Overprescribed and overpriced: Just say ‘no’ to Nexium

How much money do you really need to spend to treat frequent heartburn or even acid reflux? $250 a month? $120 a month? Try as little as $24.

Last year U.S. consumers and their insurance companies spent an astonishing $4.8 billion on Nexium, one of several prescription proton-pump inhibitors (PPIs) to treat heartburn and acid reflux. It’s no wonder the “purple pill” was the second-highest-selling branded drug in 2008, behind Lipitor.

The problem, though, is that Nexium is no better at treating heartburn or gastroesophageal reflux disease (GERD) than cheaper generics or similar drugs available without a prescription, according to a new Consumer Reports Best Buy Drugs report. 

More than 15 million Americans suffer from heartburn every day. If you have occasional heartburn and have not been diagnosed with GERD, your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or their generic equivalent or drugs like Pepcid AC or Zantac 150 or their generic equivalent (known as H2 blockers).  

But if you suffer from heartburn twice a week or more for weeks or months on end, you may have GERD, often known as acid reflux. GERD is serious and can inflame or erode the lining of the esophagus. Doctors often treat GERD with a PPI drug, which is effective and generally safe, but the pricetag could drain your budget. 

If you take a PPI drug, talk to your doctor about one of several alternatives to Nexium, such as our Best Buy, Prilosec OTC, or its generic, omeprazole OTC. Switching could save you about $200 a month. Also, the prescription PPI Prevacid will be available in mid-November without a prescription. We expect that the new over-the-counter Prevacid 24HR will be comparable in price to Prilosec OTC.

Make sure you’re familiar with some simple lifestyle changes you can make to help alleviate heartburn symptoms.

Bottom line: Nexium is an expensive drug, and it’s no more effective or safer than other PPI drugs for treating GERD or frequent or severe heartburn. If you find that you need treatment, first ask your doctor for a generic or an over-the-counter drug. Prilosec OTC and its generic, omeprazole, are our Best Buy picks because they are as generally safe and effective as Nexium and considerably less expensive.

Read our latest Consumer Reports Best Buy Drugs report to learn more about treating heartburn and GERD. And find out more about our Best Buy Drugs program, which evaluates more than 200 drugs for dozens of common conditions.

-- Lisa Gill, editor, prescription drugs

Comments

[alan Leveton]

Nexxium is fine if you have really good insurance as the first poster mentions....but if you don't, the other meds CR mentions in their article are essentially the same family of drug, only not as strong. Ask your dr how many Prilosec you can take to equal a Nexium..there is a way to do this "officially" w/ a dr's ok.

BAD GERD as talked about in the article can lead to Barrett's esophagitis, a pre-cancerous condition in the throat/ esophagus, more common in smokers. The drugs in the PPI family can really help as well as w/ other life style changes...if apple juice and honey are "curing" your GERD its pretty mild, imo.

The entire "if you have good insurance its the best" argument assumes most people HAVE good insurance that covers drugs...no longer true.

[sr]

Dont listen to a word being written above, I too have tried everything under the sun, even rolaids, tums, etc gave me heartburn. I take nexium everyday and have not had a problem for 5 yrs. I have GREAT insurance so it only costs me $5/month, much cheaper than any over the counter medicines

[Rizzo]

This is a misleading article, I'm afraid. I have GERD and I have tried every PPI available, both prescription and OTC, and the only thing that works for me is Nexium. While it's true that other remedies may be effective for some people who try them, it's irresponsible of Consumer Reports to suggest that Nexium is the same as all the others -- it isn't. Yes, it's expensive but if nothing else works it's the only game in town!

[Chuck]

I suggest that you be careful about making blanket statements. I tried the other medications that you referred to and only changed to Nexium when they failed to stop my GERD symptoms. Nexium should probably be the last medication to try, but don't make the mistake of saying that is the same as the others.

[Donna Hoffman]

I was prescribed Nexium when a gastro doc saw how my esophagus was so swollen shut that I could not swallow but a tablespoon of soup at a time. Nexium does more than reduce stomach acid, it also heals. Of course, I have to watch my diet: no citric acid in fruit, drinks, food etc.: no caffeine; no chocolate. I've tried half a dozen other types of meds and they work periodically but not like Nexium. I feel normal when I take Nexium.

[JB]

After several weeks of suffering and waking up with acid burning in my throat/chest and pain throughout the day - I became resigned to the fact I was going to have to take medication for it. I wanted to give a natural remedy one final try and tried Mott's Natural Hand Pressed Apple Juice (no sugar or Vitamin C added) and within a few minutes of drinking the apple juice the burning and pain dissipated and went away shortly thereafter. I use preemptive measures sometimes with meals by drinking it prior to eating.

I realize this might not work for everyone, but for my acid reflux it has worked very well and has kept me from having to take medication on a daily basis.

