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

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

Prilosec

Most common
headache (up to 6.9%)
abdominal pain (up to 5.2%)
diarrhea (up to 4%)
nausea (up to 4%)

Nexium vs. Prilosec Dosage

Nexium

Dosage
Dosage Table
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

Dosage
Dosage Table
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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