Compare Omeprazole vs. Nexium

Head-to-head comparisons of medication uses, side effects, ratings, and more.

Prilosec
(Omeprazole)

Nexium
(Esomeprazole)

Treats heartburn and stomach ulcers. Prilosec (Omeprazole) gives you long-lasting heartburn relief. Choose the cheapest proton pump inhibitor because they all work equally well for heartburn.Treats heartburn and stomach ulcers. Nexium (Esomeprazole) gives you long-lasting heartburn relief. But this purple pill ain't cheap! The generic forms of alternative drugs work just as well, and are usually less expensive.
Find lowest prices
Powered by GoodRxSave on your next prescription. Be sure you’re getting the lowest price for your medication, even if you have insurance.
Reviews & ratings
Button Group. All currently active
Button Group. All currently active
5.5411558669001755Omeprazole
Reviews for Prilosec (Omeprazole)
80%
of people say Prilosec (Omeprazole) is worth it
59%
say it works well
7%
say it's a big hassle
Reviews for Nexium (Esomeprazole)
75%
5% vs. Prilosec (Omeprazole)
59%
Same vs. Prilosec (Omeprazole)
11%
4% vs. Prilosec (Omeprazole)
Side effects
OmeprazoleNexium

The Omeprazole FDA package insert doesn’t have numbers about how common side effects are.

More about Omeprazole side effects »

The Nexium FDA package insert doesn’t have numbers about how common side effects are.

More about Nexium side effects »
How it works
OmeprazoleNexium
Prilosec (Omeprazole) is a proton pump inhibitor (PPI). It lowers the amount of acid in your stomach, treats heartburn, and heals ulcers.Nexium (Esomeprazole) is a proton pump inhibitor (PPI). It lowers the amount of acid in your stomach, treats heartburn, and heals ulcers.
Type of medication
OmeprazoleNexium
Acid reducer
Proton pump inhibitor
Prescription or OTC
Acid reducer
Proton pump inhibitor
Prescription or OTC
Available as
OmeprazoleNexium
  • Extended release
  • Extended release
Used for (click to learn more)
OmeprazoleNexium
Risk factors for serious side effects
OmeprazoleNexium
    • Helicobacter pylori infection
    • Autoimmune disease
    • Being hospitalized
    • Antibiotic use
    • Osteoporosis
    • Age 50 or older
    • Using high medication doses
    • Long-term therapy (1 year or more)
    • Smoking
    • Use of other medications that weaken bones
      Detailed Prilosec (Omeprazole) risks & warnings »
        • Helicobacter pylori infection
        • Autoimmune disease
        • Being hospitalized
        • Antibiotic use
        • Osteoporosis
        • Age 50 or older
        • Using high medication doses
        • Long-term therapy (1 year or more)
        • Smoking
        • Use of other medications that weaken bones
          Detailed Nexium (Esomeprazole) risks & warnings »
          Pregnancy category
          OmeprazoleNexium
          CFDA pregnancy category (Weigh risks vs. benefits)

          Research studies with animals found harmful effects on unborn babies. It hasn’t been properly studied in humans. The benefits might outweigh the risks even if you’re pregnant. Talk with your doctor.

          See the FDA package insert
          BFDA pregnancy category (Probably safe)

          Research studies with animals haven’t found a risk to unborn babies, but it hasn’t been properly studied in humans.

          See the FDA package insert
          Alcohol
          No specific alcohol-related info.No specific alcohol-related info.
          Food
          • Take 1 hour before a meal.
          • Take 1 hour before a meal.
          Kidneys and liver
          No specific kidneys and liver-related info.No specific kidneys and liver-related info.
          Sex
          No specific sex-related info.No specific sex-related info.
          Sleep
          No specific sleep-related info.No specific sleep-related info.
          Weight
          No specific weight-related info.No specific weight-related info.
          Upsides and benefits
          OmeprazoleNexium
          • Most people can take Omeprazole without any noticeable day-to-day side effects.
          • Omeprazole lasts longer than other types of antacids (like Zantac, Pepcid, or Tums), and you only need to take it once or twice a day.
          • You can take it in combination with a quick-acting antacid (like Maalox or Tums) if you need relief right away.
          • In studies it was better than a placebo (sugar pill) and as good as other proton pump inhibitors at treating heartburn.
          • Available as both a generic and over-the-counter option, so it's pretty affordable.
          • Most people can take Nexium without any noticeable day-to-day side effects.
          • Nexium lasts longer than other types of antacids (like Zantac, Pepcid, or Tums), and you only need to take it once or twice a day.
          • You can take it in combination with a quick-acting antacid (like Maalox or Tums) if you need relief right away.
          • In studies it was better than a placebo (sugar pill) and as good as other proton pump inhibitors at treating heartburn.
          • Available as both a generic and over-the-counter option, so it's pretty affordable.
          Downsides and risks
          OmeprazoleNexium
          • Can cause low levels of magnesium in the blood. You might need to take a magnesium supplement if you use Omeprazole long-term.
          • Although the generic is affordable, other medications might still be cheaper than Omeprazole.
          • Can interact with other drugs so be sure your doctor knows all the medicine you're taking before starting Omeprazole.
          • Doesn't start working as fast as some other antacids like Tums, Rolaids, or Maalox.
          • Like with other proton pump inhibitors, long-term use can cause weak or broken bones.
          • Can cause low levels of magnesium in the blood. You might need to take a magnesium supplement if you use Nexium long-term.
          • Can be expensive—especially the purple brand-name pill. Other alternatives are usually cheaper than Nexium and work just as well.
          • Can interact with other drugs so be sure your doctor knows all the medicine you're taking before starting Nexium.
          • Doesn't start working as fast as some other antacids like Tums, Rolaids, or Maalox.
          • Like with other proton pump inhibitors, long-term use can cause weak or broken bones.
          Tips from our pharmacists for people taking the medication
          OmeprazoleNexium
          • When using Omeprazole long-term, take a calcium citrate with vitamin D supplement daily to prevent bone loss. Be sure it's calcium citrate because it works the best when using a proton pump inhibitor.
          • Get a blood test for your magnesium level once a year; you may need a magnesium supplement while using Omeprazole.
          • Avoid drug interactions by telling your doctor all of the other medications or herbal supplements you take before starting Omeprazole.
          • Take 1 hour before a meal.
          • Don't chew or crush capsules; swallow them whole.
          • If you have trouble swallowing you can carefully open the capsules and sprinkle the inside pellets onto applesauce. Swallow the applesauce without chewing or crushing the pellets.
          • When using Nexium long-term, take a calcium citrate with vitamin D supplement daily to prevent bone loss. Be sure it's calcium citrate because it works the best when using a proton pump inhibitor.
          • Get a blood test for your magnesium level once a year; you may need a magnesium supplement while using Nexium.
          • Avoid drug interactions by telling your doctor all of the other medications or herbal supplements you take before starting Nexium.
          • Take 1 hour before a meal.
          • Don't chew or crush capsules; swallow them whole.
          • If you have trouble swallowing you can carefully open the capsules and sprinkle the inside pellets onto applesauce. Swallow the applesauce without chewing or crushing the pellets.
          Learn more
          More about OmeprazoleSide effectsReviews & ratingsAlternativesFDA package insert
          More about NexiumSide effectsReviews & ratingsAlternativesFDA package insert