Aciphex vs. Omeprazole
See how Aciphex and Omeprazole compare on approved uses, dosing, side effects, and cost.
Medically reviewed by Linda Girgis | MD, Girgis Family Medicine.
Key Takeaways
Aciphex and omeprazole are both proton pump inhibitors that reduce stomach acid to treat GERD, ulcers, and related conditions.
Aciphex is only available as a single 20 mg tablet, while omeprazole comes in multiple strengths and is sold over-the-counter.
Generic omeprazole typically costs $5 to $25 a month, far less than Aciphex's $658 to $1,536 monthly list price.
Aciphex vs. Omeprazole Drug Summary
Aciphex
Aciphex (rabeprazole sodium) is a proton pump inhibitor that reduces stomach acid to treat GERD, duodenal ulcers, H. pylori infection, and rare hypersecretory conditions like Zollinger-Ellison syndrome. It comes as a single 20 mg delayed-release tablet, usually taken once daily, with higher doses used for hypersecretory conditions.
Omeprazole
Omeprazole is a proton pump inhibitor used to treat GERD, duodenal and gastric ulcers, erosive esophagitis, and H. pylori infection. It's taken once daily before a meal in doses ranging from 20 mg to 40 mg depending on the condition, and is sold both by prescription and over-the-counter.
Aciphex vs. Omeprazole Side Effects
Aciphex
Omeprazole
Aciphex vs. Omeprazole Dosage
Aciphex
Omeprazole
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Aciphex
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
Omeprazole
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Aciphex vs. Omeprazole Indications
Aciphex
Aciphex treats acid-related conditions including erosive GERD, duodenal ulcers, and H. pylori infection, and is one of the few PPIs specifically labeled for long-term treatment of Zollinger-Ellison syndrome. It's approved for adults and adolescents 12 and older with symptomatic GERD, but not for GERD in children under 12.
Healing and maintenance of erosive or ulcerative GERD
Symptomatic GERD in adults and adolescents 12+
Duodenal ulcer healing
H. pylori eradication (with amoxicillin and clarithromycin)
Zollinger-Ellison syndrome and other hypersecretory conditions
Omeprazole
Omeprazole treats a similar range of acid-related conditions, including duodenal and gastric ulcers, erosive esophagitis, and H. pylori infection, plus pathological hypersecretory conditions. Its GERD indication extends to children as young as 2 years old, broader than Aciphex's adolescent cutoff.
Healing and maintenance of erosive esophagitis due to GERD
Symptomatic GERD in adults and children 2 years and older
Active duodenal and gastric ulcer healing
H. pylori eradication (with amoxicillin and clarithromycin)
Pathological hypersecretory conditions including Zollinger-Ellison syndrome
Aciphex vs. Omeprazole Pros and Cons
Aciphex
Aciphex has a long track record since its 1999 approval and is specifically labeled for Zollinger-Ellison syndrome at high doses, giving prescribers a clear option for severe acid hypersecretion. As a brand-name PPI available in only one tablet strength, it typically costs far more out of pocket than generic omeprazole.
Pros
Specifically labeled for Zollinger-Ellison syndrome at doses up to 100 mg per day
Approved for adolescents 12+ for short-term symptomatic GERD
Long clinical track record since its 1999 FDA approval
Cons
Only available in one 20 mg tablet strength, limiting dosing flexibility
Costs $658 to $1,536 per month without insurance, far more than generic omeprazole
Not approved for GERD treatment in children under 12
Omeprazole
Omeprazole has been on the market longer and is available generically and over-the-counter, making it one of the most accessible PPIs. It comes in multiple tablet strengths and is approved for children as young as 2, but its label carries a specific warning against combining it with clopidogrel.
Pros
Available over-the-counter and in low-cost generic versions, often $5 to $25 per month
Comes in multiple strengths (10 mg, 20 mg, 40 mg) for more dosing flexibility
Approved for GERD and erosive esophagitis in children as young as 2 years old
Cons
FDA label warns against combining with clopidogrel due to reduced antiplatelet effect
Not specifically labeled for adolescent symptomatic GERD the way Aciphex is
Not labeled for Zollinger-Ellison syndrome dosing the way Aciphex is
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