Skip to main content

What Are the Side Effects of Esomeprazole?

Doctor and patient talking in doctor’s office

When looking for relief from frequent heartburn, it’s important to research the options available and understand the possible side effects of certain drugs.

Esomeprazole is the active ingredient in Nexium 24HR and is part of a class of drugs called proton pump inhibitors (PPIs), which help reduce the amount of acid produced by the stomach.1,2

Esomeprazole: over-the-counter

Researching side effects, you will want to differentiate between over-the-counter (you don’t need a medical provider’s prescription to buy) and prescribed medication.

A dose of over-the-counter Nexium 24HR is indicated to treat frequent heartburn, meaning heartburn that occurs two or more days per week.1 A dose Nexium 24HR contains 20mg of esomeprazole. You should not take a course of Nexium 24HR for longer than 14 days in a row, unless you’ve been instructed to do so by a healthcare professional. A 14-day treatment cycle may be repeated every four months.

Does Nexium 24HR Have Side Effects?

Nexium 24HR may come with side effects and may interact with certain medications.3 Please be sure to take precautions.

Before you start

  1. Do not use Nexium 24HR if you have:
    • trouble or pain swallowing food,
    • vomiting with blood,
    • bloody or black stools
    • heartburn with lightheadedness, sweating or dizziness
    • chest pain or shoulder pain with shortness of breath; sweating; pain spreading to arms, neck or shoulders; or lightheadedness
    • frequent chest pain

    See your doctor; these may be signs of a serious condition! 3

  2. If you are pregnant or breastfeeding, ask a health professional before use.1 Research is still ongoing when it comes to determining the risk of using esomeprazole while breastfeeding. Talk to your doctor before using esomeprazole if you are breastfeeding or plan to begin breastfeeding.4
  3. Consult with your doctor or pharmacist before using over-the-counter Nexium 24HR if you are taking:
    • warfarin, clopidogrel or cilostazol (blood-thinning medicines)
    • prescription antifungal or anti-yeast medicines
    • digoxin (heart medicine)
    • diazepam (anxiety medicine)
    • tacrolimus or mycophenolate mofetil (immune system medicines)
    • prescription antiretrovirals (medicines for HIV infection)
    • methotrexate (arthritis medicine)
  4. Discuss with your doctor as well if you are taking other medications have had heartburn for the last three months, are experiencing unexplained weight loss, nausea or vomiting, stomach pain or frequent wheezing with heartburn.3

Pay attention to how you feel

Stop taking Nexium 24HR and ask a doctor if

  • your heartburn continues or worsens
  • you need to take this product for more than 14 days
  • you need to take more than one course of treatment every four months
  • you get diarrhea
  • you develop a rash or joint pain

It’s also important to note that you may be allergic to a non-active ingredient in a product containing esomeprazole.4 Non-active ingredients can include preservatives, dyes, and other substances. Make sure to read the product label closely.4

Esomeprazole by prescription

The prescription medication, referred to as just “Nexium”, is available in 20 mg and 40 mg doses of esomeprazole and might be prescribed for a longer period. Prescription Nexium is indicated to treat a wider range of issues and symptoms, including the symptoms of gastroesophageal reflux disease (GERD) and ulcers.

Esomeprazole Side Effects

Some of the below side effects have been reported from long-term prescription esomeprazole usage. Always refer to the product label for specific drug information:1

  • nausea
  • diarrhea
  • gas
  • constipation
  • dry mouth
  • sleepiness
  • headache
  • joint pain

If you experience these symptoms, stop use and talk to your doctor.

It’s possible to experience side effects that go beyond the symptoms listed above.1 Talk to your doctor if you experience other side effects or symptoms while taking prescription esomeprazole.

Things to consider before using esomeprazole

There are a few risks and precautions you should be aware of before starting a prescription course of esomeprazole. Be sure to discuss with your health care provider.

