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What to know about the purple pill for acid reflux

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What is it?How does it work?BenefitsSide effectsOther formsOther optionsContacting a doctorSummary
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
Written by Cathy Lovering
Updated on

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. 

What is the purple pill?

Overturned bottle and spilling out we see some purple pills for acid reflux
Photography by Boogich/Getty Images

Esomeprazole (Nexium) reduces the amount of acid the stomach makes. 

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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What are the purple pill benefits?

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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