Esomeprazole vs Omeprazole - which drug is better?
Drug reviews

Esomeprazole vs Omeprazole – Which one is BETTER?

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Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs. In fact, when looking at the top 15 most prescribed drugs in the UK, two PPIs made it to the top: omeprazole and lansoprazole. Although not as commonly prescribed as omeprazole, esomeprazole gained its popularity due to wide availability as over the counter medicine. Esomeprazole vs omeprazole is a review of both drugs. I will discuss various aspects concerning both medicines, such as legal classification, over the counter and prescription-only availability of both medicines and most importantly, their effectiveness. 

In summary, the following will be discussed: 

  • What are PPIs? 
  • Esomeprazole vs Omeprazole legal classification 
  • What is the difference between esomeprazole and omeprazole?
  • Esomeprazole vs omeprazole: effectiveness. Is one drug better than the other? 
  • Esomeprazole vs Omeprazole – side effects
  • Over the counter availability of esomeprazole and omeprazole
  • Prescription-only options for esomeprazole and omeprazole
  • What esomeprazole or omeprazole products can you buy? 
  • Conclusion.
  • Related posts that may interest you. 

What are Proton Pump Inhibitors? 

Proton pump inhibitors (PPIs) are class of drugs which is used in the treatment and controlling of symptoms of different conditions of gastro-intestinal nature, for example, treatment of ulcers, eradication of Helicobacter pylori (H. pylori), management of ‘reflux‘ symptoms. 

When prescribed, PPIs, including esomeprazole and omeprazole, have a wider licensed used. Over the counter esomeprazole (Nexium Control) and omeprazole (Pyrocalm Control) are used only as a short-term treatment of acid reflux symptoms (heartburn). 

Between different drugs used in the management of acid-related symptoms, PPIs are the most effective in suppressing stomach acid production

Esomeprazole vs Omeprazole legal classification 

Legally, esomeprazole and omeprazole  are classified as either: 

  • General sale medicines (GSL): available on sale in retail outlets and pharmacies, without a prescription. All GSL esomeprazole and omeprazole products can be used by adults over 18 years of age. 
  • Prescription-only medicines (POM): used in the treatment of various conditions. Both drugs are available in different forms and strengths. 

GSL availability of esomeprazole vs omeprazole

Brand name

Active ingredientForm

Buy Online

Esomeprazole products

Nexium Control

Esomeprazole 20mg

tablets & capsules

Amazon.co.uk 

Guardium Acid Reflux Control

Esomeprazole 20mg

tablets

Amazon.co.uk 

Boots Heartburn and Acid Reflux Control

Esomeprazole 20mg

capsules

Boots website

Generic Galpharm

Esomeprazole 20mg

capsules

In stores e.g. Tesco

Omeprazole products

Boots Acid Reflux Gastro-Resistant Tablets

Omeprazole 10mg and 20mg

tablets

Boots website

Pyrocalm Control

Omeprazole 20mgtablets

Various websites

As GSL product, esomeprazole has a wider presence online and in stores than omeprazole, which is only available as one branded GSL product.

Sale
Esomeprazole (Nexium Control)
3,070 Reviews
Nexium Control (14 Count) Heartburn and Acid Reflux Relief Tablets, 20mg Gastro-Resistant Esomeprazole Tablets
  • Take control of your heartburn with Nexium Control, For 24 hour protection from heartburn and acid reflux
  • Clinically proven to relieve night-time heartburn for a good night’s sleep, Just 1 pill a day for 24-hour protection and zero heartburn
  • How to use: The tablets should be swallowed whole, Do not crush or chew the tablets, Read the package leaflet before use

Prescription-only options for esomeprazole and omeprazole 

When it comes to prescribing, omeprazole is much more commonly prescribed than esomeprazole, mostly due to lower cost of omeprazole. Omeprazole is one of the most common prescription drugs in the UK

Prescription-only omeprazole comes in the following forms: 

