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
Dexilant
Nexium vs. Dexilant Dosage
Nexium
Dexilant
| 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 |
| 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
| 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
| 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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