... years and it worked great, but it was so expensive. So, I recently started taking 2-20mg over the counter pills a day instead of the 1-40mg tablet …my pharmacist said this should be the same thing. It isn't working! I have had acid reflux and heartburn worse than I've had in 2 years. Can the over the counter pills really be THAT different, or is it a coincidence that my symptoms have flared up at the same time I switched over? I haven't changed my diet or anything else in my lifestyle recently and I have been under no stress recently. Has anyone else shared this type of complaint?
I have been taking over the counter Nexium for 1 month now. I have taken Rx nexium for several?
Question posted by dboling on 10 July 2014
Last updated on 6 May 2023
The information on this page reflects personal experiences shared by our community members. It is not reviewed for medical accuracy and should not replace professional medical advice.
41 Answers Page 2
Turtle80
9 July 2016
I take 1 20mg tablet of over the counter Nexium and 1 over the counter tablet Pepcid. Lately even this hasn't been enough. I would say there is a large difference between OTC and Rx. I think I'll have to get a prescription again :(
mmth
5 June 2016
My doctor prescribed Nexium after I had an episode of gastric reflux so severe that an ambulance needed to be called to take me from the restaurant to the local hospital, where a gastroenterologist put me to sleep and suctioned food out of my right lung. I had apparently actually inhaled some of the Indian food I was eating at the time. Now, if I feel my gullet tighten, I stop eating for a few minutes until the food has made its way down my esophagus into my digestive tract. I have no idea whether the 20mg daily is more or less effective than 10mg taken twice daily. I would expect that it is more effective,. being spaced out into two doses before a meal rather than one large dose an hour before eating. Watch this space to find out--you'll be amongst the first to know.
Tmcleod0623
17 May 2016
I did some research on Nexium and OTC Nezium... from what I eead it is not the same the OTC is foe heartburn... no acis blocker... Nexium is an acid blocker the pharmacist said to get Omeprazole
Maryjaye
18 May 2016
Both Brand name Nexium RX and the over the counter have the same active ingredient in them. The difference is in the inactive ingredients, notably ferris oxide a form of iron. Omeprazole is the active ingredient. The generic version made by TEVA also has ferris oxide, so if you are having trouble with the OTC at 40 mg, you will most likely have it with the generic.
johnjudge
28 May 2016
First of all, I have chronic GERD. I have had issues as far back as an adolescent. I started on Prilosec back in 1996, then was switched to Nexium in 2001, both made by AstraZeneca.
Prilosec was originally sold in the U.S. by Astra-Merck, a partnership of Merck & Co. and Astra AB of Sweden. Astra eventually bought out Merck's share and merged with another company to form AstraZeneca.
Prilosec patent's expiration date was April 2001.
Nexium is one-half of the Prilosec molecule -- an isomer of it. Tweaking a tried-and-true medicine by cutting the molecule in half is a common strategy. Sometimes the drug that results has fewer side effects or is more effective. Often it works just the same. But even if that's the case, it will be chemically different enough to win its own patent, thus Nexium was born. AstraZeneca found that this half-of-Prilosec molecule seemed to get into the bloodstream more efficiently than the whole Prilosec.
Nexium Prescription versus OTC versus Generic.
Now this is important for all medications, you be the judge.
The FDA states that, Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name product. Generic drugs do not need to contain the same inactive ingredients as the brand name product. The generic drug manufacturer must prove its drug is the same as (bioequivalent) the brand name drug.
“Bioequivalent”, What does it take to conform to the FDA BIOEQUIVALENCE REQUIREMENTS?
The FDA allows a range of 80-125% of the brand name. Some generics can release too much of the active ingredient too fast.
FDA maintains a 90% confidence interval.
The bioequivalence test states that the FDA can conclude that two treatments are not different from one another if the 90% confidence interval of the ratio of a log-transformed exposure measure (AUC and/or Cmax) falls completely within the range 80-125%. The basis for the 80-125% range is arbitrary. The FDA “decided” that differences in systemic drug exposure up to 20% are not clinically significant.
