Esomeprazole (Intravenous)

Esomeprazole injections are approved for adults and children over 1-month-old with GERD that is accompanied by Erosive Esophagitis.


Intravenous Esomeprazole is used to treat excess acid in the stomach. This condition is otherwise known as GERD or Gastroesophageal Reflux Disease, particularly when this is accompanied by Erosive Esophagitis (EE).

Additionally, Intravenous Esomeprazole may be prescribed to lower the chances of bleeding in patients who experience the following after an endoscopy:

  • Acute Gastric Ulcers
  • Duodenal Ulcer

Esomeprazole is indicated for both adults and children over the age of 1-month-old. Available by prescription only, it is sold under the U.S. brand name NEXIUM I.V. This drug is supplied in many formats. However, this guide focuses on intravenous treatments of Esomeprazole.

What is GERD

GERD is defined as when excess acid in the stomach rediverts into the Esophagus.

As a Proton Pump Inhibitor, injectable Esomeprazole lowers acidity levels in the stomach, which typically causes a great deal burning, pain, and discomfort in patients.

In most cases, intravenous Esomeprazole is prescribed for the short-term (usually 10 days) to expedite relief of GERD symptoms. Following preliminary injectable doses, an oral form of Esomeprazole may be prescribed to help manage the condition.

Conditions Treated?

  • Gastroesophageal Reflux Disease (GERD), Acute Gastric Ulcers, Duodenal Ulcer, Erosive Esophagitis, Acid Reflux, Gastritis

Type Of Medicine?

  • Proton Pump Inhibitor (PPI)

Side Effects

Patients are generally counseled about the main side effects of Esomeprazole, which include but aren't limited to:

The Most Common Side Effects of Esomeprazole:

  • A Distended Stomach
  • Abnormal Heartbeat
  • Burping
  • Changes in Urine Color
  • Colic
  • Constipation
  • Coughing, Runny Nose, Sneezing, and/or Sore Throat
  • Diarrhea
  • Distorted Sense of Movement
  • Dry Mouth
  • Eye Irritation
  • Feeling Dizzy or Lightheaded
  • Fevers or Chills
  • A Headache
  • Heartburn
  • Hives
  • Lesions
  • Lumps at the Injection Site
  • Pain in the Joints or Muscles
  • Skin or Eyes that Look Yellow
  • Skin that Peels or Blisters
  • Targeted Pain in the Side or Back
  • Trouble Swallowing
  • Vertigo or Spinning Sensation

The Rare Side Effects of Esomeprazole:

  • A High Temperature
  • Appetite Loss
  • Changes in The Stool Color
  • Coffee Ground Vomitus
  • Convulsions
  • Feeling Dizzy
  • Feeling Sleepy All the Time
  • Mood Swings
  • Muscle Weakness
  • Tetany or Muscle Spasms
  • Tremors

When to Call a Doctor

Most of the side effects of Esomeprazole injections go away with time. However, certain adverse reactions should never be ignored. These include when you suspect or experience:

1. An Allergic Reaction to the Drug ' Anaphylaxis could be fatal if left untreated. Read more in the warnings below.

2. Persistent Diarrhea' If you have watery stools that are accompanied by a high temperature and pain in the stomach, contact your healthcare provider immediately.


A trained nurse or healthcare will inject a metered dose of Esomeprazole into the veins.

Dose Amounts for GERD with EE

Children Doses for GERD with EE

The dosage amounts for children who have GERD with EE vary based on the patient's age and weight:

Children 1-17 Years Old

The following doses are outlined for children between the ages of 1 and 17 years of age, based on weight:

  • Children Who Weigh Less Than 55 kg: 10 mg | 1X per Day
  • Children Who Weigh 55 kg or More: 20 mg | 1X per Day

Infants 1-Month-Old to Less Than 12 Months Old

  • 0.5 mg | 1X per Day

In infants and children, the dose should be administered by IV Infusion lasting 10-30 minutes.

Adult Doses for GERD with EE

  • 20-40 mg | 1X per Day for 10 Days

This dose can be administered by:

1. IV Infusion lasting 10-30 minutes
2. Intravenous Injection (Minimal 3 Minutes)

Patients with Acute Liver Impairment

The dose should not exceed 20 mg within a 24-hour period.

Lowering the Risk of Bleeding - for Gastric and Duodenal Ulcers

NEXIUM I.V. may be prescribed within the preliminary 72 hours after patients receive therapeutic endoscopy. It's generally prescribed to reduce the risk of bleeding. The following dosage amounts are recommended:

  • Initial Treatment: 80 mg | IV Infusion Lasting 10-30 Minutes
  • Continuous Treatment for 3 Days: 8 mg per Hour

Note: Adjusted doses are needed for patients with severe liver impairment.

