How To Take Levothyroxine With Nexium

In our latest question and answer, the pharmacist discusses how to safely take levothyroxine with Nexium (esomeprazole).


I had thyroid removed 4 years ago and took levothyroxine in morning and waited 1 hour to eat. But now I need to take my Nexium in the morning as it doesn't help at other times I tried. Now I take levothyroxine when I get up wait 45 minutes and then take Nexium and wait another 45 minutes, then eat breakfast. Am I doing this correctly to get the benefit of both? Thank you for any suggestions.

Asked by Granny B On Jun 25, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jun 27, 2018

Meds With FoodIt can often be difficult to take levothyroxine (brand names Synthroid, Levoxyl) with other medications due to the specific (and strict) dosing instructions for the medication. When prescribed levothyroxine, it is extremely important that it be taken consistently, the same way every day.

Levothyroxine Dosing Recommendations

Levothyroxine should ideally be dosed as follows:

  • Take on an empty stomach with a full glass of water at least 30 to 60 minutes before breakfast. Be sure to take levothyroxine apart from other medications as well as they can decrease absorption. In general, the rate and extent of absorption for levothyroxine is best when administered on an empty stomach.

The reason it is so important to take levothyroxine consistently is to avoid fluctuations in drug absorption, which can make a significant impact on your therapy. Levothyroxine is dosed in micrograms, which is 1/1000th of a milligram. We are talking small doses here. A small change in your dose can make a huge difference in how you feel.

Nexium Dosing Recommendations

Like levothyroxine, Nexium needs to be dosed a specific way for optimal effects. The most common dosing recommendation is as follows:

  • Take Nexium on an empty stomach, at least 60 minutes before meals and ideally before the first meal of the day.

The reason it is important to take Nexium (and all PPI medications) before food is because the drug needs time to become absorbed. Unlike antacids like Tums and Rolaids, Nexium doesn't simply neutralize stomach acid, but inhibits, or "shuts off" proton pumps, decreasing acid production. Nexium needs to be absorbed and available at the site of action (i.e. proton pumps) before food is ingested, which activates acid secretion.

Taking Levothyroxine With Nexium

In an ideal scenario:

  • Levothyroxine should be taken first thing in the morning, at least 30 minutes before Nexium with a full glass of water. Remember that it is important to take levothyroxine the same way every day.
  • After at least 30 minutes from levothyroxine administration, take Nexium.
  • Eat your first meal of the day about 60 minutes after taking Nexium for best effects.

Per your inquiry, you are taking your medication correctly, with levothyroxine being dosed first, followed by Nexium, followed by food. Your Nexium may be slightly more effective if you wait 60 minutes instead of 45 minutes to eat, but this may not be that significant for most individuals.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Office: 716-389-3076

About Levothyroxine

Levothyroxine, also known as T4, is a thyroid replacement medication for the treatment of hypothyroidism. It is available both as a brand name (Synthroid, Levoxyl) and generically. T4 is converted in the body to more biologically active, T3. For most individuals, taking levothyroxine (T4) will sufficiently treat hypothyroidism but a small percentage of individuals don't efficiently convert T4 to T3. For these individuals, mixed T4/T3 products may be preferred. Levothyroxine is generally well tolerated and side effects are often attributable to the wrong dosage, which can manifest as symptoms of either hypothyroidism or hyperthyoidism. It is important to stay on the same generic manufacturer of levothyroxine to reduce the variability between products. Small differences in products (e.g. different inactive ingredients) could affect how your body dissolves, absorbs and utilizes the medication. If your pharmacy is constantly switching manufacturers of levothyroxine, be sure to speak with them about your concerns. Levothyroxine is known as a narrow therapeutic index drug. A small change in dose can have a major impact on how the medication affects you. Levothyroxine should be administered on an empty stomach, about 30 minutes prior to other medication and food.

About Nexium (Esomeprazole)

Nexium (esomeprazole), pronounced (es oh ME pray zol), prevents the production of acid in the stomach. It is used for a variety of indications including gastroesophageal reflux disease (GERD), ulcers, certain bacteria in the stomach, and inflammation of the esophagus. It can also be used to prevent ulcers in those taking certain medications such as NSAIDs (e.g. ibuprofen) Nexium. Nexium should generally be taken 30 to 60 minutes before food for optimal effects. In addition, it can often take one to two weeks of continuous dosing for the best effects, but dosing should not be done for more than 14 days in a row without consulting your doctor.

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