1. About esomeprazole
Esomeprazole reduces the amount of acid your stomach makes.
It's used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD) - GORD is when you keep getting acid reflux. It's also taken to prevent and treat stomach ulcers.
Sometimes, esomeprazole is taken for a rare illness caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.
Esomeprazole also comes mixed with naproxen, a medicine that reduces inflammation and pain in joints and muscles.
Esomeprazole comes as capsules, tablets, granules and as a liquid.
All types of esomeprazole are available on prescription. You can also buy the lowest-strength 20mg tablets and capsules from pharmacies.
2. Key facts
- It's usual to take esomeprazole once a day in the morning.
- Common side effects include headache, diarrhoea and stomach pain. These tend to be mild and go away when you stop taking the medicine.
- Esomeprazole is called by the brand names Nexium, Nexium Control, Emozul and Ventra.
- When esomeprazole is mixed with naproxen it's called the by brand name Vimovo.
- If you've bought esomeprazole without a prescription and your symptoms don't improve after 2 weeks, see a doctor before taking any more.
3. Who can and can't take esomeprazole
Esomeprazole can be taken by adults. Children should only have esomeprazole if their doctor prescribes it.
Esomeprazole isn't suitable for some people. To make sure that it is safe for you, tell your doctor if you:
- have had an allergic reaction to esomeprazole or any other medicines in the past
- have liver problems
- cannot absorb certain types of sugars including glucose or sucrose
- are due to have an endoscopy
Ask your doctor if you should stop taking esomeprazole a few weeks before your endoscopy. This is because esomeprazole may hide some of the problems that would usually be spotted during an endoscopy.
4. How and when to take it
It's usual to take esomeprazole once a day, first thing in the morning. You can take it with or without food.
If you take esomeprazole twice a day, take one dose in the morning and one dose in the evening.
Swallow tablets whole with a drink of water. If you have problems swallowing tablets, you can put them in a glass of water. Stir until the tablets start to break up, then drink straight away.
If you have problems swallowing capsules, you can open up esomeprazole capsules and empty the contents into a glass. Mix with some water and drink straight away. Fill the glass with water again, and drink that as well to make sure there's no medicine left at the bottom of the glass.
If your child is under 12 years old, their doctor may prescribe esomeprazole granules which come in sachets. Empty the granules into a glass and mix with some water, then encourage them to drink it straight away.
How much to take
Each tablet or capsule contains 20mg or 40mg. Each sachet contains 10mg.
The usual dose to treat:
- heartburn and acid reflux is 20mg a day
- gastro-oesophageal reflux disease is 20mg to 40mg a day
- stomach ulcers is 20mg a day
- Zollinger-Ellison syndrome is 80mg a day - this can increase to 160mg a day depending on how well it works for you
Doses are usually lower for children and people with liver problems.
Will my dose go up or down?
Sometimes your doctor will increase your dose if it isn't working well enough.
Depending on the reason you take esomeprazole, you may take a higher dose to begin with, usually for a month or two. After this, your doctor may recommend that you take a lower dose.
How long will I take it for?
If you have bought the medicine yourself from a pharmacy or supermarket, tell your doctor if you feel no better after taking esomeprazole for 2 weeks. They may want to do tests to find out what's causing your symptoms or change you to a different medicine.
If you take it on prescription, you may only take it for a few weeks or months, depending on your illness. Sometimes your doctor may advise you to take it for longer, even many years.
Your doctor may suggest taking esomeprazole only when you have symptoms. This means you won't have to take it every day. Once you feel better, you can stop taking it - often after a few days or weeks. Taking esomeprazole this way isn't suitable for everyone. Speak to your doctor about what's best for you.
What if I forget to take it?
If you usually take it:
- once a day, take the missed dose as soon as you remember, unless it's less than 12 hours until your next dose - in which case skip the missed dose.
- twice a day, take the missed dose as soon as you remember, unless it's less than 4 hours until your next dose - in which case skip the missed dose.
Do not take a double dose to make up for a forgotten dose. If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.
What if I take too much?
It is very unlikely that taking one or two extra doses by accident will cause any problems. However, you should check with your doctor if you have taken too much and have any of these symptoms:
- feeling sweaty
- a fast heartbeat
- feeling sleepy
- blurred vision
- feeling confused or agitated
5. Side effects
Most people who take esomeprazole do not have any side effects. If you do get a side effect, it is usually mild and will go away when you stop taking esomeprazole.
