Nexium vs Prilosec: Potent medication for treating Acid reflux

Have you lately experienced heartburn? If yes, then you’re not alone- as more than 60 million Americans have experienced heartburn at least once in a month, and many of such patients have heartburn symptoms almost every day. It’s difficult enough to suffer, often happens after your medication choices for GERD (Gastroesophageal reflux disease) which can make it even worse with time

The two common OTC prescription Proton Pump Inhibitors (PPIs) for this condition are esomeprazole (Nexium OTC) and omeprazole (Prilosec OTC). Both are available under an over-the-counter drug label that works for your heartburn problems.

Wondering how long can you take Nexium OTC? Stick to this article and take a look at the later sections of this guide to know further information about it.

How do PPIs work?

Proton Pumps are enzymes that are present in your stomach which plays an important role to produce hydrochloric acid which is the main component of acids present in your stomach.

These acids help your stomach in digesting food more properly. In cases when the muscles between the esophagus and your stomach don’t close properly, these acids make their way through the esophagus. This is why you experience a burning feeling throughout your chest and at your throat that is directly associated with GERD.

It can also initiate other chest and lung problems such as cough, asthma, and pneumonia.

Proton Pump Inhibitors reduce the amount of these acids created by proton pumps. These inhibitors work efficiently when you take them at least 30 minutes before having your meals. Plus, you’ll need to have them for several days or sometimes weeks to see improvements in your condition(s).

Proton pump inhibitors are used for the purpose since1981 and are considered to be the most effective medication to cater to stomach acid reflux

Why are PPIs prescribed?

PPIs like Prilosec and Nexium OTC are considered effective to reduce and treat acid-related conditions. Such as heartburn, GERD, duodenal ulcers and stomach (caused by Pylori infection), esophagitis (erosion of esophagus), and Zollinger-Ellison Syndrome (an ailment in which because of tumors, acid production increases).

Nexium vs Prilosec OTC – What is the difference?

Nexium vs Prilosec OTC or esomeprazole vs. omeprazole, there’s no difference in both drugs. They are used to treat the same ailment, however, there’s a slight difference in their chemical production.

Nexium OTC is a PPI that minimizes the acid production in your stomach having only one isomer. While Prilosec OTC contains two isomers.

Isomers on the other hand is a term used for the molecules indicating the same chemicals arranged in quite a dissimilar way. In other words, you can say that Nexium and Prilosec are made using the same blocks which are put together differently.

Since the isomer difference seems minor, they have the potential to work in different ways depending on the quantity of the drug taken. For instance, the isomer present in the Nexium OTC functions even slower on your body than that of isomers in Prilosec. This means that the longer a drug stays in your body, it can work even longer to prevent your body from producing excess acids. Eventually, reducing the production of acids for a longer time.

Nexium OTC is considered effective in treating acid-related issues much faster in contrast to Prilosec. Your liver breaks down esomeprazole differently so you may need to have fewer drug interactions as of omeprazole.


Studies indicate the difference between Prilosec and Nexium OTC as the advantages they provide to the patients in certain conditions.

A study done in 2002 showed that the same dose was given to patients suffering from the same condition of GERD. Esomeprazole provided more effective results than omeprazole.

Through another study done in 2009, it was found that Nexium OTC (esomeprazole) provided faster and longer relief to esophagitis patients.

The American College of Gastroenterology says after reviewing these studies, that there’s no major difference in the effectiveness of both the PPIs when it comes to treating gastric issues. Additionally, experts believed that they have many similar effects on GERD symptoms overall.

Relief price

When the PPIs were reviewed in terms of effectiveness by many first-hand physicians, they found no major change. But there was a significant price difference among Nexium vs Prilosec OTC.

Until 2014, Nexium OTC was available at a relatively higher price and you could have it only after a doctor’s prescription. Now, Nexium offers an over-the-counter formula that is relatively competitive to the Prilosec OTC. However, generic omeprazole can be obtained at a lower price compared to Prilosec OTC.

If you have a medical insurance or Medicaid facility, you may have to consult the company before getting PPIs. This is because traditionally, medical insurance companies do not cover over-the-counter medicines and products. However, the PPIs market has forced medical insurance companies to cover OTC PPIs. In case your insurance company still doesn’t cover Nexium OTC or Prilosec OTC, a prescription of generic omeprazole would be taken as an option.

