Aciphex vs. Famotidine
See how Aciphex and Famotidine compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Aciphex is a proton pump inhibitor that blocks acid production more completely than famotidine, an H2 blocker.
Famotidine works faster for occasional heartburn, while Aciphex provides longer healing for erosive GERD and ulcers.
Famotidine costs far less and is available over the counter, while Aciphex requires a prescription and costs significantly more.
Aciphex vs. Famotidine Drug Summary
Aciphex
Aciphex (rabeprazole) is a proton pump inhibitor that reduces stomach acid production to treat GERD, ulcers, and hypersecretory conditions like Zollinger-Ellison syndrome. It comes as a delayed-release tablet taken once daily, with higher doses used for severe acid conditions. It is also used with antibiotics to eradicate H. pylori infection.
Famotidine
Famotidine is an H2-receptor antagonist that lowers stomach acid to treat ulcers, GERD, and erosive esophagitis. It is taken as a tablet or liquid, usually once or twice daily, and is available both by prescription and over the counter. It also treats hypersecretory conditions like Zollinger-Ellison syndrome.
Aciphex vs. Famotidine Side Effects
Aciphex
Famotidine
Aciphex vs. Famotidine Dosage
Aciphex
Famotidine
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg twice daily | Weeks 1-6 |
| Maximum dose | 40 mg once daily | Weeks 1-8 |
| Dose changes | 1 increase | As tolerated |
Aciphex
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Famotidine
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg twice daily | Weeks 1-6 |
| Maximum dose | 40 mg once daily | Weeks 1-8 |
| Dose changes | 1 increase | As tolerated |
Aciphex vs. Famotidine Indications
Aciphex
Aciphex treats acid-related conditions including erosive GERD, duodenal ulcers, and Zollinger-Ellison syndrome. It also helps heal ulcers caused by H. pylori infection when combined with antibiotics. Rabeprazole is approved for adults and adolescents 12 and older, but not for younger children.
Healing of erosive or ulcerative GERD
Maintenance of GERD healing
Duodenal ulcer healing
H. pylori eradication with antibiotics
Zollinger-Ellison syndrome
Famotidine
Famotidine treats duodenal and gastric ulcers, GERD, and erosive esophagitis, and helps manage hypersecretory conditions like Zollinger-Ellison syndrome. It is also used off-label for stress ulcer prevention in critically ill patients and for chronic hives unresponsive to other treatments. Famotidine is approved for both short-term treatment and longer maintenance therapy.
Duodenal ulcer treatment and maintenance
Benign gastric ulcer treatment
GERD and erosive esophagitis treatment
Zollinger-Ellison syndrome
Off-label stress ulcer prevention in ICU (off-label)
Aciphex vs. Famotidine Pros and Cons
Aciphex
Aciphex offers potent, long-lasting acid suppression and is one of the few PPIs specifically labeled for Zollinger-Ellison syndrome at doses up to 100 mg daily. It requires a prescription and typically costs far more than over-the-counter options like famotidine.
Pros
Specifically FDA-approved for Zollinger-Ellison syndrome up to 100 mg/day
Also approved for H. pylori eradication when combined with antibiotics
Once-daily dosing covers most approved uses
Long-standing safety record since FDA approval in 1999
Cons
Only available by prescription, with no OTC option
Typically costs $658 to $1,536 per month without insurance
Only sold as a single 20 mg tablet strength
Contraindicated with rilpivirine-containing HIV medications
Famotidine
Famotidine offers effective acid reduction with a strong safety record and no boxed warning, and it comes in prescription and OTC strengths for flexible use. It works faster for occasional symptoms but generally provides less complete acid suppression than a PPI like Aciphex.
Pros
Available over the counter as well as by prescription
Much lower typical cost, roughly $10 to $90 per month
Comes in tablet, liquid, and injectable forms for flexible use
No boxed warning, unlike some other acid-reducing drug classes
Cons
Requires dose adjustment in moderate to severe kidney impairment
Can cause confusion or hallucinations in elderly or kidney-impaired patients
Provides less complete acid suppression than a PPI for severe erosive GERD
May need dosing as often as every 6 hours for some conditions
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