Nexium Dosages: Your GoodRx Guide

Nexium (esomeprazole) is a popular proton pump inhibitor (PPI) medication. It’s been around for over 20 years, and has been available as a lower-cost generic since 2015. Nexium is also available over the counter (OTC), so you can buy it without a prescription.

Nexium works by telling your body to make less stomach acid. Stomach acid can be problematic if your body makes too much of it, or if it goes into the esophagus (food pipe). When there’s damage to the lining of your stomach, such as with peptic ulcers, the acid also makes it hard for your body to heal. Nexium, though, can treat these problems related to stomach acid.

But if you’re taking Nexium, it’s important to know how much to take. This is especially true if you’re taking it OTC to self-treat your symptoms. Below, we’ll review typical Nexium dosages. But we strongly recommend speaking to your provider and pharmacist before starting the medication. Most of the conditions discussed here shouldn’t be treated at home.

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What Nexium dosage forms are available?

Nexium comes in three different dosage forms: a delayed-release (DR) capsule, a DR tablet, and powder packets you can mix with water.

OTC Nexium is available as a 20 mg DR capsule and tablet. Prescription versions come in the following forms:

• 2.5 mg powder packets

• 5 mg powder packets

• 10 mg powder packets

• 20 mg capsules and powder packets

• 40 mg capsules and powder packets

Both OTC and prescription versions should be taken at least 1 hour before meals. The OTC capsules and tablets should be swallowed whole. Don’t cut, chew, or crush them. Prescription Nexium capsules can be swallowed whole, or opened and mixed with applesauce. You shouldn’t mix the contents with other foods or liquids.

How to prepare Nexium powder packets

Nexium packets have to be prepared following special instructions shortly before you take a dose:

1. Mix one packet with 1 tablespoon (15 mL) of water. If two packets are needed, mix their contents with 2 tablespoons (30 mL) of water.

2. Stir the mixture well.

3. Let the mixture sit and thicken for 2 to 3 minutes.

4. Stir again and drink. You should consume the mixture within 30 minutes of preparing.

5. If any residue remains in your cup or container, add some water, stir, and drink the water. This will help make sure you receive your full Nexium dosage.

What’s the typical Nexium dosage for adults?

The OTC version of Nexium is labeled for relief of frequent heartburn. Prescription Nexium is FDA approved to treat the following conditions in adults:

• Gastroesophageal reflux disease (GERD)

• Erosive esophagitis (EE) — inflammation of the esophagus

• Lowering the risk of stomach ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs)

• Helicobacter pylori (H. pylori)infection

• Zollinger-Ellison syndrome (ZES)

Heartburn

The OTC Nexium dosage for heartburn is 20 mg once daily. You should only take it for 2 weeks at a time. You should also wait at least 4 months before taking another 2-week course.

Talk to your healthcare provider before taking OTC Nexium for more than 2 weeks in a row, or for more than 2 weeks every 4 months.

GERD

The Nexium dosage for GERD is 20 mg once daily. It’s recommended to take Nexium for 4 weeks. If your symptoms don’t go away, your healthcare provider may prescribe another 4 weeks (for a total of 8 weeks).

Erosive esophagitis

The Nexium dosage for initial treatment of EE is 20 mg or 40 mg once daily for 4 to 8 weeks. You may need to repeat this treatment course if your esophagus doesn’t fully heal the first time around.

After your EE has healed, your healthcare provider may suggest continuing Nexium 20 mg once daily. This can help prevent the condition from coming back. Your healthcare provider will help decide how long to keep taking Nexium.

Lowering the risk of stomach ulcers from NSAIDs

The Nexium dosage for NSAID ulcer prevention is 20 mg or 40 mg once daily. In clinical studies, people took it for up to 6 months for this purpose. Your healthcare provider will help determine the right amount of time for you to take Nexium for ulcer prevention.

H. pylori infection

The Nexium dosage for H. pylori infections is 40 mg once daily for 10 days. You must also take two antibiotics during this time: amoxicillin (Amoxil) and clarithromycin. This triple-therapy combination ensures that you fully kill the H. pylori bacteria.

Zollinger-Ellison syndrome

The recommended starting Nexium dosage for ZES is 40 mg twice daily. Depending on your response, you may need a higher dose. In rare cases, some people may need up to 240 mg per day. Continue to take Nexium as instructed by your healthcare provider until they tell you to stop it.

What’s the typical Nexium dosage for children?

Nexium is FDA approved to treat GERD and EE in children. Children ages 12 to 17 can take Nexium capsules and powder packets. Children under 12 years old should only take Nexium powder packets. People under 18 years old shouldn’t take OTC Nexium without a healthcare provider’s OK.

GERD

The children’s Nexium dosage for GERD depends on your child’s age. Children between 1 and 11 years old typically take 10 mg once daily for up to 8 weeks. Kids between 12 and 17 years old should take 20 mg once daily for 4 weeks.

Erosive esophagitis

The recommended children’s Nexium dosage for EE is based on their age and body weight:

Are there any dosage adjustments for medical conditions?

Your healthcare provider will consider other medical conditions you may have when prescribing Nexium. But there aren’t many situations that require dosage changes.

Dosage for people with liver problems

The liver is important for breaking down Nexium. So if your liver isn’t working well, the medication can build up in your body. This can raise the risk of side effects. If you have mild to moderate liver problems, you’ll likely take the typical Nexium dosage.

If you have severe liver problems, it’s recommended to take lower doses of Nexium. In most cases, you should take no more than 20 mg daily.

What happens if you miss a dose of Nexium?

If you miss a dose of Nexium, take it as soon as you remember. But if it’s almost time for your next dose, skip it and start back on your regular schedule. Don’t take a double dose because you forgot one earlier. This can lead to more side effects, like headache or diarrhea.

Missing a dose or two won’t typically cause significant problems. But it’s possible to have rebound acid after missing enough Nexium doses. This can happen after taking it daily for as little as 2 months.

What should you do if you take too much Nexium?

Large doses of Nexium may cause uncomfortable side effects, like a fast heart rate, sweating, or blurry vision. If you think you or your child has taken too much Nexium, it’s best to get in touch with a healthcare provider. You can also call Poison Control at 1-800-222-1222. But if anything seems severe, seek emergency medical help.

How to save on Nexium

There are many ways to save on Nexium, which is available as both a brand-name and generic medication. By having your healthcare provider write a prescription for OTC Nexium, GoodRx can help you save.

• Save with GoodRx. GoodRx can help you save over 50% off the average retail price of the generic OTC version. Generic Nexium’s price at certain pharmacies is as low as $29.68 with a free GoodRx discount.

• Save with a copay savings card.If you have commercial insurance, you may be eligible to pay as little as $15 for the prescription version of Nexium using a savings card from the manufacturer.

Why trust our experts?

Written by:

Aileen Chu, PharmD, BCPS

Aileen Chu, PharmD, has over 8 years of experience working as a clinical pharmacist in the emergency department, where she sees the consequences of people not being empowered to take their medications correctly. This experience has made her especially passionate about helping patients understand their medications and ensuring that medications are affordable and accessible.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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