Acid reflux, also called GERD (Gastroesophageal Reflux Disease), can be a painful condition that allows acid to build up in your stomach causing a burning sensation in your chest or abdomen. The acid can also travel from the stomach into the esophagus causing a very painful burning sensation. The good news is there are effective medications on the market that can successfully help you deal with this issue and diminish the pain associated with it.
Two of the most commonly prescribed proton pump inhibitors for GERD are Dexilant and Nexium. When deciding between Dexilant vs. Nexium, many patients struggle to determine which medication is the better choice for their specific needs. This Dexilant versus Nexium comparison will provide vital information about both drugs, including their mechanisms of action, effectiveness, side effects, and costs, to help you understand the difference between Dexilant and Nexium and choose the right treatment for your acid reflux.
What are proton pump inhibitors?
Proton pump inhibitors (PPIs) such as Dexilant (dexlansoprazole) and Nexium (esomeprazole) are acid‑suppressing drugs used mainly for GERD, erosive esophagitis, and ulcers.
- PPIs are a class of medicines that reduce stomach acid by blocking the gastric “proton pump” (the H+/K+‑ATPase) in parietal cells, which is the final step in acid secretion.
- They are prodrugs that are absorbed in the small intestine, then activated in the acidic canaliculi of parietal cells, where they irreversibly inhibit the pump and thereby lower gastric acidity for 24 hours or more.
- In the U.S., FDA‑approved PPIs include omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole, and rabeprazole; they are indicated for conditions such as GERD, erosive esophagitis, peptic ulcer disease, and Zollinger‑Ellison syndrome.
How Dexilant and Nexium Work
How does Dexilant (dexlansoprazole) work?
- Dexilant contains dexlansoprazole, the R‑enantiomer of lansoprazole, and is formulated as a dual delayed‑release capsule with two types of enteric‑coated granules that dissolve at different pH values to provide two peaks in plasma concentration.
- As a PPI, dexlansoprazole specifically inhibits the gastric H+/K+‑ATPase in parietal cells, blocking the final step of acid production and suppressing both basal and stimulated acid secretion.
- The dual delayed‑release design extends the time intragastric pH stays above 4 over 24 hours compared with standard lansoprazole, which helps provide prolonged symptom control in GERD.
How does Nexium (esomeprazole) work?
- Nexium contains esomeprazole, the S‑isomer of omeprazole, which is also a PPI that is activated in the acidic environment of parietal cell canaliculi and irreversibly inhibits the H+/K+‑ATPase proton pump.
- Like other PPIs, esomeprazole reduces both basal and meal‑stimulated acid secretion, improving healing of erosive esophagitis and reducing GERD symptoms.
- Esomeprazole is metabolized predominantly by CYP2C19 and CYP3A4; inter‑individual variability in CYP2C19 can influence exposure and response.
Key Takeaway: Both Dexilant and Nexium are proton pump inhibitors. They both work much that same way, which is to reduce the amount of acid that is being produced in the stomach. With less acid production, it is less likely for the acid to travel up into the esophageal area, causing the burning sensation. The goal of treatment is to reduce the number of times acid reflux symptoms occur and to diminish the pain associated with the disease.
How to take Dexilant and Nexium
Dexilant (dexlansoprazole)
- FDA‑approved adult doses are: 60 mg once daily for up to 8 weeks for healing of erosive esophagitis; 30 mg once daily for maintenance of healed erosive esophagitis and relief of heartburn for up to 6 months; and 30 mg once daily for 4 weeks for symptomatic non‑erosive GERD.
- Dexilant capsules can be taken without regard to food, and should be swallowed whole; alternatively, the capsule can be opened and the intact granules sprinkled on one tablespoon of applesauce and swallowed immediately without chewing.
- In moderate hepatic impairment (Child‑Pugh B), a maximum daily dose of 30 mg is recommended; no specific adjustment is needed for renal impairment.
Nexium (esomeprazole)
- For adults with GERD and erosive esophagitis, typical oral dosing is 20–40 mg once daily for 4–8 weeks, with maintenance regimens often at 20 mg once daily; pediatric doses are weight‑based.
- Esomeprazole is generally recommended before a meal, often 30–60 minutes before breakfast, because proton pumps are activated with food and pre‑meal dosing improves efficacy.
- Delayed‑release capsules should be swallowed whole; if needed, they may be opened and granules mixed with applesauce and swallowed without chewing; specific instructions vary by product labeling.
