Nexium

Nexium is an oral acid-reducing medication containing Esomeprazole as its active ingredient. It belongs to the Proton Pump Inhibitor (PPI) drug class and is manufactured by AstraZeneca (UK–Sweden).

Esomeprazole is the S-isomer of Omeprazole. It works by irreversibly inhibiting H⁺/K⁺ ATPase (the proton pump) on parietal cells in the stomach — the final step of acid secretion — effectively suppressing hydrochloric acid (HCl) production.

Esomeprazole has higher bioavailability than Omeprazole due to slower metabolism via CYP2C19, resulting in higher plasma levels and longer duration of action. It reduces acid secretion by over 90% with continuous use.

Nexium is the originator brand of Esomeprazole, available in 20 mg and 40 mg strengths. It is one of the world's best-selling PPIs.

GERD (Gastroesophageal Reflux Disease): Nexium treats heartburn and acid reflux, both erosive esophagitis and non-erosive reflux disease. It promotes oesophageal ulcer healing and prevents relapse.

Peptic Ulcer Disease: Treats acid-related ulcers including gastric ulcers and duodenal ulcers, as well as NSAID-induced ulcers.

H. pylori Eradication: Used in combination with antibiotics (Triple Therapy) to eradicate Helicobacter pylori — the primary cause of peptic ulcers.

Zollinger-Ellison Syndrome: Treats conditions of excessive acid production caused by gastrinoma tumours.

NSAID Ulcer Prevention: Prevents gastric ulcers in patients requiring long-term NSAID pain relief.

GERD:

• Erosive Esophagitis: Esomeprazole 20–40 mg once daily for 4–8 weeks
• Maintenance: 20 mg once daily

Peptic Ulcer:

• Duodenal Ulcer: 20 mg once daily for 4 weeks
• Gastric Ulcer: 20–40 mg once daily for 4–8 weeks

H. pylori Eradication:

• Esomeprazole 20 mg + Amoxicillin 1 g + Clarithromycin 500 mg twice daily for 7–14 days

How to take:

• Take 30–60 minutes before a meal (preferably before breakfast)
• Swallow whole with water — do not crush, chew, or break the tablet
• If you miss a dose, take it as soon as you remember. Skip if close to the next dose

Common side effects:

• Headache
• Nausea
• Diarrhoea or constipation
• Abdominal pain, flatulence
• Dry mouth

Less common side effects:

• Skin rash
• Dizziness
• Insomnia

Serious side effects (rare, but important with long-term use):

• C. difficile infection — severe diarrhoea from Clostridioides difficile colitis
• Bone fractures — PPI use longer than 1 year may increase risk of hip, spine, or wrist fractures
• Hypomagnesemia — may occur with use longer than 3 months, causing muscle cramps and cardiac arrhythmia
• Vitamin B12 deficiency — long-term PPI use may reduce B12 absorption
• Interstitial Nephritis — very rare kidney inflammation

Do not use:

• Allergy to Esomeprazole, Omeprazole, or other PPIs
• Concurrent use with Rilpivirine (HIV medication) — contraindicated
• Concurrent use with Nelfinavir — contraindicated

Use with caution:

• Liver disease — severe hepatic impairment: do not exceed 20 mg/day as Esomeprazole is hepatically metabolised
• Anticoagulants — Esomeprazole may enhance the effect of Warfarin; monitor INR
• Clopidogrel — PPIs may reduce the efficacy of Clopidogrel via CYP2C19; consult your doctor
• Pregnancy and breastfeeding — may be used when necessary but consult your doctor first
• Long-term use — use the lowest effective dose for the shortest necessary duration to minimise risks

Nexium vs. Omeprazole: Esomeprazole (Nexium) is the S-isomer of Omeprazole with higher bioavailability and slower metabolism, resulting in higher plasma levels. In practice, both are similarly effective for typical GERD, but Esomeprazole may have an edge in severe erosive esophagitis. Nexium is the originator brand and more expensive than generic Omeprazole.

Nexium vs. Losec (Omeprazole originator): Losec is the originator Omeprazole brand, also by AstraZeneca. Both are PPIs from the same company — Nexium (Esomeprazole) is the refined S-isomer developed subsequently.

Nexium vs. other PPIs (Lansoprazole, Pantoprazole, Rabeprazole): All PPIs share the same mechanism. They differ in pharmacokinetics and drug interactions. Esomeprazole and Omeprazole have more drug interactions (via CYP2C19) compared to Pantoprazole or Rabeprazole. Choose based on indication and concurrent medications.

Nexium vs. H2 Blockers (Ranitidine, Famotidine): PPIs suppress acid far more potently than H2 Blockers. PPIs are appropriate for moderate-to-severe GERD and peptic ulcers. H2 Blockers are suitable for mild symptoms or occasional use.

Esomeprazole begins inhibiting the proton pump within 1 hour of ingestion, but full effect requires several days as newly generated proton pumps must also be inhibited.

Timeline:

• 1–2 hours: Drug starts working; acid secretion decreases; heartburn may begin to ease
• 1–4 days: Significant improvement in heartburn and reflux symptoms
• 1–2 weeks: Maximum acid suppression achieved; most symptoms resolve
• 4–8 weeks: Complete healing of oesophageal or gastric ulcers (for Erosive Esophagitis)

Important: Take 30–60 minutes before a meal because PPIs work best when proton pumps are active (preparing to secrete acid for digestion).

If symptoms do not improve within 2 weeks, consult your doctor for further evaluation such as endoscopy.

Nexium is a pharmacist-dispensed medication. You can order online from Intimo Life.

Can I buy Nexium online?

Yes. Order through Intimo Life — select the product, consult with a licensed pharmacist online, and receive your medication at home.

Do I need a prescription?

A doctor's prescription is not required, but the medication must be dispensed by a licensed pharmacist. At Intimo Life, our pharmacist will review your symptoms and health history to confirm suitability before shipping.

How does Intimo Life ship orders?

We deliver nationwide in Thailand with discreet packaging — no product names on the outside.