Nexium vs. Prilosec: Similarities & Differences
Medically reviewed by Femi Aremu, PharmD
Many Americans risk developing digestive disorders due to unhealthy eating or lifestyle practices, such as excessive alcohol consumption or smoking.
Among these risks is a digestive disorder called gastroesophageal reflux disease (GERD). GERD occurs when stomach acid flows back into the mouth through the esophagus (food tube) instead of traveling to the stomach.
Fortunately, effective treatment options exist for GERD and its symptoms, which include heartburn, acid reflux, and stomach ulcers.
Two treatment options are Nexium (esomeprazole) and Prilosec (omeprazole). Nexium and Prilosec are orally administered (taken by mouth) medications that are categorized as proton pump inhibitors (PPIs) used to treat the symptoms of GERD.
While Nexium and Prilosec are chemically related, making them relatively similar, they carry some distinct differences, such as their active ingredients and dosing requirements.
This article will provide an in-depth analysis of Nexium and Prilosec, comparing and contrasting their indications, dosing requirements, potential side effects, and more.
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What Is Nexium?
Nexium, containing the active ingredient esomeprazole, is an orally administered PPI that decreases acid in the stomach. Nexium is available by prescription and as an over-the-counter (OTC) medication.
PPIs work by decreasing the amount of acid your stomach makes.
The Food and Drug Administration (FDA) approved OTC Nexium (Nexium 24HR) as a short-term treatment option for frequent indigestion or heartburn.
In comparison, prescription Nexium is FDA-approved for a longer list of uses, including the following:
In adults and children 12 and up, short-term treatment to heal erosive esophagitis (EE), which is inflammation of the esophagus that damages the tissue lining
Maintenance of EE healing in adults
Short-term treatment of heartburn and associated symptoms of GERD in adults and children 12 and older.
Lower the risk of stomach ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs) in people at high risk (those age 60 and older with a history of ulcers).
Treatment of Helicobacter pylori (H. pylori, a type of bacteria that causes infection in the stomach) in adults (along with the antibiotics amoxicillin and clarithromycin) to lower the risk of duodenal (c-shaped segment of the small intestine) ulcers from recurring.
Long-term treatment of pathological hypersecretory conditions (medical conditions where the body produces too much stomach acid), including Zollinger-Ellison syndrome in adults.
Sometimes, healthcare providers prescribe medications for uses that are not FDA-approved. This is called off-label prescribing.
Nexium is prescribed off-label for issues that include but are not limited to:
Treatment of children younger than 12, generally with other medications
Treatment of adults with an active ulcer caused by NSAID and who continue to take the NSAID
Treatment of adults with eosinophilic esophagitis (inflammation of the esophagus caused by eosinophils, a type of white blood cell)
How Does Nexium Work?
Nexium works by decreasing the amount of acid your stomach makes. It is available in several formulations and can be found in OTC, by prescription, and in brand and generic forms.
You may see it as Nexium (brand), including OTC formulations such as Nexium 24HR or esomeprazole (generic).
Nexium is administered in various ways, including tablets, capsules, and granules.
The pharmacy commonly dispenses Nexium for adults (those 18 and older) as generic esomeprazole delayed-release (DR) capsules, a medication designed to last longer in the body so that fewer doses are needed.
What Is Prilosec?
Prilosec, containing the active ingredient omeprazole, is a PPI. Like Nexium, it works by decreasing acid in the stomach. Prilosec is available both OTC and by prescription.
As with OTC Nexium, OTC Prilosec is also used for short-term treatment of frequent indigestion or heartburn two or more times per week.
Prescription Prilosec is dispensed in pharmacies primarily as generic omeprazole, as many brand-name forms are no longer available.
However, healthcare providers often refer to Prilosec and omeprazole interchangeably, so this article will also refer to both names.
Prescription omeprazole is FDA-approved for the following uses:
Treatment of active duodenal ulcer in adults
Treatment of H. pylori in adults to lower the risk of duodenal ulcer from recurring
Treatment of active benign gastric ulcer in adults
Treatment of GERD (that causes symptoms) in adults and children 2 and older
Maintenance of EE healing in adults and children 2 and older
Pathological hypersecretory conditions in adults causing excessive discharge of a substance made by the body
Sometimes, omeprazole is prescribed off-label for specific uses, including but not limited to:
Prevention of ulcers caused by NSAIDs
Treatment of adults with eosinophilic esophagitis
How Does Prilosec Work?