It is important to note that they only conclude that the two treatments are “not different” from one another. They do not conclude that they are the “same”. However, if the 90% confidence interval falls outside the 80-125% range, one could conclude that the two treatments are different from one another.
For one, additional ingredients, known as excipients, can be different and are often of lower quality. Those differences can affect what’s called bioavailability — the amount of drug that could potentially be absorbed into the bloodstream.
Two, The FDA standards also do not specifically regulate how quickly the medicine reaches peak concentration in the blood. That can become a major issue for patients who take generic versions of time-release drugs (Nexium), which constitute 10% of the market, according to IMS Health.
In the case of some medications, small differences can have large effects. Just be careful.
Jay S. Cohen M.D. "I might add that many doctors and pharmacists are not aware of the many limitations of the FDA's testing of generic drugs. The FDA allows different drug formulations and different rates of release and absorption. The FDA accepts generic drugs that are 20% weaker or 25% stronger than the brand name medication. These problems explain why generics are ineffective for some patients, and why generics are too strong and cause drug side effects in others."
Maryjaye
29 May 2016
Thanks for sharing that. I have taken Nexium since about 2002 for GERD and Barrette's Esophogus. Unil 2014, it has kept the Barrette's from progressing. Due to insurance issues and AZ stopping their program, I have had to take other forms including the Nexium suspension, all of which contain ferris oxide. I am more symptomatic than ever. My new GI doc, the hospital department head, said the FO can cause problems for certain people. He scoped me, and I am currently waiting for the "staging" of the cells. then we can fight the insurance company. HYour information will be helpful.
martinrivera
31 Oct 2016
This is a professional medical response. Very well written!! Be aware that Doctors that treat critical illness that can lead to death rarely will allow a patient to take the same generic medication, AND the insurance company pays for the brand even if it is available generically. The insurance companies know that these type patients are higher risk and need to be controlled with their medications on a higher level of efficacy or else hospitalization occurs more frequently - a possibility they avoid at all cost. It is cheaper to pay more for brand than to cover any length of hospitalization.
MooseCaboose
5 Sep 2017
By the same logic of patients being at higher risk due to exacerbation of co-conditions, worsening of illnesses overall, increase in medical costs as well as increase in chance of serious conditions leading to death, insurance companies should also cover brand name for patients who are chronically ill. But they don't and even the necessity to fight for their needs increases the seriousness of their illnesses exponentially. Obviously insurance companies don't care and unless they have the brainstorm to notice how much money they are wasting because of their stupidity they will continue to act without a care at all for the patients.
Kayebth
15 April 2016
This happened to me when I was taking orher prescription meds like this and they made them over the counter, it didn't work!
I was on the AZ&Me program for NEXIUM for two years where they sent it to me free, I have to take the 40mg twice a day. They stopped the program this year & I have to pay for it myself still prescription cause the over the counter ones don't work for me at all! They are missing an ingredient that's in the prescription ones.
My insurance won't cover it, its way too expensive so my Dr. told my insurance co I have to have it, they pay for half of it now but it's still too expensive but I have no choice.
Good luck!
Minor
14 April 2016
I took 1 40mg 2x a day with some sevier stomach issue due to heavy nsaids used to treat a heart infection... Cleared up in 2 weeks. I had some gut issues recently due to same issue nsaids ate up my gut. Went bought 3pk otc nexium. Took 2 pills 2x a day for 5 days then 1 pill a day for 2 weeks and cured. Every month i will take 1 a day for 2 weeks to prevent it in future ... Cardio recommended dosage. Worked like a charm
judicap
1 March 2016
The same has happened to me. Ever since I started over the counter nexium things got worse! I still think that there is a difference. I'm going to try something else it's at the pharmacy so I don't have the name at the moment, but I will give it as soon as I can. I hope it works. Thank you!
