Nexium vs. Prevacid
See how Nexium and Prevacid compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Nexium and Prevacid are both proton pump inhibitors that reduce stomach acid to treat GERD, erosive esophagitis, and ulcers, usually taken once daily before a meal.
Nexium is approved for infants as young as 1 month old for erosive esophagitis, while Prevacid is not approved for any child under 1 year old.
Prevacid comes as an orally disintegrating tablet and has a low-cost generic option, while Nexium is only available as capsules, suspension, or IV.
Nexium vs. Prevacid Drug Summary
Nexium
Nexium (esomeprazole magnesium) is a proton pump inhibitor that reduces stomach acid production to treat GERD, erosive esophagitis, and other acid-related conditions. It comes as a delayed-release capsule, an oral suspension, or an IV injection, and is usually taken once daily before eating.
Prevacid
Prevacid (lansoprazole) is also a proton pump inhibitor that lowers stomach acid to treat ulcers, GERD, and erosive esophagitis. It is available as a delayed-release capsule, an orally disintegrating tablet, or an IV injection, typically taken once daily before a meal.
Nexium vs. Prevacid Side Effects
Nexium
Prevacid
Nexium vs. Prevacid Dosage
Nexium
Prevacid
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 40 mg once daily | Weeks 1-4 |
| Dose changes | 1 increase | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | At the start |
| Maximum dose | 30 mg twice daily | If needed |
| Dose changes | 1 increase | As tolerated |
Nexium
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 40 mg once daily | Weeks 1-4 |
| Dose changes | 1 increase | As tolerated |
Prevacid
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | At the start |
| Maximum dose | 30 mg twice daily | If needed |
| Dose changes | 1 increase | As tolerated |
Nexium vs. Prevacid Indications
Nexium
Nexium is FDA-approved to heal and maintain healing of erosive esophagitis, treat short-term heartburn and GERD symptoms, reduce the risk of NSAID-related stomach ulcers, and help eradicate H. pylori infection alongside antibiotics. It is also approved for rare acid-overproduction conditions such as Zollinger-Ellison syndrome.
Healing and maintenance of erosive esophagitis
Short-term treatment of heartburn and GERD
Risk reduction of NSAID-associated gastric ulcers
H. pylori eradication with antibiotics
Zollinger-Ellison syndrome and other hypersecretory conditions
Prevacid
Prevacid is FDA-approved to heal duodenal and gastric ulcers, treat erosive esophagitis and GERD, reduce the risk of NSAID-related stomach ulcers, and help eradicate H. pylori infection as part of triple therapy. It also treats rare acid-overproduction disorders such as Zollinger-Ellison syndrome.
Healing of duodenal and gastric ulcers
Treatment of erosive esophagitis and GERD
Risk reduction of NSAID-associated gastric ulcers
H. pylori eradication with antibiotics
Zollinger-Ellison syndrome and other hypersecretory conditions
Nexium vs. Prevacid Pros and Cons
Nexium
Nexium offers pediatric dosing down to 1 month old and a suspension form for patients who cannot swallow capsules, which sets it apart from Prevacid. It costs more than generic lansoprazole and does not come in an orally disintegrating tablet.
Pros
Approved for infants as young as 1 month old for erosive esophagitis, a broader pediatric range than Prevacid.
Available as an oral suspension for patients who cannot swallow capsules or need feeding-tube dosing.
Approved for maintenance of healed erosive esophagitis for as long as six months.
Formulated as the single S-isomer of omeprazole, giving prescribers a distinct PPI option if omeprazole has not worked well.
Cons
Typically costs more than generic lansoprazole, roughly $160 to $280 per month before savings programs.
Not approved for treating symptomatic GERD in infants younger than 1 year, only for erosive esophagitis in that age group.
Does not come in an orally disintegrating tablet form, unlike Prevacid's SoluTab option.
Labeling carries a specific warning for acute interstitial nephritis, a rare kidney reaction.
Prevacid
Prevacid has a long track record since 1995, an orally disintegrating tablet formulation, and a low-cost generic option. It carries stricter pediatric restrictions and a specific warning about fundic gland polyps with long-term use.
Pros
Available as a generic (lansoprazole) that typically costs roughly $14 to $530 per month depending on pharmacy and coverage, often less than typical Nexium pricing.
Offered as an orally disintegrating tablet (SoluTab), useful for patients who have difficulty swallowing.
Specifically approved for healing and maintenance of duodenal and gastric ulcers, not a listed Nexium use.
Longer track record, having been FDA approved since 1995, six years before Nexium.
Cons
Not approved for use in any child younger than 1 year old, a stricter restriction than Nexium's infant approval.
Trials reported higher rates of headache and abdominal pain than Nexium's label shows.
Long-term use is specifically linked to fundic gland polyps, a risk called out in its own warnings.
Its label includes a note on heart valve thickening seen in juvenile animal studies, not mentioned on Nexium's label.
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