Alka-Seltzer vs. Nexium for Heartburn: Important Differences and Potential Risks.

Key takeaways

Alka-Seltzer (citric acid/aspirin/sodium bicarbonate) and Nexium (esomeprazole) are both used to treat heartburn, but they work differently and have different uses. Alka-Seltzer combines antacids and aspirin to quickly relieve heartburn, indigestion, and pain, and is available over-the-counter. It works by neutralizing stomach acid and reducing pain and inflammation. Nexium, on the other hand, is a proton pump inhibitor (PPI) that reduces the amount of acid your stomach produces. It is used for longer-term conditions like GERD and stomach ulcers and is available both over-the-counter and by prescription. While Alka-Seltzer provides immediate relief, Nexium takes a few days to fully kick in. Alka-Seltzer is not recommended for children under 12 or pregnant women due to the aspirin content, whereas Nexium can be used by both adults and children for certain conditions. Additionally, Nexium has significant interactions with some medications like clopidogrel (Plavix), which Alka-Seltzer does not.

Alka-Seltzer

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Esomeprazole

(Nexium)

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Summary for Alka-Seltzer

Over-the-counter

Alka-Seltzer is a medication used to treat symptoms of heartburn, such as upset stomach and headache. While there are multiple products under this brand, this page focuses on the combination medication containing 3 active ingredients: citric acid, sodium bicarbonate, and aspirin. It comes as tablets that are dissolved in water. You drink the mixture by mouth, typically every 4-6 hours as needed.

Indications for Alka-Seltzer

Heartburn, indigestion, and sour stomach with headache, body aches, or pain
Upset stomach and headache from having too much food or drink
Headache, body aches, and pain alone

Pros and Cons for Alka-Seltzer

Pros

Combination of three medications in a single pill
Easy to take for people who have trouble swallowing pills
Available over the counter

Cons

Might not be safe for children 12 years old and younger
Might need to take multiple times per day
Might not be safe for people with certain health conditions (e.g. kidney problems, heart problems, high bleeding risk)

Common Side Effects for Alka-Seltzer

See Risks and Warnings

Warnings for Alka-Seltzer

Stomach bleeding and ulcers
Reye's syndrome in children
Allergic reactions

Summary for Nexium

Prescription or over-the-counter

Esomeprazole (Nexium) is a medication used to treat conditions that are caused by too much stomach acid, such as heartburn or acid reflux. It's available both with a prescription and over the counter (OTC). Take esomeprazole (Nexium) an hour before a meal so that it can start working before you eat. It can take a couple days for you to feel its full effects, so consider taking other quick-acting antacids in the meantime until the medication effect kicks in.

Indications for Nexium

For adults only:

Heartburn — OTC only
Lower the risk of stomach ulcer due to nonsteroidal anti-inflammatory drugs (NSAID)
Lower the risk of duodenal ulcer caused by Helicobacter pylori (H. pylori) infection
Other medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)

For adults and children:

Gastroesophageal reflux disease (GERD)
Inflamed esophagus due to GERD

Pros and Cons for Nexium

Pros

Can continue to use with antacids, such as calcium carbonate
Provides longer-lasting relief than some other heartburn medications
Available as over-the-counter and lower-cost generic options
Granules or pellets inside the capsules can be mixed with water or applesauce, so convenient for people with difficulty swallowing pills

Cons

Takes 1 to 4 days for the medication to fully kick in, so not the best choice for immediate heartburn relief
Significant interaction with clopidogrel (Plavix), which can raise the risk of blood clot
Long-term use might weaken bones and raise the risk of bone fracture
Can lower magnesium and vitamin B12 levels