Esomeprazole (brand name Nexium) relieves a number of stomach-related complaints. It works by blocking a proton pump and reducing the production of acid in the stomach.
In this article, we will investigate what ailments Nexium is used for, how it works, its side effects and whether or not it has any contraindications.
Contents of this article:
Here are some key points about Nexium. More detail and supporting information is in the main article.
- Nexium is a proton pump inhibitor
- Proton pump inhibitors are some of the most widely sold drugs in the world
- Side effects of Nexium include headache, nausea and flatulence
- The main effect of esomeprazole is a marked decrease in stomach acid production
- Nexium use might increase the risk of hip fractures
- Proton pump inhibitors inhibit hydrogen potassium ATPase
- Nexium is predominantly used to treat gastroesophageal reflux
- Nexium might prevent certain nutrients from being broken down and absorbed
- Nexium is a competitive inhibitor of the enzyme CYP2C19.
What is Nexium?
Nexium is a proton pump inhibitor and reduces the amount of acid produced in the stomach.
Nexium is a proton pump inhibitor, one of the most widely sold groups of drugs in the world.
Proton pump inhibitors such as Nexium substantially reduce stomach acid secretion. The site of action for this group of drugs is the parietal cells in the stomach wall; these cells secrete hydrochloric acid and intrinsic factor (an important factor in the absorption of vitamin B12).
The drug works by inhibiting hydrogen potassium ATPase (H+/K+ ATPase), a transporter that is responsible for acidifying the stomach.
Nexium is most commonly used to treat the following conditions:
- Dyspepsia: also known as indigestion. Symptoms include upper abdominal fullness, nausea, heartburn and upper abdominal pain
- Peptic ulcer disease: a gap in the lining of the stomach, oesophagus or intestine
- Gastroesophageal reflux disease (GERD): a chronic condition where the mucosa is damaged by stomach acid coming up from the stomach into the esophagus; the main symptom is heartburn. Nexium's reduction of stomach acid eases the symptoms of GERD and prevents damage to the oesophagus
- Zollinger-Ellison syndrome: a pancreatic tumor overstimulates the production of stomach acid.
Nexium is sometimes used by patients who are taking nonsteroidal anti-inflammatory drugs (NSAIDs). This is due to NSAIDs' propensity to produce stomach ulcers; Nexium helps prevent their formation.1
There are a number of proton pump inhibitors available, including Aciphex, Zegerid, Prilosec, Protonix and Prevacid. When used for milder diseases, Nexium's effects are comparable to other similar drugs on the market. However, Nexium appears to be more effective than some others when used in particularly severe cases.2
Esomeprazole also appears to increase erosive esophageal healing, compared with some other leading brands.3
Side effects of Nexium
The most common side effects of Nexium are:
- Decreased appetite
- Dry mouth
- Unusual taste in the mouth
- Abdominal pain.
Severe, rarer side effects of Nexium include:4
- Severe allergies
- Dark urine
- Chest or back pain
- Changes in heart rhythm
- Yellow coloration of the eyes or skin
- Extreme fatigue and muscle weakness
- Unusual bleeding or bruising
- Paresthesia (experiencing a tingling or prickly sensation)
- Persistent sore throat
- Severe stomach pain.
Adverse events with Nexium
There are a number of potential adverse events that might arise from Nexium use. These include the following:
There is some evidence that long-term use of esomeprazole can increase the chances of hip fracture.
Proton pump inhibitors can interfere with calcium absorption, potentially weakening bones. Their use may also impact on normal bone recycling by inhibiting proton pumps that are involved in bone creation and remodeling.5
Nexium could increase the risk of Clostridium difficile based diarrhea, according to a number of studies.
Clostridium difficile based diarrhea
Some evidence suggests that Nexium and other proton pump inhibitors might cause an increased rate of Clostridium difficile-based diarrhea.6
One study found a 30% increased chance of developing hospital-acquired pneumonia in patients prescribed proton pump inhibitors.7
Nexium and other proton pump inhibitors are associated with the development of benign polyps on the fundic glands (secretory areas of the stomach). Nexium is not, however, associated with cancer.8,9
Some studies have recently found a correlation between proton pump inhibitors and chronic kidney disease. At this stage, it is not clear whether the link is causal.10
Some evidence suggests that, because gastric acid breaks down food, there may be some nutritional deficits if the acid is not present. Some studies have shown a possible interference with the absorption of calcium, iron and vitamin B12.11
There are many confounding variables, however, and how these factors interact is not yet fully understood. The strongest evidence for nutritional shortfalls is in regard to magnesium.12
Nexium interactions with other drugs
Nexium is a competitive inhibitor of the enzyme CYP2C19, so other drugs that rely on this enzyme might be affected by its use. For instance, diazepam and warfarin are broken down by CYP2C19. Levels of these drugs in the body might rise if taken alongside a proton pump inhibitor.
Other drugs, such as clopidogrel (Plavix) depend on CYP2C19 to be converted into their active form; their effect will therefore be reduced if taken alongside esomeprazole.
A change in stomach acidity also changes the way certain drugs are absorbed. Some drugs require an acidic environment to be absorbed, such as ketoconazole or atazanavir. Others, including erythromycin, are degraded by stomach acid, so in more alkaline situations they will be absorbed in greater quantities.
Taking a class of drugs commonly used to reduce acid in the stomach is linked to a higher risk of developing chronic kidney disease, compared with not taking them.
A new study published in the Cochrane Database of Systematic Reviews has found that eradicating the common Helicobacter pylori bacterium with a short course of antibiotics could be enough to reduce the risk of gastric cancer.