Key Takeaway: These medications must be taken on a daily basis for a set period of time. Patients who use Nexium will take a dosage of between 20mg and 40mg per day. Each patient is likely to begin their regiment at 20mg or 30mg, but that can be increased as much as 50 percent or up to 40 mg if necessary. The patient will continue take this medication for at least four to eight weeks. On the other hand, patients who use Dexilant will be given a dosage of 30mg per day. These patients will continue to take this drug for a four-week period, at which point they will be reevaluated.
What interacts with Dexilant and Nexium?
Class‑wide PPI interaction patterns
- All PPIs increase gastric pH, which can reduce absorption of drugs that need acid (e.g., ketoconazole, some iron salts) and increase exposure to drugs like digoxin; they also can affect CYP‑metabolized drugs such as warfarin, phenytoin, and diazepam.
Dexilant (dexlansoprazole)
Key interactions from the FDA label include:
- Atazanavir: should not be co‑administered because Dexilant can substantially decrease atazanavir concentrations and reduce antiviral efficacy.
- Drugs with pH‑dependent absorption: may alter bioavailability of ampicillin esters, digoxin, iron salts, ketoconazole and similar agents; monitoring or alternatives may be needed.
- Warfarin: cases of increased INR and prothrombin time have been reported with PPIs; monitor INR closely when used together.
- Tacrolimus: may increase tacrolimus whole‑blood levels, especially in CYP2C19 intermediate or poor metabolizers; drug‑level monitoring is advised.
- Methotrexate: concomitant use, especially with high‑dose methotrexate, can elevate and prolong methotrexate and hydroxymethotrexate levels; temporary withdrawal of the PPI during high‑dose therapy can be considered.
- Rilpivirine‑containing products: PPIs are contraindicated with rilpivirine due to risk of loss of virologic response; this is stated as a class warning and applies to dexlansoprazole.
Nexium (esomeprazole)
Representative interaction issues include:
- Rilpivirine: esomeprazole should not be used with rilpivirine‑containing products because of significant reductions in rilpivirine exposure and risk of virologic failure.
- Clopidogrel: as a CYP2C19 substrate, clopidogrel’s activation can be reduced; esomeprazole can decrease exposure to clopidogrel’s active metabolite and may lessen its antiplatelet effect, so alternative acid suppression or antiplatelet strategies are often recommended.
- Warfarin: PPIs can increase INR and bleeding risk; monitoring is advised.
- Methotrexate: like other PPIs, esomeprazole may elevate methotrexate levels, especially with high doses; temporary PPI interruption may be needed.
- Other CYP‑metabolized drugs: esomeprazole can alter levels of diazepam, phenytoin, and others, requiring monitoring or dosage adjustment.
Side effects of Dexilant and Nexium
Common class effects
- Across PPIs, common adverse reactions include headache, abdominal pain, diarrhea, nausea, and upper respiratory infections.
- Long‑term use has been associated (mostly in observational data) with increased risk of Clostridioides difficile–associated diarrhea, hypomagnesemia, vitamin B12 deficiency, iron deficiency, and possibly osteoporosis‑related fractures; causality is not firmly established for all associations.
Dexilant (dexlansoprazole)
- Most common adverse reactions (≥2%) include diarrhea, abdominal pain, nausea, upper respiratory tract infection, vomiting, and flatulence.
- Important warnings and precautions include:
- Clostridioides difficile–associated diarrhea, especially in hospitalized patients.
- Possible increased risk of osteoporosis‑related fractures of hip, wrist, or spine with long‑term or high‑dose PPI therapy.
- Hypomagnesemia (sometimes severe), typically after at least three months and often after a year of therapy, with potential for tetany, arrhythmias, and seizures.
- Postmarketing reports include serious hypersensitivity reactions, anaphylactic shock, acute renal failure, severe cutaneous reactions (Stevens–Johnson syndrome, toxic epidermal necrolysis), and bone fractures.
Nexium (esomeprazole)
- Common adverse effects include headache, abdominal pain, diarrhea, nausea, flatulence, constipation, and dry mouth.
- Less common but serious reactions reported with esomeprazole and the PPI class include:
- Acute interstitial nephritis, sometimes leading to renal dysfunction.
- Clostridioides difficile–associated diarrhea.
- Hypomagnesemia with prolonged use, sometimes requiring PPI discontinuation.
- Possible increased risk of osteoporosis‑related fractures with long‑term, high‑dose use.
- Cutaneous and systemic lupus erythematosus, usually reversible after discontinuation.
