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

Most common
headache (up to 5.5%)
flatulence (up to 1%)
diarrhea (up to 4%)
abdominal pain (up to 4%)

Aciphex

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

Nexium vs. Aciphex Dosage

Nexium

Dosage
Dosage Table
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

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

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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