Nexium, or esomeprazole, relieves a number of stomach-related complaints. It works by blocking a proton pump and reducing the production of acid in the stomach.

They are commonly prescribed to treat problems related to excess stomach acid, including gastrointestinal reflux disease (GERD) and peptic ulcers.

This article will look at the uses of Nexium, how it works, and any adverse effects or precautions.

Fast facts about Nexium

  • Nexium, or esomeprazole, is a proton pump inhibitor (PPI).
  • It reduces the production of stomach acid and relieves the symptoms of gastrointestinal reflux.
  • Side effects include headache, nausea and flatulence, and possibly a higher risk of a hip fracture.
  • It might reduce the absorption of certain nutrients.
  • Some people may be using a PPI without really needing one.

What is Nexium?

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Nexium and other PPIs are prescribed for gastro-esophageal reflux disease (GERD) and other gastric conditions.

Nexium is a proton pump inhibitor (PPI), one of the most widely sold groups of drugs in the world.

PPIs such as Nexium reduce stomach acid secretion. They affect the parietal cells in the stomach wall. These cells secrete hydrochloric acid and intrinsic factor, an important factor in the absorption of vitamin B 12.

The drug works by inhibiting hydrogen potassium ATPase (H+/K+ ATPase), a transporter that is responsible for acidifying the stomach.

Uses

Nexium is most commonly used to treat the following conditions:

Dyspepsia, or indigestion: Symptoms include nausea, heartburn, and upper abdominal fullness and pain.

Peptic ulcer disease: There is a gap in the lining of the stomach, esophagus, or intestine.

Gastroesophageal reflux disease (GERD): A chronic condition where stomach acid comes up from the stomach into the esophagus and damages the mucosa, leading to heartburn.

Zollinger-Ellison syndrome: A pancreatic tumor overstimulates the production of stomach acid.

Nexium may be 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.

PPIs include Aciphex, Zegerid, Prilosec, Protonix and Prevacid.

The effects of Nexium on mild symptoms are comparable to similar drugs. However, Nexium appears to be more effective than some drugs for more severe symptoms.

It also appears to improve esophageal healing rates, compared with some other leading brands.

Dosage

Nexium comes as a capsule, which prevents it from being released too quickly. A rapid release would cause the medication to be broken down by the stomach acid.

Other ways of taking it include mixing granules with water, and delivering this solution through a feeding tube.

It is usually taken once a day, at the same time every day, around 1 hour before eating. For some conditions, it is taken twice a day.

It is important to follow the doctor's instructions and to read the information leaflet carefully.


Side effects

The most common adverse effects of Nexium are:

Less commonly, it may lead to:

  • allergic reactions
  • dark urine
  • chest or back pain
  • acne
  • changes in heart rhythm
  • fever
  • yellow coloration of the eyes or skin, known as jaundice
  • extreme fatigue and muscle weakness
  • unusual bleeding or bruising
  • paresthesia, a tingling or prickly sensation
  • persistent sore throat
  • severe stomach pain
  • muscle spasms and shaking
  • diarrhea and watery stools
  • seizures

If anyone has any of these symptoms, they should contact a doctor immediately.

Risks

Nexium can give rise to some additional problems.

Hip fracture

There is some evidence that long-term use of esomeprazole can increase the chances of hip fracture.

One theory is that PPIs interfere with calcium absorption, which may weaken bones.

Another is that they impact normal bone recycling by inhibiting proton pumps in the body that are involved in bone creation and remodeling.

One study found no link between intestinal calcium absorption and PPI use in women after menopause. The researchers note that this could be because it was a short-term investigation, lasting only 30 days, or because people who use a PPI may have other risk factors already.

Other studies have found no link between low calcium absorption and PPI use.

Clostridium difficile infection

PPIs have been linked with an initial bout of Clostridium difficile infection (CDI) and recurrence. Some researchers suggest that some people are prescribed a PPI without needing one, and that discontinuing use could reduce the risk of infection.

Pneumonia

One study of data for 63,878 hospital admissions to a hospital in Boston, MA, from January 2004 through December 2007, found that patients using PPIs had a 30-percent higher chance of developing hospital-acquired pneumonia.

Over half of the patients admitted were prescribed a PPI, and 2,219 of them acquired pneumonia in the hospital, or 3.5 percent of all the patients.

A study in the United Kingdom (U.K.) found that outpatients using a PPI had a higher risk of pneumonia than the general population for the first 30 days of using the drug, and especially in the first 2 days.

Polyps

Nexium and other PPIs may be associated with hyperplasia, or a thickening of the stomach lining, which could lead to a benign tumor. However, evidence supporting this is limited.

Kidney damage

Some studies have found a correlation between PPIs and chronic kidney disease, but it is not clear whether the link is causal.

Nutritional

Some evidence suggests that, because gastric acid breaks down food, and because PPIs reduce the levels of acid, nutritional deficits may occur.

Some researchers have suggested that PPIs might interfere with the absorption of calcium, iron, and vitamin B 12, but more studies are needed to confirm this.

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.

Interactions

Nexium is a competitive inhibitor of the enzyme CYP2C19, so it might affect drugs that rely on this enzyme.

Diazepam and warfarin are broken down by CYP2C19. If these are used alongside a PPI, level of active ingredients in the body might rise.

Clopidogrel (Plavix) needs CYP2C19 to be converted into its active form. Using this type of drug alongside Nexium will reduce its effect.

Changes in stomach acidity can also affect the way certain drugs are absorbed.

Ketoconazole and atazanavir are best absorbed in an acidic environment. Ketoconazole is an antifungal treatment, and atazanavir is used in HIV therapy,

Erythromycin is degraded by stomach acid. A more alkaline situation will increase absorption.

Overdose

An overdose can lead to:

  • confusion
  • drowsiness
  • vision problems
  • nausea
  • sweating and flushing
  • headache
  • dry mouth
  • rapid heartbeat

In the case of an overdose, contact the local poison control center or seek medical attention.

Research published in 2016 found that people using a PPI had an 11.8-percent risk of chronic kidney disease (CKD) over 10 years, compared with an expected risk of 8.5 percent if they had not used a PPI.

However, it is possible that people who are prescribed a PPI may already be at higher risk of CKD.

Is a PPI necessary?

In 2013, over 15 million Americans were using a prescription PPI.

Statistics suggest that between 40 and 70 percent of patients are given some kind of PPI during a stay in the hospital.

Studies suggest that up to 70 percent of PPI use may not be necessary, and that in 25 percent of cases, the person could stop use it without the risk of developing symptoms.

People who use a PPI and who feel they may not be at risk of symptoms should speak to their doctor about the possibility of discontinuing its use.

Always follow the physician's advice when using any medication, and read the patient information leaflet before use.