Esomeprazole (Nexium) can offer relief from heartburn and other symptoms of too much stomach acid. If you cannot take it by mouth, intravenous (IV) versions are also available.
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD
The purple pill for acid reflux is esomeprazole (Nexium). It treats a number of conditions caused by too much stomach acid, including gastroesophageal reflux disease (GERD).
Esomeprazole is available over-the-counter (OTC) and by prescription. Because of the likelihood of side effects, doctors and healthcare professionals don’t typically recommend the purple pill for long-term use.
The OTC purple pill is a delayed-release capsule. This means the medication will slowly release throughout your body so its effects last longer.
You usually take it once per day, at least an hour before eating. You can continue to take it daily for up to 14 days.
You should take the nonprescription capsule whole and try not to chew or split the capsule.
Doctors and healthcare professionals don’t recommend taking nonprescription esomeprazole more than three times per year.
Nonprescription esomeprazole treats heartburn, whereas the prescription strength version can help with other gastric-related conditions, including:
healing erosive esophagitis, where there is tissue damage to the esophagus lining
reducing the likelihood of some types of ulcers
treating certain conditions such as Zollinger-Ellison syndrome, a rare gastric disorder where the stomach produces too much acid
How does the purple pill work for acid reflux?
Esomeprazole (Nexium) is a proton pump inhibitor (PPI). Other examples of PPIs include lansoprazole (Prevacid) and omeprazole (Prilosec).
PPIs work by blocking the enzyme that forms during the final stage of acid secretion in the stomach.
It takes 1–4 days for PPIs like esomeprazole to begin to work, so healthcare professionals will not recommend these for quick relief from acid reflux symptoms.
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Esomeprazole (Nexium) and other PPIs can help heal the esophagus if you have GERD.
These medications work better than other medications to lower stomach acid, like Histamine-2 (H2) blockers. But H2 blockers work faster, often within 1–3 hours.
A 2020 review of studies found that esomeprazole lowered relapse rates in people with GERD, reduced heartburn, and lowered upper abdominal pain.
Purple pill side effects
Nonprescription esomeprazole (Nexium) can cause some side effects, including:
headaches
nausea
gas
diarrhea or constipation
dry mouth
difficulty maintaining an erection
drowsiness
More serious side effects that may require medical attention include:
rash, hives, or itching
blisters, skin peeling, or skin bleeding
irregular heart rate
muscle spasms
fatigue (low energy)
lightheadedness
severe diarrhea
new or worsening joint pain
reduced or increased urination, or blood in the urine
People who take high dose PPIs for a year or longer may also have an increased risk of bone fractures and stomach polyps.
Other esomeprazole forms
In addition to the purple pill, esomeprazole is available by prescription as an oral suspension, or soluble powder, and as an IV medication. It comes with the same potential side effects and precautions as the pill version.
If you’re using the oral suspension, follow these steps:
Stir packet contents into water.
Leave the mixture to thicken over the course of 2–3 minutes.
Stir the mixture and drink within 30 minutes.
If you can’t take the medication by mouth, a medical professional such as a nurse or doctor will administer IV esomeprazole at a clinic or hospital. The usual dose is once per day to treat GERD.
IV esomeprazole can also reduce bleeding after an endoscopy. If you’re using it for this purpose, a healthcare professional will usually give you a continuous infusion over 72 hours.
Other medications for acid reflux and GERD
You can take several other medications for GERD or acid reflux. Nonprescription options include OTC antacids that are best for mild GERD symptoms.
In addition to PPIs, prescription medications for GERD include H2 blockers. Examples of H2 blockers are famotidine (Pepcid) and nizatidine (Axid AR). They work faster than PPIs and last for around 4–10 hours.
Contacting a doctor
You might consider speaking with a doctor if you think you have GERD or if taking the purple pill or other OTC medications doesn’t relieve your symptoms. You might have GERD if you experience:
heartburn
taste food or stomach acid due to regurgitation of stomach contents
nausea
chest pain
long-term cough
hoarseness
difficulty swallowing or pain when swallowing
A doctor or medical professional may recommend lifestyle adaptations, like eating different foods, to help relieve GERD symptoms. They might also recommend prescription medications.
Summary
Esomeprazole (Nexium) is the purple pill for acid reflux. You would typically take the medication once per day for up to 14 days, but no more than three times per year.
Doctors or healthcare professionals may prescribe a stronger dosage of Nexium if you have erosive esophagitis or to reduce the likelihood of ulcers.
Other medications for GERD include H2 blockers and OTC antacids.
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Hou M, et al. (2020). Efficacy and safety of esomeprazole for the treatment of reflux symptoms in patients with gastroesophageal reflux disease: A systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215048/