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Esomeprazole vs. Pantoprazole

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

Esomeprazole

(Nexium)

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Pantoprazole

(Protonix)

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Summary for Esomeprazole

Prescription or over-the-counter

Esomeprazole (Nexium) is a medication used to treat conditions that are caused by too much stomach acid, such as heartburn or acid reflux. It's available both with a prescription and over the counter (OTC). Take esomeprazole (Nexium) an hour before a meal so that it can start working before you eat. It can take a couple days for you to feel its full effects, so consider taking other quick-acting antacids in the meantime until the medication effect kicks in.

Indications for Esomeprazole

For adults only:

  • Heartburn — OTC only
  • Lower the risk of stomach ulcer due to nonsteroidal anti-inflammatory drugs (NSAID)
  • Lower the risk of duodenal ulcer caused by Helicobacter pylori (H. pylori) infection
  • Other medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)

For adults and children:

  • Gastroesophageal reflux disease (GERD)
  • Inflamed esophagus due to GERD

Pros and Cons for Esomeprazole

Pros

  • Can continue to use with antacids, such as calcium carbonate
  • Provides longer-lasting relief than some other heartburn medications
  • Available as over-the-counter and lower-cost generic options
  • Granules or pellets inside the capsules can be mixed with water or applesauce, so convenient for people with difficulty swallowing pills

Cons

  • Takes 1 to 4 days for the medication to fully kick in, so not the best choice for immediate heartburn relief
  • Significant interaction with clopidogrel (Plavix), which can raise the risk of blood clot
  • Long-term use might weaken bones and raise the risk of bone fracture
  • Can lower magnesium and vitamin B12 levels

Common Side Effects for Esomeprazole

  • Headache (4-8%)
  • Belly pain (3-4%)
  • Diarrhea (2-4%)
  • Nausea (2%)
  • Passing gas (more than 1%)
  • Constipation (more than 1%)
  • Dry mouth (more than 1%)

Warnings for Esomeprazole

  • Risk of hiding symptoms of a more serious problem
  • Sudden kidney problems
  • Severe infectious diarrhea
  • Bone fractures
  • Skin reactions
  • Lupus
  • Low vitamin B12 and magnesium levels
  • Interaction with other medications

Summary for Pantoprazole

Prescription only

Pantoprazole (Protonix) is a proton-pump inhibitor (PPI). It's used to treat symptoms of gastroesophageal reflux disease (GERD) in adults and children. It's also used to treat other conditions involving too much stomach acid, such as erosive esophagitis, in adults only. Pantoprazole (Protonix) is taken by mouth, typically once daily for most conditions. Some of the more common side effects of this medication include headache and diarrhea. Pantoprazole (Protonix) isn't available over-the-counter (OTC).

Indications for Pantoprazole

Pros and Cons for Pantoprazole

Pros

  • Can continue to use with antacids, such as calcium carbonate
  • Available as a lower-cost generic medication
  • Oral tablets can be taken without regard to food
  • Available in oral granules and suspension for people with trouble swallowing

Cons

  • Long-term use might weaken bones and raise the risk of bone fractures
  • Might cause or worsen lupus
  • Interacts with warfarin (Coumadin), which can raise the risk of bleeding
  • Not available over-the-counter

Common Side Effects for Pantoprazole

  • Headache (12%)
  • Diarrhea (9%)
  • Nausea (7%)
  • Belly pain (6%)

Please note: Side effect percentages are listed for adults with GERD.

Warnings for Pantoprazole

  • Risk of hiding symptoms of a more serious problem
  • Sudden kidney problems
  • Severe infectious diarrhea
  • Bone fractures
  • Skin reactions
  • Lupus
  • Low vitamin B12 and magnesium levels
  • Interaction with other medications
  • Inaccurate lab work

Prices with our coupons for Esomeprazole vs. Pantoprazole

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Esomeprazole30 capsules / 40mg
$13.25$22.11
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Pantoprazole30 tablets / 40mg
$9.87$16.43
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