Common side effects
Common side effects may happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:
- feeling or being sick (nausea or vomiting)
- stomach pain or wind
Serious side effects
Serious side effects happen in less than 1 in 1,000 people. Call a doctor straight away if you have:
- joint pain and abnormal changes in your skin, especially in parts of your body exposed to the sun, such as a red, raised rash on your arms that can spread, blisters, or a red rash on your cheeks and nose. These can be signs of a rare condition called subacute cutaneous lupus erythematosus. This can happen even if you've been taking esomeprazole for a long time.
- yellow skin, dark pee and tiredness. These can be signs of liver problems.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to esomeprazole.
Urgent advice: Contact a doctor straight away if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.
These are not all the side effects of esomeprazole. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effects to the UK safety scheme.
6. How to cope with side effects
What to do about:
- headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.
- diarrhoea - drink plenty of water to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee.
- feeling or being sick (nausea or vomiting) - try taking esomeprazole with or after a meal or snack. It may also help if you don't eat rich or spicy food while you're taking this medicine.
- constipation - eat more high-fibre foods such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor.
- stomach pain or wind - steer clear of foods that cause wind like lentils, beans and onions. It might also help to eat smaller and more frequent meals, eat and drink slowly, and exercise regularly. Some pharmacy remedies, such as simethicone may relieve symptoms of wind.
7. Pregnancy and breastfeeding
Esomeprazole isn't usually recommended during pregnancy as there's no firm evidence it's safe.
A medicine called omeprazole, which is similar to esomeprazole, is safe in pregnancy.
However, if you're pregnant, it's always better to try to treat your symptoms without taking a medicine.
Your doctor or midwife may suggest eating smaller meals more often and avoiding fatty and spicy food.
They may also suggest raising the head of your bed 10 to 20cm by putting something under your bed or mattress, so that your chest and head are above your waist. This helps stop stomach acid travelling up towards your throat.
If these lifestyle changes don't work, you may be recommended omeprazole to help ease your symptoms.
Esomeprazole and breastfeeding
Esomeprazole may get into breast milk, but it's not known whether it harms the baby. A medicine called omeprazole, which is similar to esomeprazole, is safe to take while breastfeeding. Speak to your doctor to discuss what is best for you and your baby.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines can interfere with esomeprazole and make you more likely to have side effects.
Tell your doctor if you're taking these medicines before you start taking esomeprazole:
- digoxin (a heart medicine)
- cilostazol (a medicine used to treat painful legs caused by poor circulation)
- antifungal medicines such as itraconazole, ketoconazole or posaconazole
- methotrexate (a medicine used to treat cancer and conditions like psoriasis and rheumatoid arthritis)
- HIV medicines
- phenytoin (an anti-epilepsy medicine)
- rifampicin (an antibiotic)
- blood thinning medicines, such as clopidogrel
- citalopram, escitalopram, clomipramine or imipramine (antidepressants)
- tacrolimus (a medicine used for eczema or to prevent organ rejection after a transplant)
These are not all the medicines that may not mix well with esomeprazole. For a full list see the leaflet inside your medicines packet.
Mixing esomeprazole with herbal remedies and supplements
Do not take St John's wort, the herbal remedy for depression, while you're taking esomeprazole. St John's wort may stop esomeprazole working as well as it should.
Tell your pharmacist or doctor if you're taking other medicines including herbal remedies, vitamins or supplements.
9. Common questions
How does esomeprazole work?
Esomeprazole is a type of medicine called a proton pump inhibitor (PPI).
Proton pumps are tiny substances in the lining of the stomach which help it make acid to digest food.
Esomeprazole prevents proton pumps from working properly. This reduces the amount of acid the stomach makes.
When will I feel better?
You should start to feel better within 2 to 3 days. It may take up to 4 weeks for esomeprazole to work properly so you may still have some acid symptoms during this time.
If you bought esomeprazole without a prescription, and feel no better after 2 weeks, tell your doctor. They may want to do tests or change you to a different medicine.
Is it safe to take esomeprazole for a long time?
If you take esomeprazole for more than 3 months, the levels of magnesium in your blood may fall. This can make you feel tired, confused, dizzy and cause muscle twitches, shakiness and an irregular heartbeat. If you get any of these symptoms, tell your doctor.
