Nexium Pros and Cons vs. Generic Prilosec for Acid Reflux

Nexium Pros and Cons vs. Generic Prilosec for Acid Reflux

During a flare-up, people with severe heartburn will usually try anything to relieve the pain. Dietary changes and weight control can help ease symptoms, but many patients rely on medication to control their acid reflux. In fact, Prilosec OTC was the top-selling digestive aid in 2013, driving $358.8 million in sales from U.S. patients alone. Most acid reflux medications available today fall into one of three distinct categories:

  • Antacids. These are the least-potent option and include perennially popular heartburn remedies like TUMS, Rolaids, Pepto-Bismol and Alka-Seltzer.
  • H2 blockers. This drug class falls somewhere in the middle, strength-wise, and features brand-name formulations like Zantac, Pepcid and Tagamet.
  • Proton pump inhibitors (PPIs). These are the most powerful and potent acid reflux medications you can buy, whether via prescription or over-the-counter formulations. Popular OTC PPIs include Nexium (esomeprazole), Prilosec (omeprazole), Zegerid (omeprazole/sodium bicarbonate) and Prevacid (lansoprazole). Prescription PPI brands include Protonix (pantoprazole), Dexilant (dexlansoprazole) and Aciphex (rabeprazole).

PPIs are extremely effective at eliminating excess stomach acid production, which can shoot pain up into your esophagus. Despite their usefulness, PPIs aren’t a good choice for those who suffer from frequent heartburn or indigestion. Since long-term or daily PPI use can cause severe health problems, antacids or H2 blockers are better for treating GERD.

In order to help you make an informed decision, we’ll compare the two most popular PPI brands below: Prilosec OTC and Nexium. You’ll find the costs, side effects and FDA warnings for each drug, plus any lawsuits filed and settled against them.

PPI #1: Prilosec OTC

Sold generically as omeprazole, doctors usually prescribe Prilosec to treat chronic acid reflux symptoms and ulcers from H. Pylori infections. Prilosec helps heal acid-damaged tissue in your stomach and esophagus by radically decreasing gastric acid production in the short-term. While your doctor or gastroenterologist may prescribe Prilosec to you, it’s also available in generic omeprazole and branded OTC formulations.

Average Prilosec Cost

Approximately $250 per year.

Potential Prilosec Side Effects

Patients most frequently report headaches and abdominal pain while taking Prilosec OTC. But continual PPI use (i.e., longer than the recommended 14 days) is also linked to the following serious health complications:

  • A severe intestinal infection called Clostridium-difficile (C-diff)
  • Chronic vitamin B-12 and D deficiencies that may cause unusual muscle weakness, a sore tongue, or tingling in your hands/feet
  • Increased risk of developing bone fractures, dementia, and heart attack

FDA Warnings About Prilosec

The U.S. Food and Drug Administration indicates that OTC PPIs “are marketed at low doses and are only intended for a 14-day course of treatment up to 3 times per year.” But the agency also acknowledges that consumers “may take these products for periods of time that exceed the directions on the OTC label.” They warn consumers about the risks involved with using OTC PPI medications for extended periods without following a doctor’s supervision.

Prescription Required?


Lawsuits Filed/Settlements Paid

Injured patients have filed Prilosec OTC lawsuits, but none have yet reached a settlement with the drug’s manufacturer. Further studies show new dangers from long-term PPI use, so legal experts say it’s a positive indicator regarding future settlements.

PPI #2: Nexium

Nexium sold generically as esomeprazole, is the next-best thing to Prilosec for treating GERD and stomach ulcers from bacterial infections. As a PPI, it has the strongest effect on reducing stomach acid production and GERD-related symptoms. So, what makes Nexium different from Prilosec? Nexium contains a much more potent version of the exact same chemical, making it the most effective single-dose PPI available. Essentially, Nexium’s active ingredient forms a plug that seals your stomach valves closed and completely blocks all gastric acid secretion. So, Nexium is the preferred PPI drug for treating a condition called Zollinger-Ellison Syndrome as well as Barrett’s Esophagus patients.

Average Nexium Cost

Approximately $3000 annually.

Potential Nexium Side Effects

Since Nexium and Prilosec are almost chemically identical and carry the same short-term and long-term side effect risks.

FDA Warnings About Nexium

The FDA warning about increased bone fracture risks also applies to Nexium. In December 2014, the FDA updated Nexium’s warning label to include possible contraindications and dangerous drug interactions. The new warning mentions that patients taking the blood thinner Plavix/clopidogrel or HIV/antiretroviral therapy drugs should avoid PPIs like Nexium.

Prescription Required?

Yes, although OTC Nexium is available without a prescription. You may also purchase generic esomeprazole in most pharmacies and grocery stores nationwide.

Lawsuits Filed/Settlements Made

Nexium’s manufacturer, AstraZeneca, settled than one class action lawsuit with the U.S. Department of Justice in 2015. That February, a jury found AstraZeneca liable for promoting Nexium as more effective than its cheaper, nearly identical competitor Prilosec. That same month, the U.S. Justice Department announced AstraZeneca would pay to resolve charges in an alleged Nexium kickback scheme.

To date, no Nexium plaintiffs filing personal injury lawsuits have reached a settlement. However, as evidence grows that PPIs can cause life-threatening side effects after long-term use, Nexium’s manufacturer may approve future settlements.

If you or a loved one have been harmed by a PPI, you may have a case. Get your free claim evaluation today to see if you may qualify for financial compensation. After submitting your information, a lawyer will contact you to discuss your case and how to get the justice you deserve.

Related: Alternatives to Nexium and Prilosec for Acid Reflux

Mandy Voisin

Mandy Voisin is a freelance writer, blogger, and author of Girls of the Ocean and Star of Deliverance. As an accomplished content marketing consultant, mom of four and doctor's wife, Mandy has written hundreds of articles about dangerous drugs and medical devices, medical issues that impact disabled Americans, veterans' healthcare and workers' compensation issues since 2016.