Prilosec vs. Protonix

See how Prilosec and Protonix compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both Prilosec and Protonix are proton pump inhibitors that lower stomach acid to treat GERD and erosive esophagitis, but neither is approved for fast, on-demand heartburn relief.

  • Prilosec is available over the counter and covers more approved uses, including ulcers and H. pylori treatment, while Protonix is prescription-only and also comes as an IV injection.

  • Protonix is FDA-approved for children as young as 1 year old for short-term GERD treatment, an indication not listed for prescription Prilosec.

Prilosec vs. Protonix Drug Summary

Prilosec

Prilosec (omeprazole) is a proton pump inhibitor that reduces stomach acid to treat ulcers, erosive esophagitis, and GERD. It comes as a delayed-release capsule, tablet, or oral suspension, usually taken once daily before a meal. It is also sold over the counter for frequent heartburn.

Protonix

Protonix (pantoprazole) is a proton pump inhibitor that lowers stomach acid to treat erosive esophagitis from GERD and hypersecretory conditions like Zollinger-Ellison syndrome. It comes as a delayed-release tablet, oral suspension, or IV injection, usually taken once daily before a meal. Protonix is prescription-only but is also approved for children age 1 and older.

Prilosec vs. Protonix Side Effects

Prilosec

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

Protonix

Most common
headache (>2%)
abdominal pain (>2%)
nausea (>2%)
diarrhea (up to 9%)

Prilosec vs. Protonix 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

Protonix

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 40 mg once daily Weeks 1-8
Maximum dose 80 mg twice daily If needed
Dose changes 2 increases As tolerated

Prilosec vs. Protonix Indications

Prilosec

Prilosec is FDA-approved for a broad range of acid-related conditions, from ulcer healing to long-term GERD management. It also has a role in combination therapy to eradicate H. pylori infection.

  • Duodenal and gastric ulcer treatment

  • Erosive esophagitis caused by GERD

  • Maintenance of erosive esophagitis healing

  • Symptomatic GERD

Protonix

Protonix's approved uses focus on healing erosive esophagitis and controlling acid in hypersecretory disorders. It is one of the few PPIs approved for children and available in an IV form for patients who cannot take pills.

  • Short-term treatment of erosive esophagitis (GERD)

  • Maintenance of erosive esophagitis healing

  • Zollinger-Ellison syndrome and hypersecretory conditions

  • Approved for children age 1 and up (short-term EE/GERD)

Prilosec vs. Protonix Pros and Cons

Prilosec

Prilosec has the longest track record of any PPI and the widest set of FDA-approved uses, including ulcers and H. pylori treatment. It is also the only one of the two sold without a prescription.

Pros

  • Available over the counter as Prilosec OTC

  • Broader range of FDA-approved uses, including ulcers and H. pylori

  • Comes in capsule, tablet, and oral suspension forms

Cons

  • No IV formulation for patients who can't take it by mouth

  • Recommended lower dose for Asian patients on maintenance therapy

  • Not FDA-approved for use in children

Protonix

Protonix offers more formulation flexibility for hospitalized or pediatric patients but has a narrower set of approved uses than Prilosec. It always requires a prescription, even at the lowest dose.

Pros

  • Available as an IV injection for patients who can't take it orally

  • FDA-approved for children as young as 1 year old

  • Delayed-release oral suspension option for those who can't swallow tablets

Cons

  • Not available over the counter, always needs a prescription

  • Narrower range of approved uses, with no ulcer or H. pylori indication

  • Wide list price range depending on formulation and pharmacy

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