Prilosec works by decreasing the amount of acid made by your stomach. It is available in several formulations and can be found over the counter, by Rx, and in brand and generic forms.
You may see it as Prilosec (brand), including OTC formulations such as Prilosec OTC or omeprazole (generic).
It is available in tablets, capsules, and orally disintegrating tablets. Pharmacies commonly dispense prescription omeprazole for adults as generic omeprazole capsules.
Dosage Comparison
The following offers general dosing guidelines for Nexium vs. Prilosec. Remember, however, that your exact dosage may vary based on various factors, including preexisting conditions, allergies, and height and weight, among others. Moreover, dosing may differ based on the drug's mode of administration.
Always talk with a healthcare provider before using Nexium or Prilosec.
Nexium
General dosing guidelines for Nexium are as follows:
The adult dose of OTC Nexium is 20 milligrams (mg) by mouth once daily in the morning (before eating) for 14 days. If heartburn returns, the two-week treatment can be repeated every four months.
For prescription Nexium, the adult dose varies by condition but is generally 20 mg or 40 mg by mouth once daily.
For conditions like Zollinger-Ellison syndrome, the prescribed dose may be higher, such as 40 mg twice daily. The dose for children and adolescents depends on medical conditions, age, and weight.
Prilosec
General dosing guidelines for Prilosec are as follows:
The adult dose of OTC Prilosec is 20 mg orally once daily (with a full glass of water) 30 minutes before breakfast for 14 days. If heartburn returns, the two-week treatment can be repeated every four months.
For prescription omeprazole, the adult dose varies by condition but is generally 20 or 40 mg by mouth once daily. The prescribed dose may be higher for conditions like Zollinger-Ellison syndrome, such as 60 mg once daily.
The dose for children and adolescents depends on medical conditions, age, and weight.
Comparing Efficacy
It's no coincidence that the active ingredients found in Nexium and Prilosec sound almost alike. These drugs are chemically very similar and act similarly on the body.
Regarding efficacy, some studies found that Nexium may be more effective than Prilosec. For example, a review of studies found that Nexium was more effective in decreasing acid production and that its effects lasted longer than Prilosec.
One study found Nexium significantly more effective than omeprazole in people with GERD and erosive esophagitis.
Another study compared Nexium with four other PPIs, including omeprazole, and found that Nexium was most effective in controlling GERD symptoms.
It's important to note that either Nexium or omeprazole can be effective. Always consult your healthcare provider for personalized medical advice.
Side Effects & Safety
Because of their similar chemical structure and drug class, Nexium and Prilosec have similar side effects.
Nexium: Common Side Effects
Common side effects of Nexium in adults and children include:
Headache
Stomach problems like nausea, gas, diarrhea, stomach pain, and/or constipation
Symptoms associated with a dry mouth
Prilosec: Common Side Effects
Common side effects of Prilosec in adults and children include:
Headache
Stomach problems, such as stomach pain, nausea, diarrhea, vomiting, and/or gas
Symptoms associated with a dry mouth
Nexium vs. Prilosec: Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
Serious side effects and their symptoms associated with Nexium and Prilosec include the following:
Anaphylaxis (severe allergic reaction): Seek emergency medical help if you experience urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Severe skin reactions: Seek emergency help if you have a fever, sore throat, burning eyes, skin pain, red or purple rash, blistering or peeling skin
Bone fracture: PPIs may increase the risk of hip, wrist, or spine fracture. The risk is higher with higher PPI doses and longer duration of treatment. The prescribing information recommends that healthcare providers prescribe the lowest effective dose for the shortest time possible.
Lupus (new onset or worsening of lupus)
Treatment for a more extended period (about three years or more) may cause a deficiency of vitamin B12 (cyanocobalamin).
Fundic gland polyps (abnormal tissue growths that occur in the upper portion of the stomach), which are usually associated with PPI use of at least one year
Low magnesium levels (may occur after several months, but usually after at least a year of PPI treatment), which may lead to low calcium and/or low potassium levels
Because of the risk of severe side effects, the prescribing information recommends PPIs be prescribed at the lowest effective dose and for the shortest time possible.
