How Long Does It Take for Nexium to Start Working? - GoodRx (2024)

Acid reflux. Heartburn. Gastroesophageal reflux disease (GERD). You may have heard of these common digestive issues.

Heartburn is a symptom of acid reflux. Acid reflux is when acid flows backwards from the stomach to your esophagus (a tube that connects your mouth and stomach). If your acid reflux is bothersome or severe, and you often experience heartburn, you may have GERD.

Thankfully, there are many treatment options available for GERD, including lifestyle changes, medications, and even surgical procedures. A group of medications called proton pump inhibitors (PPIs) are a first-choice option for treating GERD. This includes Nexium (esomeprazole).

Here, we’ll cover five important tips for taking Nexium — including how long it takes Nexium to start working, what time to take it, and more.

What’s Nexium?

Nexium (esomeprazole) is one type of PPI. PPIs work by decreasing stomach acid, which helps relieve symptoms of heartburn and GERD.

Nexium comes in many oral forms. It comes as 20 mg tablets and capsules, and 40 mg capsules. It’s also available as granule packets that range from 2.5 mg to 40 mg in strength. Some of these forms are available over the counter (OTC), and others are prescription-only:

• OTC: 20 mg capsules and tablets (Nexium 24HR)

• Prescription-only:40 mg capsules and all packet strengths

The 2.5 mg and 5 mg packets are brand-only (Nexium). But all other products are available as lower-cost generic options.

What does Nexium treat?

Prescription Nexium is FDA-approved to treat various digestive conditions. This includes GERD, erosive esophagitis (inflammation of the esophagus), ulcers caused by Helicobacter pylori (H. pylori) infections, and more.

OTC Nexium 24HR is only used to treat frequent heartburn.

5 tips for taking Nexium

Before taking any PPI, talk to your healthcare provider. They can look at your symptoms and make sure that taking a PPI is a good option for you.

Here, we’ll answer some commonly asked questions about taking Nexium. Being informed will help you get the most benefit from your Nexium prescription.

1. How long does it take Nexium to work?

If you’re taking Nexium for heartburn or GERD, it can take up to 4 days to kick in. But some people feel benefits within just 1 day. If it’s been 4 days since you started Nexium and you’re not feeling any signs of relief, let your healthcare provider know.

While you’re taking Nexium, you can also consider lifestyle changes to ease heartburn or GERD. For information on what food and drinks can make heartburn better or worse, we have another article that covers this in-depth.

And for information on helpful lifestyle changes — like eating smaller meals, elevating the head of your bed, and quitting smoking — check out our article with tips to relieve acid reflux naturally.

2. What time should I take Nexium?

If you’re only taking Nexium once a day, it’s best to take it in the morning before you eat with a full glass of water. By taking it in the morning, you’ll get the most symptom relief during daytime hours while you’re awake. If your prescribed dose is twice a day, you can take it in the morning and again before dinner.

Try to take your dose(s) at the same time(s) each day. This will help you remember to take it.

3. Should I take Nexium with food?

Probably not. It’s usually recommended to take PPIs 30 to 60 minutes before eating a meal.

The product information for Nexium 40 mg capsules and granule packets states you should take them at least 1 hour before meals. This is because much of the research on PPIs show that they’re best absorbed when taken on an empty stomach.

While some smaller studies show that it doesn’t matter when you eat in relation to taking Nexium, your best bet is to take it at least 30 to 60 minutes before the first meal of the day if you can. If this isn’t possible for you, talk to your healthcare provider about the best way to take Nexium.

Keep in mind: If you have trouble swallowing pills, it’s okay to open up the Nexium capsules and take them with 1 tbsp of applesauce. Make sure you swallow without chewing. The granule packets are also an option if you have trouble swallowing.

4. Should I separate Nexium from other medications?

It depends. Many oral medications rely on stomach acid to be absorbed. So if you take them close to the time you take Nexium, they may not work as well.

But knowing when and how to separate PPIs from your other medications is a bit tricky because we don’t have much research on how to do this.

Some medications have specific guidelines on how to take them if you also take a PPI. For example, the antiviral Epclusa (sofosbuvir/velpatasvir) should be taken 4 hours before a PPI. But few medications have specific guidelines on this.

So if you take other oral medications, talk to your healthcare provider or pharmacist. They can help you figure out if it’s necessary to space out your other medications from Nexium.

Nexium can have other drug interactions, too. For example, it’s best to avoid Nexium if you’re taking clopidogrel (Plavix), rifampin (Rifadin), or St. John’s wort. Clopidogrel may be less effective when taken with Nexium. And rifampin and St. John’s wort can make Nexium less effective.

This isn’t a complete list of Nexium drug interactions. So be sure to give your provider or pharmacist a full list of your medications, including OTC products. They can check for interactions and tell you how to manage them.

5. What can I do if I experience side effects from Nexium?

Common Nexium side effects are usually mild and may improve on their own as your body adjusts to the medication. They can include:

• Headache

• Dry mouth

• Stomach pain

• Gastrointestinal (GI) side effects like diarrhea, constipation, gas

Keep in mind that prescription Nexium is usually recommended for short-term use (about 1 to 2 months). And OTC Nexium shouldn’t be used for more than 14 days in a row. So even if you experience these side effects, they may not last long. But if these side effects affect your daily life, reach out to your healthcare provider.

Serious Nexium side effects

Some Nexium side effects are more likely when it’s taken for months or years. And they can be more serious, too. That’s why it’s best to follow your provider’s instructions for how long to take Nexium. Taking it for longer than prescribed or recommended can raise the risk of these side effects.

Though rare, some serious side effects that can occur with Nexium include:

• Bone fractures

• Low magnesium and vitamin B12 levels

• Severe diarrhea caused by C. difficile-related infection

• Kidney problems

• Autoimmune diseases, like lupus

• Stomach polyps (collection of cells in the stomach)

If you’ve been taking Nexium for a while, talk to your healthcare provider. If it’s appropriate, they can give you recommendations for how to stop Nexium.

But in some cases, taking Nexium long term may be recommended. Still, there may be ways to protect yourself against serious side effects. For example, your provider might recommend foods that are high in calcium and vitamin D to keep your bones strong. They also may recommend supplements to prevent low magnesium or B12.

How to save money on Nexium

Esomeprazole is available as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 90% off the average retail price of generic Nexium. Prescription-only, generic Nexium 40 mg capsules may be as low as $13.00 with a free GoodRx discount at certain pharmacies. And if you get a prescription for generic OTC Nexium, the 20 mg capsules could be as low as $16.47. Check out this article for more information on how to use a GoodRx discount with OTC medications.

• Save with a copay savings card. If you have commercial insurance or you’re uninsured, you may be able to get brand-name Nexium for as little as $15 per month if you use the manufacturer’s savings card.