[Shawn]

I really disagree with this article. I panic if I forget to refill my Nexium on time. I started out with a few generics and not only did they not relieve my Gerd, they caused stomach cramps and diarhea.
The few times I have had to go without my Nexium for 1 to 2 days, I was miserable. NONE of the over the counter medications that you stated in your article gave any kind of relief.
I did say no to overpriced Nexeum, by making a personal phone call to my mail order pharmacy, who found a way to make my 90 day twice a day perscription only cost $100.00. I suggest that individual with health insurance check to see if they have mail-order pharmacy and check the cost.(It was costing me $300.00 for 60 day supply and that was my co-payment!)

[Jake]

I suffer from chronic GERD. Took Nexium with excellent results for two years then switched to generic omeprazole - also with good results for about a year. Until . . . I had a very painful few weeks of acid reflux. Doubled omeprazole: not much relief. Tried Prevacid: a little better. Went back to Nexium: almost back to no symptoms.

Anecdotal evidence from friends and siblings who suffer indicates we are all different in our response to these drugs and we change over time based on aging, stress, diet, travel, etc. Getting the diet and pharmaceuticals right is a lot of trial and error.

It is a very frustrating disease. All these drugs treat the symptoms, not the cause. GERD suffers don't secrete too much acid, our LES (lower esophageal sphincter) either opens too often and/or is too weak allowing acid to reflux up the esophagus.

I read that a physician trained his LES to close tightly and eliminated his GERD. Maybe that's the solution.

[jaie]

I battled periodic hearburn for about 10 years. I would get it bad for a couple of days, and with taking tums and watching what I ate it would go away. About three years ago my doctor gave me some nexium samples and I loved them. The best thing about it is that I only take a pill when I have heartburn, which is about on average every six weeks. I will get heartburn, take a pill with water, and can dump hot sauce on my food and I'm golden. The initial cost of nexium is high, but for me I save because I used to go through about 2 bottles of antacids a month.

[Bob Smith]

I have been taking priosec for seven years and recently was reading a story in CU on Health about men with ED and it mentioned it could be caused by heartburn meds. I stopped taking prosec and my erections are improving. I was wondering was priosec on of the meds that can cause ED in men?
Thanks
Bob

[David]

I've used generic omeprazole for some time with good results. I buy the Costco brand for ~$18 for a 42 day supply. My biggest complaint is the almost impossible to open blister packs that all of this medicine seems to use for packaging. I end up with a pile of non-recyclable packaging and sore hands from opening it. Is this some sort of crazy government requirement?

[Doug]

I have a genetic problem that results in acid overproduction and a poor working valve that lets acid and food come up. I cannot funtion without prescription Losec for more than a week without doubling over in pain.
I have tried Nexium and every other cheap to expensive treatment. Even though many of these medicines are supposedly working the same or have same ingredients, they do not work the same. They range from ineffective to nasty side effects. Nexium led to powerful stomache cramps after a month. It did give better round the clock acid control though.
Losec is my miracle drug, no side effects and very good acid control, no more ulcerations. Cost has never been an issue as our insurance plans cover 100%.
Not everyone responds the same to treatments.
Remember to take a B12 suplement when on these drugs, so your energy stays up. If you feel fatigue or low on energy see your pharmacist about B12 loss on this.
For the record I am an athletic, healthy person with no habits or typical triggers for any acid problems, just the way it is.

[Billy]

My GERD began with burning chest pain, for which my doctor nose dived away from me as if I were contagious, dumping me off on a cardiologist, who, among other things/tests, put me on Nexium, which did absolutely nothing. After all that was over and the cardiologist found nothing wrong and told me to go away, I started taking generic Pepcid, which amazingly made the burning pain go away almost immediately. It worked pretty well, for a while, but generic Prilosec works even better. One every other day, and while it ain't cheap even in generic form, it's worth every penny.

[Ann Harper]

I agree that Nexium is expensive, but I disagree with this report as to its effectiveness. I used to take prescription Prilosec (my dose was doubled after the smaller dose wasn't working well), but was having lots of trouble with my throat & voice. I thought it was caused by draining sinuses or something related to my respiratory system. The real culprit, however, was my GERD. The Prilosec was not taking care of the systems, so my doctor switched my prescription to Nexium. It really did a better job for me. Perhaps my case is rare, but it's true. I am fortunate that I have good health insurance and my prescriptions are fully covered after I've spent my substantial co-pay, but it's worth it.

[John]

Nexium helped me but was so expensive that I switched to omeprazole and it worked just as well. I saw no difference at all. It is my understanding that they are almost identical.

[Herb]

I have tried prilosec otc, the generic version, prevacid,aciphex, and all the otc stuff, I've changed my lifestyle, raised the head of my bed. Nexium works for me..I would be careful dealing with absolutes on what will work for somebody or not...It is not always that simple.

[Gerald]

I have a great deal of respect for your comments on Nexium. I have been diagnosed with GERD and was on Nexium. I have tried Prilosec OTC and Prevacid and there is no comparison for the relief. I have a friend that has had a similar experience in treatment. I can't explain why, but am willing to pay the difference for the relief. My family physician is more than willing to prescribe a cheaper alternative but at least in my case they do not perform as well.