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Esomeprazole (Nexium)

Proton Pump Inhibitorprescriptionoral · predicted

S-isomer of omeprazole providing more consistent acid suppression due to lower CYP2C19 first-pass metabolism. Irreversibly inhibits gastric H+/K+-ATPase. Higher intragastric pH and longer acid suppression than racemic omeprazole in some studies. Used for GERD, erosive esophagitis, H. pylori eradication (triple therapy), and NSAID ulcer prophylaxis. Available OTC (20 mg) and prescription.

Projected serum levels — 20 mg, once daily

Esomeprazole (Nexium)
Esomeprazole (Nexium) modeled serum levels, 20 mg once daily over 15 days Population-based pharmacokinetic estimate. Steady state reached after approximately 1 days. 0 5 10 15 20 Day 0 Day 4 Day 8 Day 11 Day 15 Time on a regular schedule ≈ steady state · day 1

Maintenance schedule: 20 mg once daily (oral).

Modeled steady state after ~1 days: peak ≈ 10.0 mg, trough ≈ 0.000 mg body load. Population-based estimate over 15 days for a 20 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.

Key facts

Category
Proton Pump Inhibitor
Route modeled
Oral
Model confidence
predicted
Half-life
1.3 h
Common dose
20 mg
Suggested maximum
40 mg/day
Reference dose range
10–40 mg (single dose)
Suggested cadence
once daily
Validated against
40 mg oral — Cmax 1.5 mg/L at 1.5 h

Documented interactions

  • danger
    Carbamazepine (Tegretol) + Esomeprazole (Nexium) CYP induction

    Carbamazepine (Tegretol) inducer of CYP3A4 predicted to change Esomeprazole (Nexium) AUC by ~0.49x

  • danger
    CBD (Cannabidiol) + Esomeprazole (Nexium) CYP inhibition

    CBD (Cannabidiol) reversible_inhibitor of CYP2C19 predicted to change Esomeprazole (Nexium) AUC by ~2.07x

  • danger
    Efavirenz (Sustiva) + Esomeprazole (Nexium) CYP induction

    Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Esomeprazole (Nexium) AUC by ~0.35x

  • danger
    Ethinyl Estradiol + Esomeprazole (Nexium) CYP inhibition

    Ethinyl Estradiol reversible_inhibitor of CYP2C19 predicted to change Esomeprazole (Nexium) AUC by ~2.07x

  • danger
    Fluconazole + Esomeprazole (Nexium) CYP inhibition

    Fluconazole reversible_inhibitor of CYP2C19 predicted to change Esomeprazole (Nexium) AUC by ~2.07x

  • danger
    Fluoxetine (Prozac) + Esomeprazole (Nexium) CYP inhibition

    Fluoxetine (Prozac) reversible_inhibitor of CYP2C19 predicted to change Esomeprazole (Nexium) AUC by ~2.07x

Serum checks 236 modeled interaction pairings for esomeprazole (nexium) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.

Research behind this entry

  1. Esomeprazole versus omeprazole in the treatment of erosive esophagitis: results of a randomized, double-blind, multicenter study Richter JE et al. · American Journal of Gastroenterology, 2001 DOI

    Large RCT (2425 patients) demonstrating esomeprazole 40 mg healed erosive esophagitis in 93% of patients at 8 weeks versus 87% with omeprazole 20 mg, with significantly faster symptom resolution.

  2. Esomeprazole: pharmacokinetic advantages over omeprazole Andersson T et al. · Clinical Pharmacokinetics, 2001 DOI

    PK study showing esomeprazole has 50% higher AUC than omeprazole due to reduced CYP2C19 first-pass metabolism, with less interindividual variability and half-life of 1.2-1.5 hours.

2 published studies referenced in the app, each with a plain-language summary.