Why Dexilant and Nexium Costs So Much in America
American patients pay dramatically more for Dexilant and Nexium than people in virtually every other developed nation. Examining the root causes of these inflated prices reveals why finding affordable treatment for GERD (gastroesophageal reflux disease) has become such a burden for millions of Americans.
Unregulated Pricing Gives Manufacturers Free Rein Over Costs
The primary driver behind Dexilant and Nexium’s high U.S. price tag is simple: pharmaceutical companies face no federal price caps.
While countries like Canada employ regulatory bodies that scrutinize and negotiate medication costs to ensure affordability, the United States allows drugmakers complete freedom to set prices based on profit goals rather than patient needs. This lack of negotiation power and price regulation means you’re often paying multiples of what the medication actually costs to produce and distribute, compared to regulated markets.
Extended Patent Monopolies Block Affordable Generic Competition
Both Dexilant (dexlansoprazole) and Nexium (esomeprazole) benefited from extended patent protections that limited generic competition in the U.S. for many years. Though some generics are now available, brand-name versions still command higher prices because manufacturers held exclusivity for long periods, preventing broader market competition that typically drives prices down.
Development Expenses Justify Excessive American Pricing
Bringing Dexilant and Nexium to market involved substantial research, multi-phase clinical trials, and navigating complex FDA approval processes. However, because U.S. policy lacks direct price controls or centralized bargaining for most drugs, manufacturers can charge disproportionately high prices in America, even though patients in regulated markets pay a tiny fraction of those costs.
Advertising Budgets Inflate Your Pharmacy Bill
Major pharmaceutical companies allocate enormous budgets for consumer advertising, physician detailing, and brand promotion. These marketing costs, aimed at maintaining high demand for branded versions of Dexilant and Nexium, are ultimately embedded in what American patients pay at retail.
Insurance Coverage Rarely Translates to Real Savings
Having health insurance doesn’t guarantee affordable access to Dexilant or Nexium. The labyrinth of coverage tiers, formulary restrictions, pharmacy benefit manager negotiations, and sky-high deductibles often means you’ll still face substantial out-of-pocket expenses. Even with coupons, which help lower costs significantly, many patients still pay tens to hundreds of dollars per month. For example, Dexilant coupons bring prices down to around $85–$90 for a 30-day supply, but brand or higher retail prices often exceed $250 without them; and for Nexium, coupon prices can be as low as about $20–$30 for a typical supply, yet average retail prices without discounts can be several hundred dollars.
The Bottom Line: American Patients Subsidize Global Drug Development
When you combine unrestricted pricing, patent monopolies, heavy marketing costs, and ineffective insurance systems, you get a healthcare market where Americans routinely subsidize pharmaceutical profits. You’re paying premium prices not because the medication costs more to make, but because U.S. policy permits it, and often encourages it.
Your Alternative: CIPA-Certified Canadian Pharmacies
Canada’s pharmaceutical pricing regulations mean that CIPA-certified pharmacies can provide Dexilant and Nexium at substantially reduced costs without compromising quality or safety:
- Dexilant: At a Canadian pharmacy like CanDrugStore.com, a 90-day supply of brand Dexilant 30 mg or 60 mg can cost approximately $244–$567 USD, depending on strength and quantity. You can buy 90 Dexilant capsules online from a Canadian pharmacy through CanDrugStore.com.
- Nexium: Canadian pricing for Nexium tablets (e.g., 20–40 mg, various quantities) typically ranges from about $34–$78 USD for an 84-tablet supply. You can buy 90 Esomeprazole tablets online from a Canadian pharmacy through CanDrugStore.com.
These aren’t temporary discounts or special promotions; they reflect regulated pricing differences between the Canadian and U.S. markets. By using a verified prescription referral service like CanDrugStore.com or similar CIPA-certified Canadian pharmacies, American patients can obtain Dexilant and Nexium at a fraction of standard U.S. retail pricing, offering sustainable savings for managing GERD without financial hardship.
Conclusion
Dexilant is the latest acid reflex drug to be approved by the FDA (Food and Drug Administration), but initial studies have proven it to be as effective as Nexium. Dexilant is also less expensive, which may make it a better option for some. Talk to your doctor about your option and work with your doctor to find the best treatment for you.
References
National Library of Medicine. 2023. Proton Pump Inhibitors (PPI)
FDA.gov. 2016. Highlights of Prescribing Information
MedlinePlus.gov. 2023. Esomeprazole
MayoClinic.org. 2026. Esomeprazole (oral route)