Talk to your doctor or pharmacist to determine what PPI would be better for you. You may need to consider the following options:

  • Medical condition
  • Side effects
  • Combination with other medications

Side effects

Patients suffering from esophagitis infections or gastric issues taking PPIs don’t really suffer from any side effects. However, some people may infrequently suffer:

  • Nausea
  • Diarrhea
  • Headache
  • Vomiting
  • May expose to an allergic reaction
  • Dizziness
  • Stomach pain
  • Acute kidney failure symptoms
  • Seizure
  • Irregular heart rate
  • Fever
  • Constipation
  • Gas
  • Symptoms of cold (flu, sneezing, stuffy chest, sore throat, etc.)

Experts believed that the side effects are more associated with esomeprazole. They also believe that PPIs can be the reason for an increase in risks of:

  • Postmenopausal women can experience wrist and spine fractures. It happens especially when the medications are prescribed for a year with higher doses.
  • After hospitalization, the body gets prone to colonel bacterial inflammation.
  • Pneumonia
  • The subject can also experience nutritional deficiencies like magnesium and vitamin B-12.

People using PPIs have reportedly experienced a higher acid production in their bodies when they stop using them. However, the reason behind the condition is still completely hidden.

To treat your acid issues, it is suggested to use PPIs not more than four to eight weeks. If you still feel like taking them regularly due to the acidic condition, then talk to your doctor first. Your doctor will determine if you need to take the same prescription for longer.

It is also recommended that once the treatment duration reaches its end, start tapering off the medication gradually so your body gets used to treating itself.


It is also recommended that you should know about the possible drug interactions and risks linked to the PPIs’ regular usage.

Risk elements

  • Asian bodies may take longer to process PPIs and they may take different proton pump inhibitors.
  • Can have liver disease
  • Can experience lower magnesium levels
  • Risks are there for breastfeeding mothers, for those women who are pregnant or planning to become.

Drug interactions

Before your doctor prescribes you PPIs or any other long medication, make sure to inform your doctor about any medicine you already are taking for any other disease.

Nexium and Prilosec can react with drugs, vitamins, and herbs. According to the FDA, a warning has been issued that the Prilosec OTC can reduce the efficiency of the medicines used as a blood thinner.

You should never combine both drugs together. The warning has been precisely announced for the Prilosec OTC other PPIs have not been tested in this regard.

Following are the drugs that you should not combine with either Prilosec or Nexium OTC.

  • Nelfinavir
  • Clopidogrel
  • Delavirdine
  • Rilpivirine
  • Rifampin
  • John’s wort
  • Risedronate

These drugs can interact with Prilosec and Nexium OTC but still can be taken with either PPI.

  • Aripiprazole
  • Amphetamine
  • Atazanavir
  • Bosentan
  • Bisphosphonates
  • Cilostazol
  • Carvedilol
  • Citalopram
  • Cyclosporine
  • Clozapine
  • Escitalopram
  • Antifungal drugs

To have a side-by-side comparison, look at the following table to have a comprehensive Nexium vs Prilosec difference.

Nexium (Esomeprazole)

Prilosec (Omeprazole)

Beneficial for Stomach Ulcers and Heartburn

For optimum heartburn relief, Nexium (esomeprazole) is a perfect medicine that you can rely on. But before having it to treat a long-term heartburn problem, consult a medical professional.

Treats the release of stomach acids and Heartburn effectively

Prilosec (omeprazole) treats long-term heartburn issues and provides relief from acid reflux. Long-term usage can put you at risk. Consult your doctor before having it for the long term.

Benefits of using Nexium

Benefits of using Prilosec

Nexium is safe to be taken daily without any measurable side effects

Prilosec can also be taken daily as it doesn’t cause any harsh side effects.

It keeps in your body for a longer period of time, this is why there’s no need to take it twice a day like other antacids including Zantac, Tums, or Pepcid.

Prilosec (omeprazole) lasts in your body for up to 72 hours more than any other heartburn medicine like Zantac, Pepcid, and tums.

Nexium can also be taken along with any quick-acting antacid such as Tums or Maalox in case of quicker relief.

For quicker relief can be taken combined with other antacid medicines like Tums and Maalox.

Nexium is one of the inexpensive OTC and generic options for patients suffering from heartburn.

OTC and generic options are there as well.

The brand name has coupons available at the pharmacies. Ask your doctor or pharmacist about them.

Is safe to use for children of one year of age and older.

Downsides of Nexium

Downsides of Prilosec

Nexium doesn’t start working rapidly like other antacids, which include Maalox, Rolaids, and Tums.

