GERD Home > Prilosec vs. Nexium

Many people wonder, "What is the difference between Prilosec vs. Nexium?" Although both medications are very similar chemically, there are important differences between the two medications. Prilosec and Nexium are approved for nearly the same conditions, but Prilosec is approved for use in children as young as two years old, while Nexium is only approved for adults. Also, Prilosec is more affordable than Nexium.

An Overview of Prilosec vs. Nexium

Prilosec® (omeprazole) is a medication known as a proton pump inhibitor (PPI). Nexium® (esomeprazole magnesium) is also a PPI. Although they are very similar medications, there are some important differences between the two medications.
Nexium and Prilosec are very similar molecules. Prilosec was available first and is a mixture of R and S enantiomers of omeprazole. Nexium is just the S enantiomer of omeprazole. Enantiomers are forms of molecules that are almost exactly the same, but are "opposites." You might think of your right and left hands as being enantiomers. They are very similar to each other, but they are opposites (although they are mirror images of each other, if you put one hand on top of the other, they are different).

Prilosec vs. Nexium: Uses

Nexium and Prilosec are approved for nearly all of the same uses. They are both approved to treat the following conditions:
  • Duodenal ulcers (ulcers in the very first part of the intestine after the stomach). Both Prilosec and Nexium can be used to treat a duodenal ulcer due to a Helicobacter pylori infection. Prilosec (but not Nexium) is also approved to treat duodenal ulcers due to other causes.
  • Gastric ulcers (stomach ulcers). Prilosec and Nexium are approved to treat benign (noncancerous) gastric ulcers. However, Nexium is only approved to treat gastric ulcers due to nonsteroidal anti-inflammatory drugs (NSAIDs), while Prilosec is approved to treat gastric ulcers of all causes.
  • Gastroesophageal reflux disease (GERD). Prilosec and Nexium help treat GERD, helping to relieve heartburn and heal esophagitis (damage to the esophagus) due to GERD.
  • Pathological hypersecretory conditions. Prilosec (but not Nexium) is approved to help treat these conditions (when too much stomach acid is produced), such as Zollinger-Ellison syndrome.
Prilosec is approved for children as young as two years old; Nexium, however, is approved only for adults.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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