bschill
27 Oct 2015
I have read many posts above; it seems many have poor results with OTC Nexium even when they double up on the half-strength pills. I used the Rx version beginning 3 or 4 years ago, thanks largely to the discount card which gave me a $20 monthly cost. This even dipped down a notch in late 2014, only to nearly disappear when I tried to refill in April 2015. I switched to OTC because the cost was so low; in fact I started taking just one 22.3 mg capsule a day (which made the monthly cost well under the $20), and things seemed to be going well. That is, until I landed in the hospital in early June with erosive esophagitis and blood in my stool. Docs had me take 4 OTC pills a day (2 caps twice daily) for several weeks, after which I had an endoscopy showing I had healed up nicely. Backed off to 2 a day which I am still on, and doing well as far as I can tell. I am booked for another endoscopy in early December.
I have to wonder why 40 mg is the standard dose for Rx Nexium, but half that for the OTC. And why is the OTC labeled as a drug for a 14 day course of treatment? As if that’s going to cure the problem forever? Nobody has ever cautioned me about using it as a maintenance drug at 40 mg/day.
But my main beef here is: how can Astra Zeneca justify the high sticker price for the Rx version when the OTC version is a fraction of the price on a per-milligram basis? Esomeprazole is just that, no different or better if it requires a prescription. The only way some of us can afford it is with the maker’s “voucher” or discount card, in combination with insurance, which in my case still leaves a pretty high out of pocket cost for me. The bottom line is that the maker is overcharging big-time, and the insurance companies are enabling this practice by paying so much in this case. And remember, when we pay our insurance premiums, we all pay for overcharging even if we are not affected directly.
Harrysadog
11 Sep 2015
I hope most read my earlier comment. Two 22.3, 24 hour slow release OTC NEXIUM will not even come close to the RX 40mg. The RX 40mg is immediate release. The OTC is a slow release of the drug meant to release a tiny bit over a 24 hour period. It's the same medication but you are only receiving around 1.6mg per hour so it's basically doing about the same as a Rolaid. Same drug, just not blocking the acid production the 40mg RX or immediate release is designed to do.
Ask your pharmacy for TEVA generic esomeprazole magnesium (Nexium). Call around to different pharmacies. Walmart may be less expensive than CVS. You have to ask for the generic in most cases. They want to sell brand name. Don't waste any more of your hard earned money on the 24 hour release. It CAN'T do what the RX 40mg does. Be well.
Shera1313
26 July 2015
Having same problem with otc nexium vs prescription. Has anyone had any luck with other otc medicines similar to prescription nexium that helps with GERD?
jls7968
18 July 2015
Same here I am up to 3 otc pills a day. And still have problems the 1 a day 40 has worked for 10 years now insurance decided no coverage because of over the counter is available.
dcwriter
18 July 2015
I'm sorry the OTC is not working for you either. Sometimes insurance companies are willing to pay if your doctor certifies that alternatives are not working well. Good luck. I hate being on this Rx at all because of the negative side effects, including loss of minerals/bone loss. But better than Barrett's progressing to cancer!
jls7968
3 Oct 2015
Finally got insurance to cover RX Nexium , been going thru other health issues but I changed my primary care Dr. And explained to him what was going on with Nexium and the OTC, explained OTC just will not work for me so he did a RX and of course insurance refused about a week later it was cleared by Insurance. Dr. certified I could not take anything else. Now back on Nexium 40mg daily I am so thankful.
bits660
27 June 2015
I too tried the OTC Nexium ..took double dose and it did not work like my 40ml rx script.
Back in the day i was charged big time without insurance.