It may take up to an hour to start noticing the effects of Prilosec (omeprazole).

It takes several days and weeks for Nexium to show results to provide continuous relief from heartburn and ulcers.

Prilosec can react with other drugs if combined for faster relief. Let your pharmacist or doctor know prior to mixing one or more OTC drugs to your Prilosec while suffering from heartburn.

Nexium may not work best on patients over the age of 65 and older. This is because they have a high risk of severe diarrhea and bone fractures.

Continuing Prilosec can put you into many severe health problems that may include low levels of vitamin B2, and Magnesium, and osteoporosis.


Once you stop using Prilosec, it can also create rebound acid secretion in which your body tends to create more acids than it was producing before Prilosec. 

Nexium is used for

Prilosec is effective for

  • Bacterial Infection – H. Pylori
  • GERD
  • Treatment and Prevention of induced gastric ulcers – NSAID
  • Duodenal Ulcer Disease
  • Stomach Ulcer
  • GERD
  • Heartburn
  • H. Pylori
  • Erosive esophagitis
  • Prevent stress ulcers in patients with severe complications
  • Excessive Stomach Acid secretion
  • Treat Stomach ulcers
  • Prevent ulcers resulting from NSAID

 Dosage Forms

Dosage Forms

  • Injections
  • Pills
  • Packet
  • Powder
  • Pills

Lowest Price available

Lowest Price available



Reviews so far

Reviews so far

According to 1239 reviews

11% find it less effective

59% find Nexium works well

75% rely on it

According to 1167 reviews

8% find it less effective

59% say it worked well

80% rely on it

Possible Side effects

Possible Side effects

Nexium (esomeprazole) doesn’t show any side effects but may occur in long-term use.

Prilosec has 11 possible side effects:

  • Abdominal pain
  • Headache
  • Diarrhea
  • Nause
  • Vomiting
  • Flatulence
  • Upper Respiratory Infections
  • Acid regurgitation
  • Constipation
  • Rash
  • Dizziness

Possible Risks and Risk Factors

Possible Risks and Risk Factors

  • Kidney Injury
  • Stomach Cancer
  • Bone Fractures
  • Lupus
  • Severe Diarrhea (can be treated at the hospital)
  • Risk of cancer
  • Lupus (for those who have a history of systemic lupus erythematosus or cutaneous)
  • Diarrhea with C.difficile infection (will be treated through antibiotics while being hospitalized)
  • Bone Fractures (Osteoporosis, with bone issues that may take more than 1 year to treat.
  • Low levels of Magnesium and Vitamin B12
  • Kidney failure

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Frequently Asked Question

Nexium is a prescription medicine that is used to treat heartburn and the symptoms of gastroesophageal reflux.

Prilosec is an OTC prescription medicine used for the treatment of gastroesophageal reflux and intense heartburn symptoms.

Nexium and Prilosec medicine reside on the same class of drugs called proton pump inhibitors that perform relatively similarly.

Nexium and Prilosec both work efficiently in treating GI complications and gastroesophageal symptoms. However, Nexium works comparatively faster than Prilosec.

Recently, FDA has defined Nexium and Prilosec in the category B medications for pregnancy. This shows that the medicines are safe to use during pregnancy.

Take away

Typically, you can take any PPI that is safe to be taken regularly and cost you less. You also need to keep in mind that PPIs can only treat gastric disorders and GERD symptoms. They are not prescribed to treat the cause or the lingering disease that is causing the symptoms. However, they can provide instant short-term relief only after your doctor’s advice.

To deal with heartburn and GERD issues, lifestyle change should be your first option. You can try:

Weight management
Refrain from smoking or tobacco use (if applicable)
Avoiding heavy meals before your sleeping hours (if applicable)
A lingering GERD ailment can result in esophageal cancer. Although some GERD patients reportedly get esophageal cancer eventually, it’s crucial to remain aware of the potential risks.

It is suggested to take PPIs, either Nexium OTC or Prilosec OTC depending on your conditions and discussion with your doctor.

A recommended dosage of Prilosec is 20-60mg once a day. It should be taken as a whole without crushing, chewing, or opening.

For relief from heartburn and GERD, you can use these OTC drugs occasionally:

Acid reducing drugs such as Pepcid (famotidine) or Tagamet (cimetidine).
Calcium carbonate chewable tablets
Magnesium oxide and Aluminum hydroxide liquids.