Nexium generic availability, cost, and dosage

Acid reflux, with symptoms of heartburn, is also known as gastroesophageal reflux disease (GERD; a more serious form of acid reflux). One may have heard of or taken a medication called Nexium to help relieve this condition. Nexium is part of the proton pump inhibitor (PPI) class of drugs and contains the active ingredient esomeprazole. PPIs work by decreasing the amount of acid produced by the stomach. Nexium was approved by the U.S. Food and Drug Administration (FDA) in 2001. Nexium is chemically similar to Prilosec (omeprazole), the first PPI approved by the FDA in 1989.

Now, Nexium is available in brand and generic, prescription, and over-the-counter forms. As of 2020, almost 1.3 million people in the U.S. filled over 5 million prescriptions for generic Nexium. Although many refer to this medicine as Nexium, generic esomeprazole can offer significant cost savings. Continue reading to learn more about Nexium and its generic esomeprazole. 

RELATED: Nexium vs. Prilosec: Differences, similarities, and which is better for you

Is there a generic for Nexium?

The FDA approved the first generic of prescription Nexium, esomeprazole, in January 2015. Nexium is still a brand-name product but is more popularly dispensed by pharmacies as generic esomeprazole. Generic esomeprazole is made by many pharmaceutical manufacturers. If a healthcare provider prescribes Nexium, the pharmacist will likely dispense esomeprazole unless a patient or the healthcare provider specifically requests the brand name. 

Nexium and esomeprazole can also be purchased over-the-counter. 

What are the differences between brand name and generic Nexium?

New brand-name drugs undergo extensive testing to be approved by the FDA. Manufacturers that make generic drugs are held to the same strict manufacturing standards. However, because the brand-name drug has been extensively tested, generic manufacturers do not have to design new clinical trials. However, they must prove that their generic medication is as safe and effective as the brand and has the same effect on the body—reaching the same levels in the same amount of time. Generic drugs may appear different from the brand name, but they contain the same active ingredient and work the same. There is a significant difference in the cost, though, as generics can cost up to 80% less than their brand-name counterparts.

Appearance

Different generic manufacturers produce generic versions of Nexium, which may result in different appearances. Despite any differences in appearance, such as different shapes or colors, esomeprazole and Nexium work the same way and are equally effective. 

Dosage forms

Whether brand-name or generic Nexium are prescribed, both are prescribed at the same dosage and frequency. Brand-name and generic Nexium are available in several dosage forms, including:

Over-the-counter:

• Nexium 24HR (esomeprazole magnesium) 20 mg delayed-release capsules
• Nexium 24HR (esomeprazole magnesium) 20 mg Clear Minis (capsules) 
• Nexium 24HR (esomeprazole magnesium) 20 mg delayed-release tablets 
• Nexium 24HR (esomeprazole magnesium) 20 mg Easy-Open capsules (for households without young children)

Prescription:

• Nexium (esomeprazole magnesium) 20 mg delayed-release capsules
• Nexium (esomeprazole magnesium) 40 mg delayed-release capsules
• Nexium for delayed-release powder packets for oral suspension (2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg): The contents of a packet are mixed with water in a container and consumed within 30 minutes of mixing. The mixture should not be stored for later use.

*Nexium is generally taken by mouth. However, the (opened) prescription esomeprazole capsules or oral suspension can be administered through the tube for those with gastric or nasogastric tubes.

Clinical studies

Brand and generic drugs contain the same ingredients and have the same FDA-approved uses. Because generics offer significant cost savings, most patients take them and find them as effective as the brand. After all, the FDA requires generics to be bioequivalent to the brand. This means that the generic drug results in the same concentrations in the blood over the same period of time as the brand.

Some studies do find that there may be differences between brand and generic. For example, one 2020 study done in Taiwan compared brand and generic antidepressants. The researchers found that those who took a brand-name antidepressant had a lower risk of a hospital visit than those who took a generic. 

However, studies like this are more the exception than the norm—data from the FDA shows that 90% of all prescription drugs in the US are filled for generics. 

The following table summarizes important information about Nexium and its generic esomeprazole. 

How much is generic Nexium?

The table below shows the significant cost savings from brand-name Nexium to generic esomeprazole. A prescription of 30, 40 mg capsules of brand-name Nexium without insurance would cost about $355. However, using a free SingleCare card and choosing generic drugs could mean paying as low as $12 for 30, 40 mg capsules of esomeprazole.

Note: If purchasing OTC strength Nexium, a prescription will be needed from a healthcare provider to apply the SingleCare discount.

How to switch from Nexium to esomeprazole

When issuing a prescription for this PPI, a healthcare provider will generally write the prescription as “Nexium.” State laws allow pharmacists to dispense generics of brand-name drugs, even if the prescription is written for the brand-name drug—unless a person or a healthcare provider specifically indicates not to substitute the brand with a generic. 

If taking brand-name Nexium and want to switch to the generic, check with the healthcare provider or pharmacist. The brand-name and generic products contain the same ingredients and dosage, so switching to generic should be an easy transition. Always consult a healthcare provider for medical advice for medication questions or concerns. 

Long-term use of Nexium

Because of the risk of side effects that may occur with long-term use, healthcare providers prescribe Nexium at the lowest effective dose for the shortest time. Some of the risks associated with long-term PPI use include:

• Increased risk of osteoporosis and related bone fractures of the hip, spine, or wrist
• Cyanocobalamin (vitamin B12) deficiency
• Low magnesium levels 
• Fundic gland polyps (a type of stomach polyp that occurs in the upper stomach)

Consult a healthcare provider for more information about Nexium use and its benefits and risks. Ensure the provider knows about any medical conditions and family medical history.

Frequently asked questions about generic Nexium

What drugs interact with Nexium?

Before taking Nexium, tell the healthcare provider about all medications being taken, including prescription and OTC drugs, vitamins, and supplements. Nexium can interact with certain drugs or supplements, such as:

• Certain antiretrovirals
• Coumadin (warfarin)
• Methotrexate
• Plavix (clopidogrel)
• Celexa (citalopram)
• Lanoxin (digoxin)
• Prograf (tacrolimus)
• Rifampin
• St. John’s wort

This is not a full list of drug interactions, and others may occur. Consult a healthcare provider for more information about drug interactions and the effects they may have. 

What foods affect Nexium?

Nexium should be taken at least one hour before eating. The capsule should be swallowed whole and not chewed or crushed. People with difficulty swallowing capsules can open the delayed-release capsule and sprinkle the contents on applesauce. 

Certain foods do not interact with Nexium but may worsen heartburn, such as fatty foods, salty foods, spicy foods, tomato sauces, citrus fruits, chocolate, peppermint, and carbonated beverages. Limiting or avoiding these foods may help improve symptoms. 

Can you take Nexium and alcohol?

While Nexium does not chemically interact with alcohol, alcohol may contribute to reflux. However, limiting alcohol consumption and staying hydrated may allow for enjoying small amounts of alcohol. Consult a healthcare provider for more information.