Prilosec Vs. Nexium Vs. Prevacid: What Is The Difference?

In our latest question and answer, our pharmacist discusses the difference between three popular PPI medications, Prilosec, Nexium and Prevacid.


I'm having some major issues with heartburn. I want THE BEST medication to treat it. I am only looking between Prevacid, Prilosec and Nexium. I have asked the pharmacy before and I am always told they are the same but one must be better than the other. Is there studies comparing these?

Asked by Colin On Dec 04, 2017

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Dec 04, 2017

Prilosec (omeprazole), Nexium (esomeprazole) and Prevacid (lansoprazole) all belong to the PPI (Proton Pump Inhibitor) class of medications and are available over the counter, without a prescription. They are often considered the mainstay of therapy for the treatment of acid reflux and GERD (Gastroesophageal Reflux Disease).

Proton pump inhibitors (i.e. 'PPIs') work by shutting down the acid pumps in the stomach, reducing acidity in the stomach and elevating pH levels. They are convenient to use as they are typically dosed just once daily. In addition, short term use (less than 14 days) is generally considered to be safe and well tolerated.

It is difficult to say that one PPI medication is better than another. 'Better' is subjective and there are many factors to consider. Some people may want the quickest onset of relief while others may want better overall acid suppression. Everyone's body chemistry varies.  Though 'Patient A' may get satisfaction and great results from Prilosec, 'Patient B' may get more benefit from Prevacid.

Independent of drug potency, we all react differently to drugs. It's a phenomenon known as pharmacogenomics, which is the study of individual genes in drug response with respect to the way a drug is absorbed, metabolized and utilized by the body. PPI drugs are so similar that sometimes the difference in effectiveness lies with the patients genetics. With that being said, sometimes it takes a little trial and error for an individual to get the response that would provide one with the best relief. 

If you want to dig in a little deeper, we can look at the few comparative studies that are available comparing these drugs.

In regard to directly comparing Prilosec vs. Nexium, at least two studies have concluded that Nexium provides more effective, overall acid control than Prilosec. In addition, there appears to be less variability in effectiveness between patients in those who took Nexium instead of Prilosec.

In addition to the studies listed above, there are an additional few that conclude that Nexium is more effective in terms of overall acid suppression than Prevacid as well. 

Even though one medication may be more effective than the others in terms of overall relief, that is not the only factor. Other comparative studies suggest that Prevacid may have a more rapid onset of maximal acid suppression than the other ones, potentially providing a quicker onset of relief.

The main takeaway is that all of these medications are very similar and are generally effective in relieving your heartburn symptoms. You may need to try more than one to find which medication is the most effective for you.

About the Pharmacist

Dr. Ying Huffman

Dr. Ying Huffman is licensed pharmacist and a 2007 graduate of the University of South Carolina. She has over 10 years of experience in community and retail pharmacy. Her inquisitive nature welcomes all questions!

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