems: This drug is processed by your liver. If you have severe liver disease, your body may not be able to process this drug as well. This could cause the drug to build up in your body and cause more side effects.

For people with low magnesium blood levels: Taking this drug for 3 months or longer can decrease magnesium levels in your blood. This can further decrease your low magnesium levels. Your doctor may give you magnesium supplements and monitor your magnesium levels.

For people with a vitamin B-12 deficiency: Taking this drug for 2–3 years can decrease vitamin B-12 levels in your blood. This can further decrease your low vitamin B-12 levels. Your doctor may give you vitamin B-12 injections and monitor your vitamin B-12 levels.

For people with osteoporosis: Using this drug every day for a long time can increase your risk of hip, wrist, or spine fractures.

For people with plans to have neuroendocrine tumor test: This drug can change the balance of your stomach acid. This may cause a test for neuroendocrine tumors to be positive when there isn’t a tumor.

Warnings for other groups

For pregnant women: Esomeprazole magnesium is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk.

For women who are breastfeeding: Esomeprazole magnesium may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For children: Esomeprazole magnesium hasn’t been studied in children younger than 1 month.

How to take esomeprazole

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Esomeprazole magnesium

  • Form: oral delayed-release capsule
  • Strengths: 20 mg, 40 mg

Brand: Nexium

  • Form: oral delayed-release capsule
  • Strengths: 20 mg, 40 mg

Dosage for GERD or erosive esophagitis

Adult dosage (ages 18 years and older)

  • Healing erosive esophagitis:
    • 20 mg or 40 mg taken once per day for 4–8 weeks.
    • If this treatment doesn’t work, your doctor may repeat the treatment for another 4–8 weeks.
  • Maintenance of healed erosive esophagitis:
    • 20 mg taken once per day.
  • Treatment of symptomatic gastroesophageal reflux disease:
    • 20 mg taken once per day for 4 weeks.

Child dosage (ages 12–17 years)

  • Healing erosive esophagitis:
    • 20 mg or 40 mg taken once per day for 4–8 weeks.
  • Symptomatic gastroesophageal reflux disease (GERD):
    • 20 mg taken once per day for 4 weeks.

Child dosage (ages 1–11 years)

  • Symptomatic GERD: 10 mg taken once per day for 8 weeks.
  • Erosive esophagitis:
    • Children who weigh less than 44 lb (20 kg): Given 10 mg once per day for 8 weeks.
    • Children who weigh 44 lb (20 kg) or more: 10 mg or 20 mg taken once per day for 8 weeks.

Child dosage (ages 1–11 months)

  • Erosive esophagitis due to GERD:
    • Children who weigh 6.6–11 lb (3–5 kg): Given 2.5 mg once per day for up to 6 weeks.
    • Children who weigh >11–16.5 lb (>5–7.5 kg): Given 5 mg once per day for up to 6 weeks.
    • Children who weigh >16.5–26.5 lb (>7.5–12 kg): Given 10 mg once per day for up to 6 weeks.

Child dosage (younger than 1 month)

This drug hasn’t been studied in infants younger than 1 month of age.

Dosage for stomach ulcer

Adult dosage (ages 18 years and older)

  • 20 mg or 40 mg taken once per day for up to 6 months.

Child dosage (ages 0–17 years)

This drug hasn’t been studied in children younger than 18 years for this condition.

Dosage for helicobacter pylori infection

Adult dosage (ages 18 years and older)

Typical dosage is 40 mg taken once per day for 10 days with amoxicillin and clarithromycin.

Child dosage (ages 0–17 years)

This drug hasn’t been studied in children younger than 18 years for this condition.

Dosage for Zollinger-Ellison syndrome

Adult dosage (ages 18 years and older)

Typical dosage is 40 mg taken twice per day. Sometimes doses up to 240 mg per day are needed.

Child dosage (ages 0–17 years)

This drug hasn’t been studied in children younger than 18 years for this condition.

Special dosage considerations

For people with severe liver problems: The maximum dosage of esomeprazole magnesium shouldn’t be more than 20 mg per day.

Dosage warnings

Take this drug as directed by your doctor. Your doctor should give you the drug at the lowest dosage possible and for the shortest time needed. This will lower your risk of side effects.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Esomeprazole magnesium is used for long-term treatment of Zollinger-Ellison syndrome. It’s used for short-term treatment of the following:

  • gastroesophageal reflux disease (GERD)
  • risk of stomach ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Helicobacter pylori infection

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your heartburn won’t improve, or the damage to your esophagus or stomach from too much acid won’t heal.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • confusion
  • drowsiness
  • blurred vision
  • fast heart rate
  • nausea
  • sweating
  • flushing (reddening and warming of your face)
  • headache
  • dry mouth

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You should have less heartburn and stomach pain. If you’re taking this drug to prevent ulcers, your doctor will do tests to check if it’s working for you.

Important considerations for taking esomeprazole

Keep these considerations in mind if your doctor prescribes esomeprazole magnesium for you.

General

  • Take this drug at least 1 hour before meals.
  • Take this drug at the time(s) recommended by your doctor.
  • Swallow the oral capsules whole. Don’t chew or crush them. If you can not swallow the capsule, you can open it and empty its contents into a tablespoon of applesauce. Swallow the mixture right away. Don’t crush or chew the granules. Don’t save it and take it later.

Storage

  • Store this drug at room temperature. Keep it between 59°F and 86°F (15°C and 30°C).
  • Keep it away from light.
  • Keep the container of the capsules tightly closed.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Liver function: Your doctor may do blood tests to check how well your liver is working. If you have severe liver problems, your doctor may give you a lower dosage of this drug.
  • Diarrhea: If you have diarrhea that’s not going away, your doctor may check for Clostridium difficile.
  • Magnesium levels: This drug may decrease the level of magnesium in your body. Your doctor may check your magnesium blood levels and give you magnesium supplements.
  • Vitamin B-12: This drug may decrease the levels of vitamin B-12 in the body. Your doctor may check your vitamin B-12 levels and give you vitamin B-12 injections.
  • Osteoporosis: This drug may increase your risk of bone fractures if you have osteoporosis. Your doctor may do tests to check for osteoporosis.

Your diet

This drug may change the balance of your stomach acid. This may change how your body absorbs certain foods. However, you don’t need to change your diet.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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