Nexium (esomeprazole) certainly wins when it comes to marketing. While it is still available by prescription as Nexium 40 mg daily, there is now a generic esomeprazole and an over the counter form (Nexium 24HR) which is 22.3 mg. Yet somehow, Nexium is still the fourth best selling brand name prescription drug in the United States. Why is that? Well, purple does well with audiences which is why drug companies market their drugs in purple packaging . . . so the purple pill Nexium has made its way into people’s hearts.
While I’m not trying to be a Nexium hater and certainly appreciate the benefit of proton pump inhibitors (PPIs), I’m astounded that doctors continue to allow their patients to pay for brand name Nexium when the generic options are just as good. Let’s take a look at what we know to be true.
- Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. Generic and OTC options exist: Prilosec and Prilosec OTC (omeprazole), Protonix (pantoprazole), and Prevacid and Prevacid 24HR (lansoprazole).
- The clinical benefit of newer and more expensive PPIs over the older generation PPIs (omeprazole, pantoprazole, lansoprazole) remains uncertain.
- A recent meta-analysis (an analysis of 15 previously published studies) looked at Nexium (esomeprazole) versus Prilosec (omeprazole) in healing gastroesophageal reflux disease (GERD), peptic ulcer disease, and eliminating Helicobacter pylori (H. pylori) infection.
- To be fair, for GERD Nexium 40 mg (prescription) was slightly better than omeprazole 20 mg (OTC) at week eight. But omeprazole also comes in a 40 mg tablet; 20 mg is a lower dose omeprazole.
- There was no difference between Nexium 20 mg and omeprazole 20 mg at week four.
- For H. pylori eradication, there was no difference in the treatment effects between esomeprazole 20 mg and omeprazole 20 mg.
Take home message: when Nexium (esomeprazole) 40 mg is compared to omeprazole 40 mg there is no better esophagitis healing rate in patients with GERD and no difference in H. pylori healing rates. The only reason to pay for a brand name PPI is if you’ve tried the cheaper generic options, they haven’t worked for you, and Nexium has. Thoughts?
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