The Six Billion Dollar Pill: Is Nexium Worth the Money?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Proton pump inhibitors (PPIs) work well for the treatment of heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers. Nexium, a brand name PPI not available as a generic, made over 6 billion dollars this past year with so many of you paying big money for it.

Why pay for Nexium? Proton pump inhibitors are available over the counter (Zegerid OTC, Prilosec OTC and Prevacid 24HR) as well as many prescription generic forms like pantoprazole (Protonix). So why would you pay for an expensive PPI when a cheaper one is available? I don’t know why. Nexium has never been shown to be superior to any of the other PPIs with the exception of a few drug-company sponsored studies which looked at “maintenance of healing of erosive esophagitis” and Nexium 20 mg edged out lansoprazole (Prevacid) 15 mg a day.

For the most part, all PPIs are created equally. It’s not just Nexium we can wonder about—Dexilant is another expensive brand name PPI—yet Nexium is still raking in an astounding 6 billion dollars a year because you (our patients) are buying it and we (some doctors) are prescribing it. Has the advertising gotten to us?

Just say no to expensive brand name drugs, when a good generic is available and essentially equivalent.

Dr O.

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