Precautions
PPIs, like Nexium or Prilosec, are not appropriate for everyone. Before you take Nexium or Prilosec, please tell your healthcare provider about your medical conditions, medical history, and family history.
You should not take Nexium or Prilosec if you are allergic to esomeprazole, omeprazole, or any inactive ingredients in Nexium or Prilosec.
Other people who should not take Nexium or Prilosec include individuals taking Edurant (rilpivirine) medication.
Nexium vs. Prilosec: Potential Interactions
Tell your healthcare provider about all your medicines, including Rx, OTC, and vitamins or supplements.
While taking Nexium or Prilosec, do not start any new medications without approval from your healthcare provider. Some drug interactions include:
Antiretrovirals medications, which are drugs used to treat human immunodeficiency virus (HIV), such as Edurant (rilpivirine) and Reyataz (atazanavir)
Blood-thinning medications, such as Jantoven (warfarin) or Plavix (clopidogrel)
Drugs used to treat conditions in which cell growth needs to be impeded, such as Rheumatrex (methotrexate)
Selective serotonin reuptake inhibitors (SSRIs, mood stabilizing medications), such as Celexa (citalopram)
Medications used to enhance blood flow in the legs, such as Pletal (cilostazol)
Immunosuppressive drugs, such as Protopic (tacrolimus)
Supplements (flowering plants) used for depression, such as Saint-John’s-wort
Medications used for the treatment of mycobacterial and gram-positive bacterial infections, such as Rifadin (rifampin)
Benzodiazepines used for pain management, such as Valium (diazepam)
Heart failure medications, such as Lanoxin (digoxin)
This is not a complete list of drug interactions. Other drug interactions may occur with Nexium or Prilosec. Consult your healthcare provider for more information about drug interactions and how they may affect you.
What Are Other Ways to Help Manage GERD?
Some lifestyle changes you can make to help with GERD symptoms include:
Lose weight, if needed.
Raise the head of your bed by 6 to 8 inches, which allows gravity to reduce reflux symptoms. Experts recommend placing blocks of wood under the legs of the bed or a foam wedge over the mattress. Simply propping yourself up with extra pillows will not help symptoms.
Begin the process of quitting smoking, if relevant.
If you have symptoms when lying down or at bedtime, try eating your final meal of the day at least three hours before bedtime.
Keep track of which foods and drinks trigger your symptoms, and avoid them. Some common triggers include citrus fruits, tomatoes, alcohol, chocolate, caffeine, fatty and spicy foods, and mint.
Consulting a registered dietitian can be helpful so you can work together to create an eating plan that can help minimize symptoms.
Summary
GERD is a gastrointestinal (GI) disorder that affects around 20% of adults in North America.
Nexium (esomeprazole) and Prilosec (omeprazole) are PPI medications that help decrease stomach acid production, reducing symptoms of GERD and other stomach and intestinal conditions.
Although they have many similarities, such as side effects and drug interactions, they have some differences, too, such as specific indications for use and dosages for certain conditions.
You can always consult your healthcare provider for these two medications.
Frequently Asked Questions
How do I store Nexium or Prilosec?
Either drug should be stored at room temperature (between 68 and 77 degrees F). Keep away from direct light, heat, and moisture.
Do not store it in the bathroom. Keep out of reach and out of sight of children and pets.
How costly is Nexium vs. Prilosec?
The cost of the prescription formulations depends on your insurance plan. However, the price should be reasonable since both medications have generic forms.
The price will vary by medicine, dosage, quantity, pharmacy, and insurance plan. You can ask your insurance provider for up-to-date coverage and co-pay information.
OTC Nexium and Prilosec are also reasonably priced, especially when you choose the generic version.
Is taking Nexium or Prilosec linked to stomach cancer?
Some studies have found that long-term use of a PPI can increase the risk of gastric cancer.
However, to avoid side effects and bad reactions, including risk of bone fractures, kidney problems, and skin problems, healthcare providers prescribe PPIs at the lowest effective dose for the shortest time possible.
As always, consult your healthcare provider for medical advice.
Read the original article on Verywell Health.
