Written by 1:08 pm OTC Medications, Product Reviews

Product Review: Nexium 24HR

Nexium (esomeprazole) 24HR is the latest medication for heartburn to become available for patients without a prescription.  As such, it joins the ranks of Prilosec OTC, Prevacid 24HR and Zegerid OTC as the fourth “proton pump inhibitor” to go OTC (over the counter). 

This move provides patients with an alternative to the previously available products and gives pharmacists an additional tool to work with when counseling and recommending treatments for a very commonly reported symptom.  According to the National Heartburn Alliance, frequent heartburn (heartburn occurring 2 or more days per week) affects 50 million people in the U.S. Nexium 24HR is approved to treat frequent heartburn.  It may be used by adults (18 years of age and older) and should not be used for more than 14 consecutive days without consulting a physician.


Before specifically getting into my review as a pharmacist of Nexium 24HR, we first need a very brief review of what it is used for.  Heartburn, also called acid reflux, is a bit of a misnomer since it technically has nothing to do with the “heart.”  The name comes from the fact that the sensation of pain typically feels as though it is coming right from behind the chest wall.  Heartburn occurs when the acid normally contained within the stomach backs up into the esophagus causing burning in the stomach, chest or throat.  Heartburn can also manifest itself with regurgitation resulting in a “sour” or bitter taste in the mouth.  Other symptoms associated with heartburn include frequent burping, stomach pain or discomfort after eating a meal or the feeling of being bloated.  It may occur more frequently while lying down than sitting up.

In order for you to understand Nexium 24HR, I need to take a moment to just make a few important distinctions between (1) heartburn, (2) frequent heartburn and (3) GERD.  1.  Heartburn is simply the occasional (once or twice a month) experience of the symptoms mentioned above.  Virtually everyone gets this from time to time.  2.  Frequent heartburn is technically the experience of these symptoms for 2 or more days per week.  For how many weeks does this have to happen to qualify as “frequent” heartburn?  Just once. Note: both Heartburn and Frequent Heartburn are SYMPTOMS.  3.  GERD (gastroesophageal reflux disease) is a disease in which acid and enzymes are backing up into the esophagus due to incomplete closing of the sphincter muscle above the stomach.  GERD should be diagnosed and treated by your doctor.  Frequent heartburn is one of the symptoms of GERD.


Treating frequent heartburn (with medications like Nexium 24HR) is the second best thing.  The best thing is to avoid heartburn altogether if possible.  Now, it is a myth that heartburn can always be controlled by simply avoiding certain dietary triggers.  Nevertheless, for many patients, dietary changes might significantly reduce the frequency of their symptoms.  Foods sometimes associated with heartburn symptoms include, but are not limited to, chocolate, coffee, alcohol, fatty and/or fried foods, peppermint, black pepper, orange juice, onions or tomatoes.  Smoking increases the likelihood you will experience the symptoms of heartburn.  Additionally, exercising immediately after eating can also contribute to this painful condition.


Nexium 24HR is just one of several ways to treat these symptoms referred to above.  There are both lifestyle (non-drug) treatments and medical (primarily drugs) treatments to help control the symptoms of frequent heartburn.

A)  The lifestyle changes that often help improve symptoms are:

  • Maintaining a healthy weight
  • Avoid clothes that fit too tightly
  • Eat smaller meals and avoid dietary triggers
  • Avoid lying down right after eating and try raising the head of your bed 6 inches

B)  Medications which help relieve the symptoms of heartburn include antacids (like Tums, Rolaids, Maalox), acid reducers (also known as H2-blockers) which include things like ranitidine (Zantac) or famotidine (Pepcid AC), and acid blockers (also known as Proton Pump Inhibitors like Nexium 24HR).

For a brief review of the various medications used to treat heartburn, check out the video below!




This blog post is especially about introducing Nexium 24HR.  It should be pointed out that I have NO direct financial ties to the makers of Nexium 24HR (i.e. Pfizer).  Nexium 24HR (esomeprazole) is approved for the short-term treatment of frequent heartburn symptoms.  It is not for “occasional” use.  When you decide to use Nexium 24HR you should plan on taking it for a full 14 days.  Think of it almost like a course of antibiotics (though it is NOT an antibiotic).  The point is that you continue to use it every day for the full 2 weeks.

The reason for this is that Nexium 24HR will take 1-4 days just to begin working.  Unlike antacids and H2 blockers, proton pump inhibitors like Nexium 24HR (as well as Prilosec OTC, Prevacid 24HR and Zegerid OTC) take time to shut down the acid producing machinery in our stomach.  Treating for 14 days will provide the opportunity for your body to heal and recover from the pain and damage associated with acid reflux.

Ideally you want to take Nexium 24HR first thing in the morning with a full glass of water before you eat anything.  Continue for a full 14 days. 

It is OK to use other products like antacids, particularly during the first 4 days, to help treat your symptoms while Nexium 24HR is beginning to do it’s job.  Hopefully, by day 4, your symptoms will be improving and the need to use other medications should diminish.

Nexium 24HR is approved to be used by patients for a 14 day treatment and may be repeated no more than once every 4 months.  In other words, if your symptoms continue beyond 14 days, you should schedule an appointment with your physician.  This is VERY important.


So what is my professional opinion on Nexium 24HR?  First of all, if you have come here seeking a medical diagnosis or patient-specific treatment recommendation, you should probably read my disclaimer page.  I like you.  But I’m not responsible for your choices.

To give my perspective, I need to talk a bit of science first.  From a purely science and medicine standpoint, Nexium 24HR (esomeprazole) is actually the “active ingredient” in Prilosec OTC (omeprazole).  Here’s the scoop.  Omeprazole is actually 2 different molecules.  Think of them like mirror images of the other, like your left and right hand.  In medicinal chemistry we call that an enantiomer.  In the case of omeprazole, only one of the “hands” is actually effective.  That “effective” hand is known as, you guessed it, esomeprazole…the only ingredient in Nexium 24HR.  The makers of Nexium basically took the active ingredient of Prilosec and created a whole new product.  Some call that cheating.  Whatever the case, when combined with powerful marketing, it turned into a multi-billion dollar drug.

Just fyi – this SAME situation occurs in the relationship between Prevacid (lansoprazole) and Dexilant (dexlansoprazole, only available by prescription at the moment).  Keep these secrets in mind and you will be well prepared to impress your friends the next time you get together.

If it were me, I would try EITHER a generic version of Prilosec OTC (omeprazole) or Nexium 24HR (if I had a coupon to make the price comparable) to treat my own frequent heartburn.  Remember that whatever choice you make, you should plan on taking the product for 2 full weeks, do NOT skip any days, and stop after the 14 days is over. 

IMPORTANT:  I’ll say it again – if your symptoms do NOT improve after 14 days it is VERY important that you get a medical examination.  Heartburn, and frequent heartburn, are both SYMPTOMS and could be a sign of a more serious underlying disease. 

©Jason Poquette and The Honest Apothecary.  Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts, quotes and links may be used, provided that full and clear credit is given to Jason Poquette and The Honest Apothecary with appropriate and specific links to the original content. 

Last modified: April 17, 2023