Dosage Instructions for Medical Workers

All dosage requirements must be adhered to improve patients' safety. Some of the main protocols include:

  • Single Site Injections 'Do not infuse Esomeprazole in conjunction with other medicines.
  • Wear Protective Gear ' Reduce the risk of transmission of infectious diseases by wearing gloves during intravenous injections. Dispose of used gloves and needles in a biohazard waste bin after use.
  • Diluents: The diluent amounts differ based on patients' age and weight. Be sure to check with the prescribing doctors before reconstitution. After diluting the mix, check for discoloration or particulates. If any of these are observed, discard the mix.
  • Flush the Line

For new or continuous treatments, be sure to flush the IV line with any of the following solutions:

  • 0.9% Sodium Chloride Injection
  • 5% Dextrose Injection
  • Lactated Ringer's Injection

NEXIUM I.V. is supplied in 20-40 mg vials containing a freeze-dried powder which must be reconstituted before use.


Multiple drug interactions have been identified for Esomeprazole. There are also noteworthy food, alcohol, and disease interactions with this drug, which are explored in detail below:

Drug Interactions

  • Atazanavir
  • Bosutinib
  • Cilostazol
  • Citalopram
  • Clopidogrel
  • Dasatinib
  • Erlotinib
  • Escitalopram
  • Eslicarbazepine Acetate
  • Gefitinib
  • Ketoconazole
  • Ledipasvir
  • Levothyroxine
  • Methotrexate
  • Mycophenolate Mofetil
  • Nelfinavir
  • Nilotinib
  • Pazopanib
  • Posaconazole
  • Rilpivirine
  • Risedronate
  • Saquinavir
  • Tacrolimus
  • Thiopental
  • Velpatasvir
  • Vismodegib
  • Voriconazole
  • Warfarin

Classes of Drugs to Avoid

The above list is not all-inclusive. As a synopsis, the following classes of drugs should be avoided with Esomeprazole injections:

  • Blood Thinners
  • CYP2C19 and CYP3A4 Inhibitors
  • Iron Tablets
  • Water Pills or Diuretics

Alcohol Interactions

Alcohol should be avoided when undergoing treatment with Esomeprazole as serious adverse reactions have been noted with concurrent use.

Food Interactions

Healthcare specialists recommend avoiding cranberry products, including cranberry juice, when undergoing treatment with Esomeprazole. Studies suggest that concomitant use increases the risk of side effects, although in some cases this may be inevitable.

Pre-Existing Conditions

When completing any new medical treatment, patients are advised to create a full list of all underlying conditions and medications being taken. This provides healthcare workers with invaluable information to gauge dosage amounts and if certain treatments are safe to prescribe. Based on medical research, certain precautions must be taken if Esomeprazole injections are ordered for patients who are diagnosed with:

  • Low Magnesium in the Blood
  • Diarrhea
  • Osteoporosis
  • Lupus
  • Liver Issues

Esomeprazole injections may cause these conditions to become worse. Reduced dosage amounts and close monitoring are necessary in these cases.

OTC Interactions

Special warnings have been given to avoid using Esomeprazole with St. John's Wort herbal supplement.


Follow the below precautions to improve safety while taking this medicine:

Timeline for Effectiveness

After receiving an injectable dose of Esomeprazole, it may take a few days before relief is experienced. To get short-term relief of GERD symptoms, your doctor may recommend taking over-the-counter antacids. Be sure to speak with your medical provider before starting antacids or any new treatment within days of receiving Esomeprazole injections.

Pediatric Applications

Injectable NEXIUM considered safe for use in children, except in neonates younger than one-month-old.

Senior Applications

Esomeprazole injections are indicated for use in seniors. However, due to the high propensity of seniors having underlying conditions, care should be taken to prescribe the appropriate dosage amounts in this profile group.

Senior patients are advised to attend all follow-ups to determine if the medicine is working or causing any adverse effects.

Patients over the age of 50 who receive Esomeprazole injections are at a higher risk of developing bone health issues, including fractures. The chances of getting a hip, wrist, or spine fracture is increased exponentially in patients taking this medicine for a prolonged period of more than 12 months or when higher quantities are prescribed.

Pregnant and Nursing Mothers

Animal studies suggest that Esomeprazole use during pregnancy could cause serious injury to developing fetuses. It is therefore not recommended for use during pregnancy.

