9 Nexium Side Effects You Should Know About

GoodRx Health

Do you remember those Tums commercials where food suddenly turns lifesize and fights unsuspecting people? It's an amusing depiction of heartburn and how antacids, such as Tums, can fight its symptoms.

But having persistent or severe heartburn, also known as gastroesophageal reflux disease (GERD), is a serious issue. In these cases, proton pump inhibitors (PPIs) such as Nexium (esomeprazole) might be a better treatment option than antacids. They stop your stomach from producing acid rather than temporarily neutralizing it.

PPIs may be effective in treating heartburn, but it's important to be aware of possible side effects.

Nexium side effects at a glance

Thankfully, side effects from PPIs like Nexium don't happen often. Those who take Nexium for a short time might occasionally experience the mild side effects listed below. But taking Nexium for a longer period of time, such as 2 months or more, can increase the risk of more serious (but rare) side effects.

Common Nexium side effects include:

• Nausea

• Diarrhea or constipation

• Feeling gassy

• Stomach pain

• Headache

• Dry mouth

• Sleepiness

Rare but serious Nexium side effects include:

• Low magnesium or vitamin B12 levels

• Bone fractures

• Skin reactions

• Kidney problems

• Infectious diarrhea

Here, we'll discuss nine notable Nexium side effects and how to manage them. Keep in mind that this isn't a complete list, so it's important to talk with your healthcare professional about your individual symptoms and concerns.

1. Nausea

Of the side effects that are possible, a gut-related one like nausea is the most likely. Fortunately, nausea from Nexium should resolve on its own. Eating bland foods and hydrating well can help manage mild nausea.

But keep in mind that GERD can also cause nausea. So it could be a sign that Nexium isn't working well.

Contact your healthcare professional if you're having persistent or worsening nausea after starting Nexium. They may need to change your Nexium dose or switch you to a different acid-lowering medication.

2. Diarrhea or constipation

Since many of Nexium's side effects are gut related, it's no surprise that constipation and diarrhea are also on the list.

Constipation is defined by having fewer than three bowel movements per week. You can often prevent or relieve constipation by implementing lifestyle changes or using over-the-counter (OTC) medications. Here are some strategies to help:

• Exercise regularly.

• Eat foods with fiber.

• Consider taking an OTC stool softener, such as docusate (Colace), or a stimulant laxative such as senna (Senokot).

Diarrhea is the opposite. It's characterized by more frequent and watery stools. If you experience mild or short-lived diarrhea from taking Nexium, you can treat it in the following ways:

• Drink lots of fluids, including water, broth, and electrolyte-rich beverages.

• Avoid fatty, fried, or fibrous foods.

• Take an OTC antidiarrheal medication, such as loperamide (Imodium A-D).

Persistent diarrhea can lead to dehydration or potentially indicate something more serious. PPIs have been associated with a higher chance of developing Clostridioides difficilediarrhea, a serious bacterial infection. Antibiotics are the only treatment for this type of diarrhea, so it's important to be seen by a healthcare professional. If you continue to have diarrhea despite treatment with loperamide or other supportive care, contact your healthcare professional right away.

3. Headache

Headache can also occur in those taking Nexium. If headaches are infrequent, an OTC pain reliever, such as acetaminophen (Tylenol), can do the trick. But it's important to use them only as needed and for a short period of time if possible.

If you're having multiple headaches per month, tell your healthcare professional. They may need to evaluate you to make sure something more serious isn't going on.

4. Dry mouth

Dry mouth is a possible side effect of many medications. Nexium is no exception. It happens when you don't make enough saliva. It can make swallowing and speaking difficult. And it can increase your risk of cavities and mouth infections if left untreated, so it's important to lessen dry mouth before it becomes a persistent problem.

Here are a few ways to increase the amount of saliva you make:

• Chew sugar-free gum or candy.

• Sip cool liquids, or suck on ice chips throughout the day.

• Try an OTC saliva substitute, such as Biotene oral rinse.

5. Sleepiness

Sleepiness is another reported Nexium side effect. But GERD can make it hard to fall asleep at night, which can lead to drowsiness. This makes it hard to know whether Nexium or the effects of undertreated GERD are causing sleepiness.

If you're still having heartburn symptoms (especially at night) after starting Nexium, tell your healthcare professional. They can help you determine if you need a dose increase, a different heartburn medication, or another intervention to help you sleep better at night.

6. Low magnesium or vitamin B12 levels

Although rare, low levels of magnesium or vitamin B12 can also result from long-term Nexium use.

Magnesium

Low magnesium is a serious health condition. It can cause muscle spasms, an irregular heartbeat, and even seizures. The risk for low magnesium is higher in people taking PPIs for at least a year, although it's been reported as early as 3 months in.

If your healthcare professional recommends taking Nexium for an extended period of time, they may monitor your magnesium levels. If your levels drop too low, they may recommend stopping Nexium or trying a magnesium supplement.

Keep in mind: Compared with prescription versions of Nexium, OTC Nexium is meant for short-term use. People who take OTC Nexium for longer than 2 weeks should do so only if their healthcare professional has recommended it.

Vitamin B12

We obtain vitamin B12 (cyanocobalamin) from food, and it needs an acidic environment in your gut to be absorbed properly. Since Nexium reduces stomach acid, it makes sense that vitamin B12 levels might drop when you're taking it.

This effect doesn't take place immediately. It usually happens over a period of 3 or more years. And it's more likely in older adults because we naturally make less stomach acid as we get older.

If you take Nexium long term and develop significant weakness or fatigue, tell your healthcare professional. These are possible symptoms of vitamin B12 deficiency.

7. Bone fractures

Nexium can also increase the risk of bone fractures in the hip, spine, and wrist. This is more common in adults ages 50 and older who are taking higher doses or taking it for over a year.

This fracture risk may be related to the fact that many calcium supplements and calcium-rich foods need an acidic environment to be absorbed. Nexium lowers stomach acid, which can reduce calcium absorption. Lower calcium absorption could lead to weaker bones over time.

If you take calcium while also taking an acid reducer like Nexium, you may want to opt for calcium citrate rather than calcium carbonate. Calcium citrate is a better option because it isn't dependent on stomach acid for absorption.

8. Skin reactions

It's very rare, but Nexium has been linked to life-threatening skin conditions such as Stevens-Johnson Syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Seek medical care right away if you develop any symptoms of these reactions, such as:

• Rash

• Flu-like symptoms such as fever, cough, and body aches

• Blisters or peeling skin

• Swelling

Another rare skin side effect is called subacute cutaneous lupus erythematosus. It typically causes a rash or plaques on the skin, but some people experience joint pain and low blood counts too. This is usually reversible after stopping Nexium.

9. Kidney problems

Another rare side effect of PPIs like Nexium is short- or long-term kidney damage.

Short-term, sudden kidney damage can occur with any amount of PPI use. But if it's caught early, stopping Nexium usually reverses any potential damage.

Some studies also hint that PPI use could contribute to chronic kidney disease. Long-term Nexium use and using it at higher doses could increase this risk. But it's unclear if PPIs make existing kidney problems worse.

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