Prilosec vs. Aciphex
See how Prilosec and Aciphex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Both Prilosec and Aciphex are proton pump inhibitors that lower stomach acid to treat GERD, ulcers, and related conditions.
Prilosec is sold over the counter and as a low-cost generic, while Aciphex is prescription-only and priced far higher.
Prilosec comes in capsule, tablet, and oral suspension forms, while Aciphex is available only as a single-strength tablet.
Prilosec vs. Aciphex Drug Summary
Prilosec
Prilosec (omeprazole) is a proton pump inhibitor that reduces stomach acid to treat GERD, ulcers, and related conditions. It is taken as a delayed-release capsule, tablet, or oral suspension, and is sold both over the counter and by prescription.
Aciphex
Aciphex (rabeprazole) is a proton pump inhibitor that reduces stomach acid to treat GERD, ulcers, and related conditions. It is taken as a single-strength delayed-release tablet and is only available by prescription.
Prilosec vs. Aciphex Side Effects
Prilosec
Aciphex
Prilosec vs. Aciphex Dosage
Prilosec
Aciphex
| 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 |
| 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 |
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 |
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 |
Prilosec vs. Aciphex Indications
Prilosec
Prilosec treats acid-related conditions including GERD, erosive esophagitis, and duodenal or gastric ulcers, and helps eradicate H. pylori infection when combined with antibiotics. It is also approved for rare hypersecretory conditions like Zollinger-Ellison syndrome. Stress ulcer prevention in critically ill patients is a common off-label use.
Duodenal and gastric ulcer treatment
Erosive esophagitis from GERD
Maintenance of esophagitis healing
H. pylori eradication (with antibiotics)
Zollinger-Ellison syndrome
Aciphex
Aciphex treats acid-related conditions including GERD, erosive or ulcerative esophagitis, and duodenal ulcers, and helps eradicate H. pylori infection when combined with antibiotics. It is also approved for hypersecretory conditions like Zollinger-Ellison syndrome. Aciphex is approved for GERD symptoms in adolescents 12 and older, unlike Prilosec's over-the-counter labeling.
Duodenal ulcer healing
Erosive or ulcerative GERD healing
Maintenance of GERD healing
H. pylori eradication (with antibiotics)
Zollinger-Ellison syndrome
Prilosec vs. Aciphex Pros and Cons
Prilosec
Prilosec has been used for decades, is available over the counter at low cost, and comes in multiple forms including capsules and oral suspension. It is not FDA-approved for immediate heartburn relief, so it can take a few days to reach full effect.
Pros
Available over the counter without a prescription
Roughly $15 to $95 per month, far cheaper than Aciphex
Multiple forms: capsule, tablet, oral suspension
Cons
Not approved for immediate heartburn relief
Dose adjustment needed for Asian patients on maintenance
More dosing strengths can complicate switching doses
Aciphex
Aciphex is prescription-only and priced significantly higher than Prilosec, but it offers a simple single-strength tablet and is specifically labeled for adolescents and high-dose hypersecretory conditions. It also carries a notable drug interaction warning with rilpivirine-based HIV treatments.
Pros
Single, simple 20 mg tablet strength for most uses
FDA-approved for GERD symptoms in adolescents 12+
Specifically labeled for high-dose Zollinger-Ellison therapy
Cons
Prescription only, no over-the-counter option
Roughly $658 to $1,536 per month, much pricier than Prilosec
Contraindicated with rilpivirine-containing HIV medications
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