Aciphex vs. Omeprazole

See how Aciphex and Omeprazole compare on approved uses, dosing, side effects, and cost.

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

Most common
headache (9.9%)
pain (3%)
pharyngitis (3%)
flatulence (3%)

Omeprazole

Most common
headache (up to 7%)
abdominal pain (up to 5%)
diarrhea (up to 4%)
nausea (up to 4%)

Aciphex vs. Omeprazole Dosage

Aciphex

Dosage
Dosage Table
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

Dosage
Dosage Table
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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