Compare omeprazole vs. Nexium vs. Zantac

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

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Prilosec (omeprazole)

Prescription or OTC

Nexium (esomeprazole)

Over-the-counter
Treats heartburn and excess release of stomach acid.

Prilosec (omeprazole) gives you long-lasting heartburn relief but has some risks if used long term.

4.0/ 5 average rating with 1167 reviewsforomeprazole
Treats heartburn and stomach ulcers.

Nexium (esomeprazole) gives you long-lasting heartburn relief but has some risks if used long term.

4.0/ 5 average rating with 1239 reviewsforNexium
Upsides
  • Prilosec (omeprazole) lasts longer (up to 72 hours) than other classes of acid reducers (like Zantac, Pepcid, or Tums).
  • Only take once or twice daily.
  • Can take together with a quick-acting antacid (like Maalox or Tums) for quick relief.
  • Generic and over-the-counter options available.
  • Safe to use in children ages 1 or older.
  • Most people can take Nexium (esomeprazole) without any noticeable day-to-day side effects.
  • Nexium (esomeprazole) lasts longer than other types of antacids (like Zantac, Pepcid, or Tums), and you only need to take it once a day.
  • You can take it in combination with a quick-acting antacid (like Maalox or Tums) if you need quicker relief.
  • Nexium (esomeprazole) is inexpensive, with over-the-counter and generic options.
  • Coupons are available for the brand name - speak to your doctor or pharmacist.
  • The packet form is a good option if you have trouble swallowing pills.They can be mixed with water for easier swallowing.
Downsides
  • Takes up to an hour to start noticing the effects of Prilosec (omeprazole).
  • Prilosec (omeprazole) can interact with other drugs. Let your doctor and pharmacist know what medications you're taking before starting Prilosec (omeprazole).
  • Long-term use of Prilosec (omeprazole) can put you at risk for many health issues such as osteoporosis, low magnesium or vitamin B12 levels, and rebound acid secretion (where your body starts to create more acid than before after stoping Prilosec (omeprazole)).
  • Doesn't start working right away like antacids (Tums, Rolaids, or Maalox).
  • It can take several days or weeks to start feeling benefits.
  • May not be the best choice for patients 65 years of age and older due to risk of bone fractures and severe diarrhea.
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Used for
  • GERD
  • H. Pylori bacterial infection
  • Prevention and treatment of NSAID-induced gastric ulcers
Dosage forms
  • Pill
  • Powder
  • Pill
  • Injection
  • Packet
Price
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Reviews
1167 reviews so far
80%
saidit'sworth it
59%
saiditworked well
8%
saidit'sa big hassle

Have you used Prilosec (omeprazole)?

Leave a review
1239 reviews so far
75%
saidit'sworth it
59%
saiditworked well
11%
saidit'sa big hassle

Have you used Nexium (esomeprazole)?

Leave a review
Side effects
11possible side effects
  • Headache
    7%
  • Abdominal pain
    5%
  • Nausea
    4%
  • Diarrhea
    4%
  • Vomiting
    3%
  • Flatulence
    3%
  • Acid regurgitation
    2%
  • Upper respiratory infection
    2%
  • Constipation
    2%
  • Dizziness
    2%
  • Rash
    2%
See more detailed side effects
The Nexium (esomeprazole) FDA package insert doesn’t have numbers about how common side effects are.
Risks and risk factors
  • Risk of cancer
  • Lupus
    • History of cutaneous or systemic lupus erythematosus
  • Severe diarrhea associated with C.difficile infection
    • Being hospitalized
    • Antibiotic use
  • Bone fractures
    • Osteoporosis
    • Using high medication doses
    • Long-term therapy (1 year or more)
    • Use of other medications that weaken bones
  • Low Vitamin B12 and Magnesium
    • Taking water pills (Magnesium)
    • Women (Vitamin B12)
    • Over the age of 30 (Vitamin B12)
  • Kidney damage
See more detailed risks and warnings
  • Stomach cancer
  • Kidney injury
  • Severe diarrhea
    • Being treated at a hospital
  • Bone fractures
    • High dose Nexium (esomeprazole)
    • Long-term treatment with Nexium (esomeprazole)
    • Low bone mineral density
    • Aged 65 years or older
  • Lupus
See more detailed risks and warnings