Dexilant is a prescription acid-reducing medication used to treat gastroesophageal reflux disease (GERD) and to heal damage to the esophagus caused by stomach acid. It belongs to a class of drugs called proton pump inhibitors (PPIs), which work by blocking the pumps in your stomach lining that produce acid. What sets Dexilant apart from older PPIs is its dual delayed-release design, which delivers the medication in two waves rather than one.
Conditions Dexilant Treats
Dexilant is FDA-approved for three specific uses in adults and children 12 and older:
- Healing erosive esophagitis: When stomach acid has worn away the lining of your esophagus, creating visible erosions or ulcers. The typical course is 60 mg once daily for up to 8 weeks.
- Maintaining healed erosive esophagitis: Once the damage has healed, a lower dose of 30 mg daily for up to 6 months helps prevent it from returning and keeps heartburn at bay.
- Symptomatic GERD without esophageal damage: If you have heartburn and acid reflux but no visible erosion, 30 mg daily for 4 weeks is the standard course.
In clinical trials, healing rates for erosive esophagitis were strong. About 85% to 88% of patients had fully healed esophageal tissue after 8 weeks of treatment, whether they were adults or adolescents aged 12 to 17.
How the Dual Release System Works
Most PPIs release their full dose at once. Dexilant’s capsule contains two types of coated granules that dissolve at different points in your digestive tract. The first batch releases one to two hours after you take it, and the second batch releases four to five hours later. This creates two distinct peaks of the drug in your bloodstream, which can extend acid suppression over a longer stretch of the day compared to a single-release PPI.
One practical advantage of this design: you can take Dexilant with or without food, at any time of day. Many older PPIs need to be taken on an empty stomach 30 to 60 minutes before a meal to work properly. That said, if you still notice symptoms after meals, taking it before eating may help.
Common Side Effects
Dexilant is generally well tolerated. In controlled clinical trials, the side effects that showed up more often than placebo were digestive in nature, and most were mild. The most common ones at the 60 mg dose were diarrhea (4.7% of patients versus 2.9% on placebo), abdominal pain (4.0% versus 3.5%), and nausea (2.8% versus 2.6%). Upper respiratory infections, vomiting, and gas each occurred in about 1.4% to 1.7% of patients on the higher dose.
Diarrhea was the most common reason people stopped taking the medication in trials, but that only happened in 0.7% of participants. For most people, side effects are manageable and resolve once treatment ends.
Risks With Long-Term Use
Dexilant shares the same long-term safety considerations as other PPIs, which become more relevant if you take the medication for months or years rather than a few weeks.
Reduced stomach acid can interfere with how your body absorbs certain nutrients. Magnesium levels can drop low enough to cause muscle cramps, irregular heartbeat, or seizures in rare cases. Vitamin B12 absorption also decreases over time, which can lead to fatigue and nerve problems. Both risks increase with prolonged use.
Bone health is another consideration. A large meta-analysis of 18 studies found that PPI use was linked to a 33% higher risk of fracture at any site, a 26% increase in hip fracture risk, and a 58% increase in spine fracture risk. The likely explanation is that lower stomach acid reduces calcium absorption, which gradually decreases bone mineral density, particularly at the hip and femoral neck. This is most relevant for older adults or anyone already at risk for osteoporosis.
These risks don’t mean Dexilant is unsafe. They mean it’s worth using at the lowest effective dose for the shortest time that controls your symptoms, especially if your condition doesn’t involve actual esophageal damage.
Drug Interactions to Know About
Because Dexilant reduces stomach acid so effectively, it can interfere with medications that need an acidic environment to be absorbed. The HIV medication atazanavir is the most critical example: taking it with Dexilant can drop atazanavir levels so low that HIV treatment fails and drug resistance develops. The two should never be taken together.
Other medications affected by reduced stomach acidity include certain antifungals, iron supplements, digoxin, and some antibiotics. If you take warfarin (a blood thinner), your clotting levels may need closer monitoring while on Dexilant, since the combination can increase bleeding risk. High-dose methotrexate levels may also rise when combined with a PPI.
One interaction that turns out not to be a problem: clopidogrel, a common blood thinner used after heart procedures. Studies in healthy subjects showed Dexilant did not meaningfully reduce clopidogrel’s effectiveness, and no dose adjustment is needed.
Generic Availability and Cost
Generic versions of Dexilant (sold under the name dexlansoprazole) have been FDA-approved since 2017 and are now available from multiple manufacturers in both 30 mg and 60 mg strengths. Generic pricing is substantially lower than the brand name, so it’s worth asking your pharmacist whether a generic is in stock if cost is a concern.