Nexium vs. Dexilant

See how Nexium and Dexilant compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both Nexium and Dexilant are proton pump inhibitors that lower stomach acid, but Nexium covers more approved conditions, including H. pylori eradication and NSAID ulcer prevention.

  • Dexilant's dual delayed-release design means it can be taken regardless of meal timing, while Nexium works best taken before eating.

  • Nexium comes in more forms, including IV and over-the-counter options, while Dexilant is available only as an oral capsule.

Nexium vs. Dexilant Drug Summary

Nexium

Nexium (esomeprazole) is a proton pump inhibitor that reduces stomach acid production. It treats erosive esophagitis, GERD-related heartburn, and helps lower ulcer risk from long-term NSAID use. It comes as a delayed-release capsule, oral suspension, or IV injection, usually taken once daily before a meal.

Dexilant

Dexilant (dexlansoprazole) is a proton pump inhibitor that reduces stomach acid production. It treats erosive esophagitis and relieves heartburn from non-erosive GERD. It comes as a delayed-release capsule with a dual-release design, taken once daily without regard to meals.

Nexium vs. Dexilant Side Effects

Nexium

Most common
Abdominal pain (up to 4%)
Diarrhea (up to 4%)
Nausea (>1%)
Headache (up to 5.5%)

Dexilant

Most common
Abdominal pain (≥2%)
Diarrhea (≥2%)
Nausea (≥2%)
Upper respiratory tract infection (≥2%)

Nexium vs. Dexilant Dosage

Nexium

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily Weeks 1-4
Maximum dose 20 mg or 40 mg IV daily If needed
Dose changes 3 increases As tolerated

Dexilant

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg once daily At the start
Maximum dose 60 mg once daily If needed
Dose changes 1 increase As tolerated

Nexium vs. Dexilant Indications

Nexium

Nexium is FDA-approved for a broad range of acid-related conditions, from healing erosive esophagitis to reducing ulcer risk during NSAID use and eradicating H. pylori infection. It also treats rare hypersecretory disorders like Zollinger-Ellison syndrome. This gives it one of the widest approved use lists among proton pump inhibitors.

  • Healing of erosive esophagitis (EE)

  • Maintenance of healed EE

  • Short-term heartburn/GERD relief

Dexilant

Dexilant is approved to heal and maintain healing of erosive esophagitis and to relieve heartburn from non-erosive GERD. Its approved use list is narrower than Nexium's, focused specifically on esophagitis and reflux symptom relief. It is not approved for ulcer prevention or H. pylori treatment.

  • Healing of all grades of EE

  • Maintenance of healed EE and heartburn relief

  • Treatment of non-erosive GERD symptoms

Nexium vs. Dexilant Pros and Cons

Nexium

Nexium has one of the broadest FDA-approved use lists among PPIs, covering ulcer prevention, H. pylori treatment, and hypersecretory conditions. It is also sold in an over-the-counter version and an IV form, adding flexibility for cost and administration. Most formulations work best when taken on an empty stomach before eating.

Pros

  • Approved for more conditions, including H. pylori eradication and NSAID ulcer prevention

  • Available as an IV formulation for patients who cannot take pills

  • Approved down to 1 month of age for erosive esophagitis, versus 12 years for Dexilant

  • Available over the counter as well as by prescription

Cons

  • Must be taken 30-60 minutes before a meal for full effect

  • Not approved for symptomatic GERD in infants under 1 year

  • Twice-daily dosing needed for hypersecretory conditions like Zollinger-Ellison syndrome

  • Lacks a dual-release delivery system, so timing around meals matters more

Dexilant

Dexilant's dual delayed-release formulation gives extended acid suppression and can be taken without regard to meal timing. Its FDA-approved uses focus specifically on erosive esophagitis healing and non-erosive GERD symptom relief. It is available only as an oral capsule, with no IV option for patients who cannot swallow pills.

Pros

  • Dual delayed-release formulation allows dosing regardless of meal timing

  • Approved specifically for non-erosive GERD symptom relief, not just esophagitis

  • Simple two-step titration for healing erosive esophagitis

  • Only PPI with this dual-release delivery system for extended acid suppression

Cons

  • Narrower list of approved uses, with no H. pylori or NSAID-ulcer indication

  • Not approved for use in patients under 12 years old

  • No IV formulation for patients unable to take oral medication

  • Roughly $270 to $470 per month without insurance, before savings programs

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