Taking esomeprazole for more than a year may increase your chances of certain side effects, including:
- bone fractures
- gut infections
- vitamin B12 deficiency - symptoms include feeling very tired, a sore and red tongue, mouth ulcers and pins and needles
If you take esomeprazole for longer than 1 year, your doctor will regularly check your health to see if you should carry on taking it.
It's not known if esomeprazole works less well the longer you take it. If you feel like it isn't working any more, talk to your doctor.
Does taking esomeprazole for a long time cause stomach cancer?
A Hong Kong study published in 2017 suggested that people taking proton pump inhibitors (PPIs) like esomeprazole for at least 3 years have a very small increased chance of developing stomach cancer. For every 10,000 people taking a PPI long term, it was thought an extra 4 people get stomach cancer.
However, the study didn't prove that PPIs were causing stomach cancer and the results may not apply in the UK.
People who take PPIs regularly shouldn't be particularly concerned by this study. However, like most medicines, PPIs have side effects, so it's best to take them for the shortest time possible. Speak to your doctor or pharmacist if you are concerned.
How do I come off esomeprazole?
Usually, you can stop taking esomeprazole without reducing the dose first.
If you've taken esomeprazole for a long time speak to your doctor before you stop taking it. Stopping suddenly could make your stomach produce a lot more acid, and make your symptoms come back.
Reducing the dose gradually before stopping completely will prevent this happening.
Are there similar medicines?
There are 4 other medicines that are similar to esomeprazole. They are:
Like esomeprazole, these medicines are proton pump inhibitors. They work in the same way as esomeprazole to reduce acid in your stomach.
They generally work as well as esomeprazole and have similar side effects, but may be given in different doses.
Sometimes, if esomeprazole isn't working or doesn't agree with you, your doctor may suggest that you try taking another proton pump inhibitor.
Are there other indigestion medicines?
There are other pharmacy and prescription medicines for indigestion and heartburn.
Antacids, like calcium carbonate (Tums), sodium bicarbonate, Maalox and Milk of Magnesia, relieve indigestion and heartburn by neutralising the acid in your stomach. They give quick relief that lasts for a few hours. They're ideal for occasional stomach acid symptoms.
Some antacids, such as Gaviscon, have an extra ingredient called alginic acid.
They work by lining your stomach so that juices from it don't splash up into your foodpipe.
They're especially good for relieving acid reflux.
Antacids are available from pharmacies and supermarkets.
H2 blockers (histamine antagonists) reduce the amount of acid made in your stomach, but they do this in a different way to proton pump inhibitors. They include famotidine (Pepcid), ranitidine (Zantac), cimetidine (Tagamet) and nizatidine (Axid).
In general, proton pump inhibitors like esomeprazole are used first because they are better than H2 blockers at reducing stomach acid.
However, if you don't get on with a proton pump inhibitor (for example, because of side effects), your doctor may prescribe an H2 blocker.
You can buy famotidine and ranitidine without a prescription from pharmacies.
Can I take esomeprazole with an antacid?
You can take esomeprazole with an antacid, for example Gaviscon. Take it 2 hours before or after your dose of esomeprazole.
Will it affect my fertility?
There's no firm evidence to suggest that taking esomeprazole will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
Can I drive or ride a bike?
Occasionally, esomeprazole can make you feel dizzy or sleepy or affect your vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better.
Can I drink alcohol with it?
Yes, you can drink alcohol with esomeprazole. However, drinking alcohol makes your stomach produce more acid than normal. This can irritate your stomach lining and make your symptoms worse.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking esomeprazole.
However, you should avoid foods that seem to make your indigestion worse, such as rich, spicy and fatty foods. You should also cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.
Can lifestyle changes help?
It may be possible to ease symptoms caused by too much stomach acid by making a few changes to your diet and lifestyle:
- maintain a healthy weight by eating healthily
- do not eat foods that can make your symptoms worse, such as rich, spicy and fatty foods, and acidic foods like tomatoes, citrus fruits, salad dressings and fizzy drinks
- cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol and smoking
- if you have symptoms at night, try not to eat for at least 3 hours before you go to bed
- raise the head of your bed 10 to 20cm by putting something under your bed or mattress so that your chest and head are above your waist