I’ve been taking Prilosec, (Omeparazole) available OTC, for a couple of months now. Because my stomach’s messed up, I have to take two 20mg tablets a day instead of one (I have to take one in the morning and one at night). I have pretty good results with it. It’s much better than the other OTC acid reducers. So my hubby suggested I try to get a 'script for it so our insurance will pick up part of the tab.
Well, my doc agreed, and called in a month’s worth of Nexium (Esomeparazole). I went to the pharmacy to pick it up. A 3-week supply of Nexium was on sale at that store for $27.99. My 'script for Nexium rang up at $67.00!! That’s considerably more expensive, even with my insurance picking up most of the tab (without insurance, it would have been over $300.00). The pharmacist said that Nexium is more effective for some people than Prilosec. I’m hesitant to spend that much more money without knowing if it’s really better.
So, if you’ve had experience with both, can you tell me if the Nexium was more effective for you, and if so, how much more effective?
Meantime, I told the pharmacy to keep the Nexium, and bought myself more Prilosec. I’m planning on calling the doctor’s office on Monday and seeing if he has any samples of Nexium so I can try it for myself.
This isn’t a personal ancedote delivered via the internet, so take it for what it’s worth, but the research rather clearly domonstrates that esomeprazole has no advantage over omeprazole. In fact, omeprazole is the exact same drug but in a racemic mixture and your body converts the inactive stereoisomer anyway.
Thanks, threemae. That’s just the kind of thing I was looking for. Still, if my doc will give me a week or two free in the form of samples, I’ll take 'em.
You’ve just experienced what keeps the big profits rolling for Big Pharma… when the Prilosec patent was running out, they made a trivial change to the molecule, called it Nexium, and got to continue to charge out the wazoo for what is essentially the same drug.
You should check with your insurer - Some health plans will pay for the OTC cost (or some part of it) for Prilosec OTC - ours did. (Full disclosure: I work for a health plan.) We even had a successful program in which we stocked the sample closets of high-prescribing docs with free samples of Prilosec OTC. We drove our overall utiilization of generic drugs to near 70%.
This is also why we refused to cover Nexium at all, unless we had medical justification from the doctor for it.
There is a small chance that you lack the enzyme or whatever needed to convert the inactive isomer in Prilosec to the active, in which case Nexium might actually be more effective. It mostly goes by race.
Okay, I read that thread, and got something very helpful from it: Omeperazole (generic Prilosec) is available in prescription form!
As I explained in the OP, the Nexium would cost more, with my insurance picking up most of the tab, than buying Prilosec over the counter. But, I’m wondering if generic prescription Omeperazole would be cheaper? I should probably call my pharmacist, ask him to check what the price would be with my insurance coverage, then call the doctor’s office. I’m certain he’d do it.
I just want to say that anecdotally, I have taken Prilosec OTC, Nexium, Prevacid, and about everything else. I have horrible problems with heartburn and stomach issues, and the Prilosec works sometimes, but if you follow their pattern of taking and non-taking, the effects wear off in a day and then when you start taking again it is non-effective for the first week. Nexium worked wonderfully, and was free to me because insurance picked up the tab. When we switched insurance, I went to get my other medication (which is on a $4 plan at Kroger) and questioned them about the Nexium. 189 a month. I have gone back to taking the Prilosec, but I notice I have some more issues with it being effective no matter what. I plan on keeping with it until my doctor and I discuss it, but Nexium was very different for me.
Prilosec, Prevacid, Nexium, etc all work on the actual acid producing cells in the stomach to reduce acid production. As a class they are known as Proton Pump Inhibitors.
Zantac, Tagamet, Pepcid etc are in a different class of drugs, collectively known as H2 blockers. They block the Histamine 2 receptors which are part of the feedback loop that signals the acid producing cells to release their acid.
Bottom line is that those medications are in different classes, operate on different receptors and aren’t related to the specific enzymes you have.
I’m on Omeprazole prescription, 2 20mg capsules once a day. I can go up to twice a day if I feel I need it. If I miss even one dose (40 mg) I’m in a world of pain (I don’t get heartburn, I cough so hard I vomit from the reflux irritating my throat lining)
See if you can get it prescription, worked for me.
It’s not that you lack the enzyme, it’s that there is a point mutation in the gene that results in a poorly functioning protein enzyme. I have that mutation, and one OTC Prilosec tab lasts ~ 36 hours for me. I don’t know off-hand which of the CYP450 enzymes metabolizes Zantac or Tagamet, but it’s most likely to be CYP2C19, 2C9, 2D6 or 3A4.
That whole extended release thing doesn’t work for me. About a year and a half ago, I had weight loss surgery. It’s enabled me to lose approx. 145lbs. which is great. But also means that, because my insides have been re-wired, and things move through my digestive system rather rapidly. That is why I have to take one in the morning and one at night.
No, no, no, it isn’t because I’m taking extended release anything. It’s because I have a genetic mutation that results in a slower metabolism of omeprazole than normal. The effects of omeprozole on your stomach are governed as much by your genetics as they are by how much stomach you have for it to act on.
