Nexium vs. Prilosec
See how Nexium and Prilosec compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Nexium and Prilosec are both proton pump inhibitors that reduce stomach acid, and Nexium is chemically the purified S-isomer of Prilosec's active ingredient.
Prilosec has been on the market longer and is available as a lower-cost generic and OTC option, while Nexium tends to cost more.
Nexium has a few extra FDA approvals Prilosec lacks, including an IV form and use in infants as young as 1 month with erosive esophagitis.
Nexium vs. Prilosec Drug Summary
Nexium
Nexium (esomeprazole) is a proton pump inhibitor that reduces stomach acid to treat GERD, erosive esophagitis, and related acid conditions. It's taken as a delayed-release capsule or oral suspension once daily, with an IV form available for patients who can't take it by mouth.
Prilosec
Prilosec (omeprazole) is a proton pump inhibitor that lowers stomach acid to treat ulcers, erosive esophagitis, and GERD. It's taken as a delayed-release capsule, tablet, or oral suspension once daily, and is available both by prescription and over the counter.
Nexium vs. Prilosec Side Effects
Nexium
Prilosec
Nexium vs. Prilosec Dosage
Nexium
Prilosec
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 20-40 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 | 120 mg three times daily | If needed |
| Dose changes | 4 increases | As tolerated |
Nexium
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | Weeks 1-4 |
| Maximum dose | 20-40 mg IV once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Prilosec
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 120 mg three times daily | If needed |
| Dose changes | 4 increases | As tolerated |
Nexium vs. Prilosec Indications
Nexium
Nexium is FDA-approved to heal and maintain healing of erosive esophagitis, treat short-term heartburn and GERD symptoms, and reduce the risk of NSAID-related stomach ulcers. It's also approved for H. pylori eradication and rare acid-overproduction disorders like Zollinger-Ellison syndrome.
Healing of erosive esophagitis in adults and teens 12-17
Maintenance of healing of erosive esophagitis
Short-term treatment of heartburn and GERD symptoms
Risk reduction of NSAID-associated gastric ulcers
H. pylori eradication combined with antibiotics
Prilosec
Prilosec is FDA-approved to treat duodenal and gastric ulcers, heal erosive esophagitis from GERD, and manage ongoing symptomatic GERD. It's also used for H. pylori eradication and rare hypersecretory conditions such as Zollinger-Ellison syndrome.
Treatment of duodenal and gastric ulcers
Treatment of erosive esophagitis from GERD
Symptomatic gastroesophageal reflux disease
H. pylori eradication combined with antibiotics
Pathological hypersecretory conditions like Zollinger-Ellison syndrome
Nexium vs. Prilosec Pros and Cons
Nexium
Nexium is available as a delayed-release capsule, oral suspension, and IV injection, giving clinicians options when oral dosing isn't feasible. It also holds pediatric approval down to one month of age for erosive esophagitis, a use Prilosec does not have. As a brand name with a shorter time on market, it tends to cost more than generic omeprazole.
Pros
IV formulation available for patients who cannot take oral medication
FDA-approved for erosive esophagitis in infants as young as 1 month
Approved for NSAID-associated gastric ulcer risk reduction
As the purified S-isomer of omeprazole, may offer more consistent acid suppression
Cons
Typically costs $160 to $280 per month without insurance, more than Prilosec
Not approved for treating symptomatic GERD in infants under 1 year
Fewer decades of real-world use data compared to Prilosec
Prilosec
Prilosec was the first proton pump inhibitor approved in the U.S. and has decades of real-world use behind it. It's available as a lower-cost generic and OTC option, making it more accessible for long-term use. It lacks an IV form, so patients unable to swallow pills have fewer options.
Pros
Roughly $15 to $95 per month without insurance, generally cheaper than Nexium
Longest track record of any PPI, first approved in 1989
Specific dosing guidance available for Asian patients on maintenance therapy
Multiple dose strengths for hypersecretory conditions up to 120 mg three times daily
Cons
No IV formulation for patients who cannot take oral medication
Not approved for pediatric erosive esophagitis in infants
Not approved for immediate relief of heartburn symptoms
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