So i went to a cndn source..they sent me nexium brand made in Singapore with turkish printing on box reads Neksium
Well 5 years later..no complaints... and the price was .65 cents a dose 40 ml $250 a year... Rx here is $115 for a 30 day supply
still on it ..
dcwriter
27 June 2015
Interesting! Glad you found one that worked. So many of our drugs are made offshore anyway, country of origin isn't that big a factor anymore.Price is sure right... I'm thinking of going back to the brand name despite the price, I'm tired of the nausea and diarrhea the OTC is causing. Didn't have it when on the brand name. I get so frustrated when supposedly well educated pharmacists insist "there is NO difference!"
dcwriter
30 June 2015
Re my original post, I just went back to Rx name brand Nexium yesterday, and I was nicely surprised that on my insurance 30 count of 40 mg is "only" $40. It used to be $85 until they lost their patent protection. That beats the equivalent of the OTC Nexium. I did not get the nausea with the Rx and heartburn has disappeared. Glad I went back on the Rx.
yoder178
6 July 2015
Let me just remind you all b/c I know your Dr's have told you all... this medication to work needs to be taken well before a meal (1 hr to 30 before eating) or 2 hr after eating. This when done correctly WILL work much much better, really! My mother is on this OTC now and has had no problem. She takes it one hour before eating her breakfast every day. Try this and see if it works. Hope this helps.
pghshops
16 June 2015
Well, just to add to the "we're not crazy"... I have been trying to stop take Nexium 40MG for years. Every few years, I try a different PPI or generic, and always end up relapsing and having to return. I recently read all the posts about how Prilosec is basically just half-strength Nexium. So, I tried taking 80MG of that - unfortunately, after only about 5 weeks later, I was back to Nexium. When they released the OTC 20MG version (from a different manufacturer yup but supposedly required to have the same active ingredients)... I immediately bought the big 42 quantity packs when they were on sale and started doubling up with (2) 20MG OTC Nexium every day. For the first 2-3 months, it worked the best of all the things I have tried to switch to and I didn't really notice any significant difference in feeling acidy.
I did however, enjoy the extra cash in my wallet, since like many of you, my insurance company refuses to cover Nexium and considers it exactly the same as all other PPI drugs and generics. Unfortunately, I started noticing I had sore throats frequently, losing my voice, or a little "lump" feeling in my throat. Sometimes even a weezy, asthma feeling after eating. Since this all happened over the winter/ early spring and had never been my symptoms of reflux in the past, I just naively assumed it was a cold or seasonal allergies. Well, once my hoarseness and clearing my throat wouldn't go away, I started looking up these symptoms and yep, back to the GERD. SO... unfortunately, I just requested again the Nexium 40MG very reluctantly. I don't like lining the pocket of pharmaceutical companies but for whatever reason, the odd chemistry in my body only seems to work with the exact formulation of the current prescription version. Luckily, it appears that they now have a Nexium "savings card" where I get my 90 day supply for $30 (or $0.33 per dose) which is much cheaper than my bargain-hunting-coupon-clipping $18 for the 42-count 20MG (costing me about $0.86 per dose to double up).
dcwriter
27 June 2015
I'm glad you found the manufacturer's savings card and you're feeling better. I used the card previously and it saves a bundle. Unfortunately, thanks to our federal government, I am now excluded from using any Rx savings cards because I'm on Medicare. I would still have to pay $85 a month for the brand name Nexium, which I've decided to do despite the cost.
Rainkitties
30 June 2015
Where is this savings card? Is it the one you can print off from the manufacturer?
Kayebth
5 April 2017
I've been on one or another for over 30yrs, starting with Tagament until it stopped working & going to the next one till it stopped working & so on & so on till I ended up on Nexium which works beautifully, howver I've had the sarme experience as all of you when it first went on the market & I thought Wow... I can save money! Yeah right... it IMMEDIATLY from the first try brought back the hellish symptoms! My doctor said its the same, the pharmacist said its the same... IT'S NOT THE SAME FOLKS! I had to get my Dr. to tell the insurance co, in writing that I've literally tried EVERY single thing on the market to o avail & I simply have to have the full prescription of 40mg twice a day.
They approved it & I have to have it re-approved every year YIPPEE right? Well, yes I'm rejoicing over not being in that unbearable pain & it took a few months to get back to normal but I'm NOT rejoicing over having a $278.00 mind numbing co-pay! Its eniugh to give me permanent serous even on the Nexium.
