Nexium vs Prilosec: What Are the Differences?

When it comes to heartburn, making the best choice of gastroesophageal reflux disease medication can become a serious choice. There are many drugs that can be purchased over the counter to deal with this condition but the most commonly prescribed medicines are Nexium (Esomeprazole) and Prilosec (Omeprazole). Both medications are called proton pump inhibitors and can be purchased without a prescription. Although both drugs treat the same health condition, they still have some areas of differences. In this medication guide, you shall learn everything you need to know about these medicines.

How Proton Pump Inhibitors (PPIs) Works

Proton pumps are known as enzymes present in the parietal cells of the stomach and they produce hydrochloric acid, which are the main component of stomach acid. The body system requires stomach acid to carry out its digestive function. However, when the muscle between the esophagus and the stomach are not positioned as it should be, the acid gets into the esophagus. When this happens, there is usually a burning sensation in the throat and chest connected with gastro-esophageal reflux disease (GERD). GERD can lead to coughing, pneumonia, and asthma. PPIs help to reduce the quantity of acid that is produced by proton pumps. These medications work best when taken about one hour before having a meal. To fully experience the effectiveness of the drug, you need to use them for a couple of days.

Contraindications of Nexium and Prilosec

Proton pumps inhibitors such as Nexium and Prilosec are usually prescribed for the treatment of gastric acid-related health condition, such as duodenal and stomach ulcers (caused by an infection), heartburn, erosion, or inflammation of esophagus, esophagitis, and Zollinger-Ellison disease.

Distinction between Nexium and Prilosec

Both Nexium and Prilosec are chemically similar but they have a couple of dissimilarities. According to some studies, the differences between them can actually provide some benefits to patients with some specific conditions. For instance, a study that was carried out and documented in Digestive Disease & Sciences stated that Nexium (Esomeprazole) has been discovered to offer more effective management of GERD than Prilosec (Omeprazole) when taken at exactly the same dosage. Some other study showed that Nexium provides better relief than Prilosec within the first week of usage.

One major distinction between Nexium and Prilosec is the price. Before now, Nexium could only be purchased with a prescription and it was quite pricey. However, the drug is now available over the counter at a relatively cheaper price. Although the price of the over-the-counter version is significantly lower that the prescription one, over-the-counter Prilosec still has a price advantage over it.

Side Effects of Nexium and Prilosec

Many people using PPIs do not experience any side effects while using these medications. However, this does not mean there is no possibility of experiencing adverse effects of the drugs. Some common side effects of Nexium and Prilosec include diarrhea, vomiting, nausea, and headache. It is important to mention that the adverse reactions are more common with Nexium than Prilosec. Taking either of the medications may also increase the risk of some other health conditions. It is possible to develop the following conditions while taking these PPIs:

  • Pneumonia;
  • Wrist and spine fractures in post-menopausal women. This may occur if you use the drug for up to a year or beyond;
  • Colon inflammation caused by bacterial;
  • Nutritional deficiencies such as magnesium and B-12 deficiencies.

Many patients have reported experiencing surplus acid production after they stopped taking PPIs. It is therefore important that you do not stop the medication suddenly; rather it is recommended that you do it gradually to avoid the side effect of sudden withdrawal.

What Should You Know before Using Nexium or Prilosec

Before you start using either of the drugs, it is important that you inform your physician about your medical history. Let your doctor know if you have liver disease or low levels of magnesium. You should also let your doctor know if you are of Asian descent. This is because your body system might take a little more time than normal to process the medication and you might need a special dosage prescription. You should also tell your healthcare provider if you are pregnant or planning to get pregnant. Your doctor should also be informed if you are nursing a baby. Provide the details of your medical history to your doctor before you start using Nexium or Prilosec

Drug Interactions

Before you start taking any medication, it is crucial that you tell your doctor of all the drugs (both prescription and non-prescription), vitamins that you are using. This is because Nexium and Prilosec can interact with other drugs. According to the Food and Drug Administration, Prilosec can minimize the effectiveness of blood thinner medications such as Plavix (Clopidogrel). Do not take these two drugs together. As a matter of fact, it is recommended that you do not use other PPIs with this medicine for safety reason.

In addition to this, there are some other drugs that should not be used with either Prilosec or Nexium. These medications include Delavirdine, Ridampin, Clopidogrel, Nelfinavir, Risedronate, Rilpivirine, and St. John's Wort. There are also some other drugs that can interact with both Nexium and Prilosec but can be taken alongside either of them. You should inform your doctor if you are using Aripiprazole, Amaphetamine, Bisphosphonates, Atazanavir, Bosentan, Escitalopram, Carvedilol, Cilostazol, Clozapine, Citalopram, Dextroamphetamine, Cyclosporine, and antifungal drugs. Your physician should also be aware if you are taking iron, Mesalamine, Fosphenytoin, Hydrocodone, Methlphenidate, Methotrexate, Voriconazole, Tacrolimus, Raltegravir, Tacrolimus, Phenytoin, Tacrolimus, or Warfarin.


There are many options of PPIs that are available to you other than Nexium and Prilosec. However, these two are the common ones you can find in the market. It is important to mention PPIs only treat the symptoms of gastro acid-related conditions and not the actual cause. You might want to consider changing your lifestyle to control heartburn and GERD. For instance, avoid eating large meals before bedtime and try managing your weight. You should also stop using tobacco to help you deal with the root cause of GERD and heartburn.