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

Most common
Headache (up to 6.9%)
Abdominal pain (up to 5.2%)
Nausea (up to 4%)
Diarrhea (up to 4%)

Aciphex

Most common
Headache (up to 9.9%)
Pain (up to 3%)
Pharyngitis (up to 3%)
Flatulence (up to 3%)

Prilosec vs. Aciphex Dosage

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

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

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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