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Protonix vs. Nexium

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

Key takeaways

Protonix (pantoprazole) and Nexium (esomeprazole) are medications that treat conditions of too much stomach acid such as gastroesophageal reflux disease (GERD). They’re both proton pump inhibitors (PPI). Protonix is available by prescription only and Nexium is available by prescription and over the counter. You can take Protonix tablets with or without food but esomeprazole is best taken an hour before a meal. They can both cause stomach-related side effects such as nausea and diarrhea. Long-term side effects are also possible and may include low vitamin B12 and magnesium levels, kidney problems, and fractures. Esomeprazole, though, may have more drug interactions than pantoprazole.

Pantoprazole

(Protonix)

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Esomeprazole

(Nexium)

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Summary for Protonix

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 Protonix

Pros and Cons for Protonix

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 Protonix

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

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

Warnings for Protonix

  • 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

Summary for Nexium

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 Nexium

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 Nexium

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 Nexium

  • 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 Nexium

  • 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

Prices with our coupons for Protonix vs. Nexium

Price Card Drug Icon
Pantoprazole30 tablets / 40mg
$15.08$89.37
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Price Card Drug Icon
Esomeprazole30 capsules / 40mg
$14.83$248.83
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