Bone Fractures

People taking esomeprazole long term might be more likely to fracture hips, spine or wrists than those not taking esomeprazole. This risk is higher for those taking a high dose of esomeprazole or those taking esomeprazole for an extended period of time, and less likely for those following a 14-day over-the-counter dose of the medication.1


Whenever you take a new prescription medication, there’s a risk of an allergic reaction. Make sure to inform your doctor about your history with allergies to esomeprazole or other drugs and medications, including:1

  • Dexlansoprazole (Dexilant)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec, Zegerid)
  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)

Interactions with Other Drugs

Esomeprazole may interact with other drugs and increase the risk of side effects. However, sometimes it’s necessary for two or more prescription medications to be used at one time.

Talk to your doctor if you’re taking any of the following medications so they can monitor the side effects and make changes to dosing if needed:1,4

  • Anticoagulants like warfarin (Coumadin)
  • Antifungals like ketoconazole (Nizoral) or voriconazole (Vfend)
  • Cilostazol (Pletal)
  • Clopidogrel (Plavix)
  • Diazepam (Valium)
  • Digoxin (Lanoxicaps, Lanoxin)
  • Diuretics
  • Erlotinib (Tarceva)
  • Human immunodeficiency virus (HIV) medications like atazanavir (Reyataz), nelfinavir (Viracept) and saquinavir (Invirase)
  • Methotrexate (Rheumatrex, Trexall)
  • Mycophenolate mofetil (Cellcept)
  • Rifampin (Rifadin)
  • Tacrolimus (Prograf)

Some drugs should not be combined with esomeprazole in any dosage. You doctor will likely recommend that you not take rilpivirine—the active ingredient in Edurant—while taking a medication containing esomeprazole.1,4

Interactions with Vitamins, Supplements and Herbal Treatments

Esomeprazole may also interact with certain vitamins, nutritional supplements and herbs, so it’s important to inform your doctor of any non-prescription medications or supplements you’re taking as well. Talk to your doctor about possible interactions with esomeprazole if you take or consume any of the following:1,4

  • Iron supplements
  • St. John’s wort
  • Cranberry products

Effects on Gut Microbiome

Because proton pump inhibitors block acid production in the stomach, they affect the PH balance of your digestive system. That can affect the mix of organisms in your gut microbiome, the collection of bacteria, fungi, and viruses that live in your digestive track.

Long-term use of prescription PPIs has been connected with higher levels of some harmful bacteria and a higher risk of some intestinal infections.5---Yet another reason a person’s use of prescription esomeprazole and other PPIs is under the watchful care of a health professional.

Additional Medical Conditions

If you’re considering esomeprazole, be sure to inform your doctor if you have of any of the following:1,4

  • Low vitamin B-12 levels. Using esomeprazole may make this condition worse.
  • Low magnesium levels
  • Osteoporosis
  • Autoimmune disease
  • Liver disease. Those with severe liver disease may experience increased effects of esomeprazole, as the medication’s removal from the body may be slower.
  • Seizures or history of seizures

Every person is different, so it’s important to understand potential side effects and discuss your medical history with a doctor before taking a new medication, including esomeprazole.

Still have questions? Please seek advice from a medical professional.

Source Citations:

  1. Esomeprazole. MedlinePlus. Accessed 9/28/21.
  2. Esomeprazole (Oral Route) – Description and Brand Names. Mayo Clinic. Accessed 9/28/21.
  3. NEXIUM 24HR – esomeprazole magnesium tablet - .  Accessed 9/27/2022.
  4. Esomeprazole (Oral Route) – Before Using. Mayo Clinic. Accessed 9/28/21.
  5. Freedberg DE, Lebwohl B, Abrams JA. The impact of proton pump inhibitors on the human gastrointestinal microbiome. Clin Lab Med. 2014 Dec;34(4):771-85. doi: 10.1016/j.cll.2014.08.008. Accessed 10/25/22.