A Guide to Heartburn Treatment with Nexium

What You Should Know About This Proton Pump Inhibitor

Nexium is taking orally.
Nexium is taking orally. Eric Audras/Getty Images

Known as the little purple pill, Nexium, which is also generically known as Esomeprazole, is available by prescription and over-the-counter. Belonging to a class of drugs known as proton pump inhibitors or PPIs, they are known as one of the most effective medications for treating heartburn and gastroesophageal reflux disease (GERD). Millions of prescriptions are filled each year.

How Does Nexium Work?

GERD is a condition in which acid from the stomach flows back into the esophagus — the pipe that food travels through from the mouth to the stomach — causing injury to the esophagus. Nexium works by releasing an enzyme that decreases the amount of acid made in the stomach. Basically doing as its name implies: inhibiting a pump.

The Increased Risks Associated with Nexium

As with many prescription medications, Nexium comes with side effects. (You can read more about those below.) As a class of drugs, PPIs have been associated with an increased risk of heart attack, kidney disease, and bone fractures.

This class of drugs was linked to heart attacks in a June 2015 PLOS One study that reviewed clinical notes of 3 million people. Stanford University researchers saw the strongest association between PPIs and cardiovascular events in those who were taking the medications over long periods of time.

As for the drug's association with kidney disease, at the American Society of Nephrology’s KidneyWeek 2015 in San Diego, two studies presented link PPIs like Nexium, Prilosec, or Prevacid — to increase chronic kidney disease risk. Both studies looked at tens of thousands of patients and both showed not causation, but at least a correlation.

Finally, several publications in the 2000s found a link between the use of PPIs and bone fractures, according to a review of the scientific literature by the U.S. Food and Drug Administration (FDA). But there was no consistent evidence linking bone density to PPI use. In fact, one study that screened out those who were at risk for fractures found no relationship between using the drug and fractures.

In all instances, communication with your doctor is key. Nexium, like other proton-pump inhibitors, is not meant to be taken for long periods of time. Many of the above studies looked at the long-term use of these medications and found at least a correlation between the medications use and the increased risk.

What to Tell Your Doctor Before and During Your Treatment

Before taking any medications, there are some things that you need to discuss with your doctor, such as:

  • The role these medications play in your GERD treatment and their risks.
  • What prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking.
  • If you are allergic to Nexium, Prevacid, Prilosec, Protonix, Aciphex, or any other medications.
  • If you have or have ever had liver disease.
  • If you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking Nexium, call your doctor.

During treatment, if you feel you also need an antacid, ask your doctor to recommend one and to tell you when and how to take it.

On the same note, if you miss a dose, contact your physician. Do not take a double dose to make up for a missed one. He or she will be able to determine if it is safe to do so, or if you should wait until your next scheduled dose.

You will also want to call your doctor if symptoms start to appear.

Possible Side Effects of Nexium

Tell your doctor if any of these symptoms are severe or do not go away:

  • Headache
  • Diarrhea
  • Upset stomach
  • Gas
  • Stomach pain
  • Constipation
  • Dry mouth

Some side effects of Nexium can be more serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

  • Hives
  • Skin rash
  • Itching
  • Difficulty breathing or swallowing
  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • Hoarseness


"Nexium." 620514-04 9346604 Rev. 02/03. U.S. Food and Drug Administration (FDA). 11 Mar 2007.

"Use of Proton Pump Inhibitors and Risk of Bone Fractures in Adults." Johnson, T. U.S. Food and Drug Administration (FDA). 3 June 2014.