Nexium vs. Dexilant

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

Andre Stone | MD

Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on September 8th, 2026.

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 helping eradicate H. pylori infection in adults when used with the prescribed antibiotics. 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

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.

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