General Question

ibstubro's avatar

What's the difference between Prilosec and Nexium for the patient?

Asked by ibstubro (18765points) August 14th, 2014

I was prescribed Nexium several years ago. I had a work prescription program and ran out of pills (and program) about the same time Nexium became OTC. I was shopping for a new, drugstore, supply this week and noticed that Prilosec had the same ingredients and claims.

Have you knowledge of this, or personal experience?

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6 Answers

Buttonstc's avatar

They are virtually the same drug (both originally mfd. by AstraZeneks) since the active ingredient does exactly the same thing.
For an interesting light on the
history of the two drugs,
there’s an interesting article
over at Science Blogs. You
can make up your own mind
about the credibility of his take
on the issue. He cites several
studies if you want to check
them out for yourself.

There’s also some interesting viewpoints expressed in some of the comments from users and others.

(if it were me, I would take Prilosec without question.)

I’ll add another little piece of info on generics and OTC products in general which may or may not be a factor here. This is something only you can determine by experience.

By law, any generic or OTC drug MUST CONTAIN the same amount of the active pharmaceutical ingredient as the original medication.

However, this does not apply to inert (or carrier, or filler) ingredients. They are obviously required to be foodgrade, safe for consumption, but that’s about it.

Many times you hear of patients complaining that a generic doesn’t work the same as the brand name.

It’s not necessarily just all in their heads because not everything about these filler ingredients has been tested.

But I’ve been taking only generic or OTC drugs for years without any problems and saving tons of money doing so.

But people have different sensitivities. If you find any significant adverse effects from the Prilosec, then you’ll have to go back to Nexium.

In all likelihood, switching will turn out just fine for you so just give it a try and see what happens.

I’m on my old iPhone so can’t do links but just put this phrase into Google in quotes. It’s easy enough to find as many other sites also refer to this article:
“Why no one should take Nexium”

Lightlyseared's avatar

So bear with me here as this may get a bit technical…

Any molecule that has a carbon atom with 4 different things (either single atoms or groups of atoms) attached to it can take 2 different forms (isomers) that are mirror images of each other. Chemically they are identical but physically they are different. This is called chirality or sometimes optical isomers. If you make a chemical like this in a lab you will get an equal amount of both versions. However in nature when an organism (be it a plant animal or whatever makes chemicals like these it always makes only one version. Because of the way living organisms function it is often the physical shape of the molecule that helps it to work. For example the chemical that make spearmint taste of spearmint has 2 versions one that tastes of spearmint and one that doesn’t but chemically they are identical.

This is an important concept in the pharmaceutical industry – if the drug can be an optical isomer then you sometimes find 1 version is more effective than the other. Sometimes the other version has vastly different effects. For example thalidomide one version is a very powerful treatment for morning sickness while the other causes birth defects (we learnt about that one the hard way), 1 version of naproxen is powerful analgesic while the other causes liver damage and has no pain relieving effects at all. There are other examples but I hope you get the idea.

Back to the question. The active ingredient in Prilosec is omeprazole while the active ingredient in Nexium is esomeprazole. Omeprazole has 2 different versions which have been called romeprazole and esomeprazole. The theory is esomeprazole has much more of an effect to reduce stomach acid so in Prilosec only half of the active ingredient is doing anything. Nexium which only contains esomeprazole should theoretically be better. Unfortunately, this being the pharmaceutical industry, there’s a catch. Most of the research that compares the effectiveness of the 2 uses the standard dose as the baseline and Nexium is sold in 40mg tablets as opposed to Prilosec’s 20mg tablets so even though Nexium appears to work better the trials weren’t comparing like with like. Very small trials that compared similar doses of the two showed less of an effect.

Bottom line if its cheaper, give it a try. Omeprazole is the most prescribed drug in the class worldwide (mainly because you can get it generic and so its cheaper) and it is very effective.

Buttonstc's avatar

That’s pretty much what the man who wrote that article described. And the studies he linked showed either very slight or no greater effectiveness for the Nexium.

The article was written 2 years ago before Nexium’s exclusive patent rights expired so the price differential was even greater.

In short, the biggest difference the two, (greater price aside) is the aggressive marketing campain for Nexium to convince Drs. to prescribe it and patients to ask for it.

Over the years they must have spent a boatload of money on marketing alone. No wonder the price was so exhorbitant. All those ads don’t come at bargain rates.

And naturally, it was fairly pointless to dump as much money into marketing Prilosec since it had gone generic. No small wonder everyone is convinced how superior Nexium is when, in fact, its effectiveness is not significantly greater.

So, if you’re buying Nexium, you are in essence making a large financial contribution to
their advertising costs. I’m sure you could find better uses for your hard earned money :) :) :)

ibstubro's avatar

I have taken Nexium for years, with insurance funding it. As I currently don’t have insurance, I recently purchased the Prilosec generic eq..

It annoys me how they package the drugs. 14 to a bottle, Nex, Prilo, generic. You can buy packages (boxes) of 42 tablets, meaning you get 3 bottles of 14 in one box. These pills are tiny. Even the small bottles would probably hold 100.

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