Painful conditions of the esophagus and stomach are common in our society. Stress, obesity, poor diet, and smoking can all play a part. Whether you suffer from acid reflux or ulcers, controlling acid is probably part of your game plan for comfort and health. But there are two very similar acid-controlling drugs from the same parent company on the market: Prilosec and Nexium. How does a savvy healthcare consumer evaluate which one is right or them?

The basics:
Prilosec (omeprazole) was introduced in 1989. Nexium (esomeprazole) was released in 2001. These two drugs are very similar chemically — they are both proton pump inhibitors. This means inhibit the secretion of hydrochloric acid. Yet, they are subtly different: Nexium is often described as a “reflected” or “left-hand” version of Prilosec. They are both products of the pharmaceutical company AstraZeneca, and some parties have described Nexium as a “follow-up drug” to the wildly successful Prilosec; it was introduced just as Prilosec’s patent protection was about to expire.

The conditions they treat:

1. Gastroesophageal reflux disease (GERD, commonly called acid reflux) is when the lining of the esophagus becomes inflamed from the regurgitation of stomach acid. Prilosec and Nexium can both treat GERD.
2. Duodenal ulcers: Prilosec and Nexium can both treat duodenal ulcers that are caused by a Helicobacter pylori infection, but only Prilosec can treat duodenal ulcers caused by other factors.
3. Gastric ulcers: Both drugs treat benign gastric ulcers, but Nexium is limited to treating such ulcers caused by nonsteroidal anti-inflammatory drugs. Prilosec can treat any type of gastric ulcer.

Your choices:

Prilosec is an older, more established drug, and thus has been approved to treat more conditions than Nexium has. If your condition is one that only Prilosec can treat, then your choice is crystal-clear.

However, if you are one of the millions of people whose condition is approved to be treated with either Prilosec or Nexium, then you have some research, discussion, and possibly even a trial run with the medication ahead of you. Someone suffering from acid reflux, for instance, would have a valid case to try either medication. If this is the case, discuss your particulars with your doctor for advice on which to start with.

The two drugs are so similar that many patients report choosing solely based on logistical factors such as availability and affordability. However, here are some other issues to consider in your comparison:

• Check your insurance plan: some cover both Prilosec and Nexium, while some only cover one choice.
• Prilosec has a generic version, while Nexium does not, which may affect your buying decision.
• Some people tolerate one drug better than its sibling; you may need to compare to learn what works for you.
• Prilosec can have a side effect of appetite loss, while this has not been reported with Nexium.
• Prilosec is generally recommended for shorter courses of treatment, while Nexium is often recommended for longer courses of 4-8 weeks.

These medications are very similar, but are not the same. Do not substitute. As with any drug, please consult your physician before taking.