Nexium Before Breakfast: A Recipe for Acid Reflux Success

Esomeprazole before breakfast may provide more enduring acid control for patients with gastroesophageal reflux disease than other OTC proton pump inhibitors.

Esomeprazole (Nexium) before breakfast may provide more enduring acid control for patients with gastroesophageal reflux disease (GERD) than other OTC proton pump inhibitors (PPIs).

New research published in Therapeutic Advances in Gastroenterology indicates that Nexium 20 mg taken 30 minutes before breakfast is superior to omeprazole (Prilosec), pantoprazole (Protonix), and lansoprazole (Prevacid).

The study authors analyzed raw data from 4 studies comparing Nexium 20 mg with the other OTC PPIs for gastric pH control.

Patients received the PPIs 30 minutes before breakfast for 5 days. Two studies were in healthy volunteers, while the other 2 were in GERD patients, and all except 6 patients were Helicobacter pylori-negative.

The investigators in all studies measured pH for 24 hours after administration on the fifth day of PPI therapy.

Patients on Nexium had gastric pH greater than 4 for much longer during the first 14 hours after administration.

Nexium resulted in 1.45 times longer acid control than Prilosec 20 mg, 2.5 times longer than Protonix 20 mg, and 1.69 times longer and 1.89 times longer than Prevacid 15 mg in 2 studies, respectively.

Nexium produced greater pH control in the majority of patients (69% to 97%) across the 4 studies.

FDA-approved OTC PPI dosing is insufficient to achieve mean 24-hour pH control below 4 except for Nexium and rabeprazole (AcipHex), which is not available OTC.

The mean Nexium dose needed to control 24-hour gastric pH was 12.6 mg in healthy volunteers and 23.6 mg in GERD patients.

Meanwhile, healthy patients and patients with GERD who took Protonix needed a mean dose of 89.2 mg and 166 mg to achieve a mean pH of greater than 4 in these populations respectively.

Nexium produced better pH control during the first 14 hours after administration, which corresponds with patients’ usual daytime hours.

The authors called for an increased emphasis on daytime pH control because the vast majority of patients have milder GERD with increased acid secretion during the day after meals.

Patients with mild or non-erosive GERD have reflux episodes primarily during waking hours due to food-stimulated acid production and transient lower esophageal sphincter relaxation.

Patients with more severe GERD have day and night acid exposure.

Previous research has suggested that acid exposure increases sharply in the 3 hours after each meal, with the greatest increase after the evening meal.