If you are pregnant, breastfeeding, or plan to be, inform your medical provider.


There's a possibility of developing Anaphylaxis after getting NEXIUM I.V. This is especially true for patients with a history of hypersensitivities. Anaphylaxis is a serious and potentially fatal condition that requires immediate medical intervention. Some of the warning signs include:

  • Hives and Rashes
  • Puffiness
  • Swollen Face or Eyelids
  • Tightness in the Chest
  • Trouble Breathing
  • Trouble Swallowing

Precautions for Medical Providers:

Due to the risk of anaphylaxis, the medical facilities should be equipped with the right counteractive drugs and tools to resolve anaphylaxis in a timely manner. This includes providing quick ways for patients to alert a nurse or healthcare worker on duty via a call button or drawstring near beds, sitting areas, and in the restroom.

Query the patient's full medical history before prescribing this medicine and monitor the patient closely following administration.

Acute Interstitial Nephritis

There is also a possibility of developing acute interstitial nephritis when taking Esomeprazole. Tell your doctor if you experience any of the following symptoms after receiving treatment:

  • A High Temperature
  • Edema
  • Pain in the Joints
  • Rashes on the Skin
  • Sudden Weight Changes

Lupus Erythematosus

If you have systematic or cutaneous Lupus Erythematosus, the condition may progress or get worse if you receive Esomeprazole injections. Be sure to follow your doctor's orders and attend all follow-up appointments post-treatment. You should also advise your medical provider right away if you experience the following symptoms after receiving Esomeprazole or NEXIUM I.V.:

  • Pain in the Joints
  • Rashes on the Skin
  • Worsening Skin Irritation with UV Exposure

Low Magnesium

Hypomagnesemia is the term used to define low magnesium levels in the bloodstream. There is an increased chance of developing this condition when patients receive:

  • Esomeprazole for More Than 12 Months
  • Esomeprazole with Water Pills or Diuretics

Magnesium deficiencies are serious and require prompt medical intervention. You should inform your healthcare provider if any of the following symptoms arise post-treatment:

  • Abnormal Heartbeat
  • Extreme Drowsiness
  • Involuntary Twitching or Spasms
  • Seizures

Medical Tests

Esomeprazole injections may alter certain medical readings. If you have an upcoming medical test or dental appointment, inform your provider of recent treatments with Esomeprazole.

Over-the-Counter Drugs

Over-the-counter (OTC) drugs should never be taken without your doctor's consent if you receive Esomeprazole. Seek medical advice before commencing treatment with vitamins, herbal supplements, NSAIDs, or other types of OTCs.


To preserve the quality and usefulness of this medicine, follow the below storage instructions:

Unopened Vials

NEXIUM I.V. vials should be stored at temperatures of 25°C (77°F.) Keep in the original cartons until the vial is ready for use. Do not place in well-lit areas.

Storage Instructions for Diluents of NEXIUM I.V.

The storage instructions for NEXIUM I.V. depend on the reconstituted mix. All diluents for injection can be stored at a room temperature of 30°C (86°F) for the following timeframes:

  • 0.9% Sodium Chloride Injections: 12 Hours
  • 5% Dextrose Injection: 6 Hours
  • Lactated Ringer's Injection: 12 Hours

Note: Discard the mix if it isn't used within this period.


NEXIUM I.V. for injection or Esomeprazole is used to treat Gastroesophageal Reflux Disease (GERD) with Erosive Esophagitis (EE) and other stomach-related ailments, such as ulcers, gastritis, esophagitis, and more. Additionally, this medicine may be ordered for patients who have developed ulcers following an endoscopy to reduce the risk of bleeding.

The medicine decreases the amount of acid in the stomach and provides patients with much-needed relief from burning chest pain and other discomforts associated with GERD.

It is indicated for children and adults. However, this medicine should not be prescribed for infants younger than four weeks old.

NEXIUM I.V. may cause flatulence, headaches, pain in the stomach, and skin irritations. These are some of the most commonly reported side effects, many of which subside with time.

Some adverse reactions require immediate medical intervention, however. These include anaphylaxis, low magnesium, and interstitial nephritis. Your doctor should provide an outline of precautions for when to call for help.

Treatment general lasts 10 days and follow-ups may be needed. When suitable, healthcare workers substitute injectable NEXIUM I.V. for oral doses.

GERD with EE is a common condition, but with treatments such as injectable NEXIUM I.V., the symptoms can be effectively managed for patients to enjoy a better quality of life.