And btw everyone... the over the counter IS NOT THE SAME AT ALL! ITS NOT IN OUR HEADS, WE ARE NOT CRAZY OR STUPID OR NUISANCES! I read in an article (sorry, don't remember which one I'm getting old) that there is an important ingredient missing entirely but again I can't tell ya what it is as I forgot (I'm gettin old)
Good luck to everyone.
DRMA03
3 June 2015
I had the same response when I converted to over the counter Nexium. Something has to be different but I haven't found anyone with answers. I expected it to be the same or better but there was less control of the heartburn, more reflux at night.
Maryjaye
3 June 2015
Please see my comments above and contact the manufacturer
dcwriter
2 June 2015
I have been on Rx Nexium for decades because of Barretts and reflux, 40 mg daily and was doing very well until I changed to OTC, 2x20 mg. My reflux isn't horrible, but it's definitely increased. My biggest problem is I'm getting nausea and bouts of pretty severe diarrhea. It took me a while to connect the two, but after reading all your helpful comments, I do believe it's the OTC Nexium. I know these can be side effects and had very mild symptoms on the Rx. I just don't trust generic meds, I tried the generic Celebrex and was that ever a disaster. And who knows really what goes into the drugs anymore, especially those manufactured offshore.
Check out People's Pharmacy for more discussion. I find them very helpful.
Harrysadog
11 Sep 2015
Just pulled up the Nexium web site. There IS a difference in the two Nexiums and we all missed it. The OTC are 24 hour extended release, an RX 40mg is a one time BAM like taking an aspirin. I read everything, even mathematically trying to figure how to make them work. Then I saw it. It plainly states, one is 24 hour release, the RX is immediate. That's why. We are all getting tiny little doses instead of the 40mg needed to do their thing. I so hope this helps everyone. Buying the OTC is for light indigestion!!! Gotta get the RX. There is a generic now made by TEVA. You have to ask for it but most carry it. It's cheaper by about 30%. Best to you all. So glad I found this.
madamenordica
23 Feb 2016
That is SO UNTRUE - BOTH the otc AND scrip Nexium are timed released. Read your scrip lit sometime instead of throwing it out. I'm not sure what the deal is with the otc version, but it certainly doesn't cut the mustard. I tried so many different drugs before finally finding nexium, it breaks my heart to realize I can't continue because I have no $ for it. I only hope I can find something that will address my upper respiratory symptoms as well as Nexium did.
Jayspot
28 June 2017
Your history sounds just like my husbands. He had been on Nexium for about 12 years with amazing healing of his Barrett's. Now our insurance company no longer has it on formulary. We are fearful of using generic knowing they can be 20/30% less effective than the brand name & still get FDA approval. We were told originally if he didn't take the Nexium 40 bid, he would develop esophageal cancer & could die within 6 mos. Prsise God we could get it at an affordable copay at that time. Now they want to take it away. The most expensive medication is the one that doesn't work! Not only would esophageal cancer treatment be monetaryily expensive, it is unnecessary with proper treatment & the joy of preventing cancer cannot be figured in dollars. What is one to do when the treatment cost is so exhorbitant?
ally2015
16 May 2015
I take the "newly released" generic by Teva USA. 40mg same as my nexium I was taking... and I have had breakthrough acid reflux everyday regardless of what I do. I can drink water and it just hangs out and of I lean over I can feel it move up my throat. This stuff SUCKS!!! However I am not willing to pay the outrageous copay to get brand. So I am going to talk to my doctor about switching to a different med. I can't keep taking 40 mg of crap nexium and then later taking 150mg of zantac because I keep having breakthrough. Anyone know a good generic like protonix or dexilant?
ally2015
16 May 2015
Oh and let me add I am starting month 2 of this crap and feel no better. It is actually worse than when it was with my nexium!
Related topics
Further information
- Nexium uses and safety info
- Nexium prescribing info & package insert (for Health Professionals)
- Side effects of Nexium (detailed)
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