Nexium vs. Aciphex
See how Nexium and Aciphex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Nexium and Aciphex are both proton pump inhibitors that reduce stomach acid to treat GERD, erosive esophagitis, and related ulcer conditions.
Nexium comes in capsule, oral suspension, and IV forms, while Aciphex is only available as a single 20 mg tablet.
Nexium's typical list price is substantially lower than Aciphex's, which can matter for patients paying without insurance.
Nexium vs. Aciphex Drug Summary
Nexium
Nexium (esomeprazole) is a proton pump inhibitor that lowers stomach acid to treat GERD, erosive esophagitis, and related conditions. It comes as a delayed-release capsule, an oral suspension, or an IV injection, usually taken once daily before a meal.
Aciphex
Aciphex (rabeprazole) is a proton pump inhibitor that lowers stomach acid to treat GERD, erosive esophagitis, and duodenal ulcers. It is available only as a delayed-release tablet, taken once daily, with higher doses split into two daily doses for certain conditions.
Nexium vs. Aciphex Side Effects
Nexium
Aciphex
Nexium vs. Aciphex Dosage
Nexium
Aciphex
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 20 mg or 40 mg IV once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| 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 |
Nexium
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 20 mg or 40 mg IV once daily | If needed |
| Dose changes | 3 increases | 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 |
Nexium vs. Aciphex Indications
Nexium
Nexium is approved for healing and maintaining erosive esophagitis, short-term relief of heartburn and GERD symptoms, and reducing the risk of NSAID-related stomach ulcers. It also treats H. pylori infection alongside antibiotics and pathological hypersecretory conditions like Zollinger-Ellison syndrome, and it has a pediatric indication down to 1 month old for esophagitis.
Healing and maintenance of erosive esophagitis
Short-term treatment of heartburn and GERD symptoms
Risk reduction of NSAID-associated gastric ulcers
H. pylori eradication with antibiotics
Treatment of Zollinger-Ellison syndrome
Aciphex
Aciphex is approved for healing erosive or ulcerative GERD, maintaining that healing, and relieving symptomatic GERD in adults and adolescents 12 and older. It also treats duodenal ulcers, helps eradicate H. pylori infection with antibiotics, and manages pathological hypersecretory conditions like Zollinger-Ellison syndrome.
Healing of erosive or ulcerative GERD
Maintenance of GERD healing
Duodenal ulcer healing
H. pylori eradication with antibiotics
Treatment of Zollinger-Ellison syndrome
Nexium vs. Aciphex Pros and Cons
Nexium
Nexium offers more dosing flexibility than Aciphex, with multiple strengths, an oral suspension, and an IV option for patients who cannot swallow pills. It also covers a broader range of approved uses, including pediatric use and NSAID ulcer prevention, and it is far less expensive out of pocket.
Pros
Available in capsule, suspension, and IV forms
Approved for pediatric use down to 1 month old
Approved for NSAID-associated ulcer risk reduction
Cons
Not approved for GERD symptoms in infants under 1 year
OTC availability can lead insurers to deny coverage
More dosage strengths to keep track of
Aciphex
Aciphex has a simpler dosing profile, with one tablet strength for most patients and a specific label for Zollinger-Ellison syndrome. It lacks the IV and pediatric options Nexium offers, and it is significantly more expensive out of pocket without insurance.
Pros
Single 20 mg tablet strength simplifies dosing
FDA-labeled specifically for Zollinger-Ellison syndrome
Approved for adolescents 12+ with symptomatic GERD
Cons
No IV formulation for patients unable to swallow pills
Not approved for GERD treatment in children under 12
Only available as an oral tablet, no suspension
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