  • Omeprazole 10mg , 20mg, 40mg. Available in the form of capsules and tablets as the generic and branded drug.
  • Omeprazole 10mg, 20mg and 40mg available in the form of dispersible, gastro-resistant tablets (Losec MUPS). 
  • Omeprazole liquid 
  • Omeprazole powder for oral suspension 

Prescription-only esomeprazole is available as: 

  • Esomeprazole 20mg, 40mg. Available as tablets and capsules including branded Nexium and other generic forms of esomeprazole. 
  • Nexium 10 mg (esomeprazole 10mg) granules for oral suspension (for mixing with water)

Note: Nexium Control, which is available over the counter contains 20mg of esomeprazole, which is equivalent to prescription-only esomeprazole 20mg. 

What is the difference between esomeprazole and omeprazole?

We already established that both drugs belong to the same class of drugs. Both drugs are used in the treatment of the same conditions. The name ‘esomeprazole’ suggests there are some similarities in term of chemistry between both drugs. Quite rightly, this is the case. 

Both drugs have the same chemical formula; however, their arrangement in ‘space’ is different. Bith drugs are called isomers

Confused? 

In other words, if your left hand represents omeprazole than the right hand would be esomeprazole. Both hands look the same, but they are mirror images of themselves.

Esomeprazole vs Omeprazole - what is the difference? Visual representation of isomers.
Esomeprazole vs Omeprazole – visual representation of isomers.

In pharmaceuticals, it is possible to bring isomers to the market as sperate drugs and market them accordingly. This is what happened to esomeprazole.         

Esomeprazole vs omeprazole: effectiveness. Is one drug better than the other? 

Proton pump inhibitors a group are considered as safe and effective drugs which are used in the management of different acid-related conditions. Their effectiveness relates to the mechanism of action, which targets the last stage of stomach acid production – excretion of acid into the stomach by proton pump. 

Other drugs used for the management of acid-related conditions stop stomach production by targeting one out of three ways by with stomach acid is produced, hence less effective, for example, a class of drugs called H2 receptor antagonists, such as ranitidine. Gaviscon and alternative products neutralise stomach acid. 

Esomeprazole vs omeprazole – is esomeprazole better than omeprazole? 

One study looked at all clinical trials and aided to see if esomeprazole is better than omeprazole in gastroesophageal reflux disease and Helicobacter pylori infection. Esomeprazole was more effective in the treatment of esophagitis (inflammation of tube, which connects the throat to the stomach). However, the comparison was made between esomeprazole 40mg and omeprazole 20mg (week 8 of the treatment). At week 4 of the study, both drugs were equally effective.  No difference in the effectiveness between drugs was observed in the treatment of H. Pylori eradication. Fifteen studies were included in this analysis. (Teng et al., 2015). 

A smaller study (with a lower number of participants) one the other hand showed ‘improved’ control of stomach acid when esomeprazole was used, as compared to omeprazole. It was suggested that optimal therapy is esomeprazole 40mg taken in the morning, which offers the most effective treatment of acid reflux disease (Dent, 2003).

More studies exist, which favour esomeprazole as more effective PPI in controlling acid production when compared to omeprazole (Scott et al., 2002). It is also suggested than esomeprazole has improved ‘chemical’ properties, which allows controlling acid production for longer than other proton pump inhibitors (Johnson & Hedge, 2002). 

Esomeprazole was found to be effective in patients who failed to respond to other PPIs (8 weeks treatment) and were still experiencing continuing gastro-intestinal reflux symptoms. A group of 99 patients were given esomeprazole 40mg daily, following lack of response to other PPIs, with 78% of patients responding to the treatment from just over four days of the start of the treatment. It was concluded that esomeprazole (40mg) significantly improved gastro-oesophageal reflux disease (GORD) symptoms (Jones & Patrikios, 2008). 

Furthermore, esomeprazole was more effective than omeprazole when used in the treatment of H. pylori infection in patients with duodenal ulcers. A large study (over 5000 patients) esomeprazole (40mg) was also more effective in healing rates than lansoprazole (Scott et al., 2002). 

Esomeprazole vs Omeprazole – side effects

As a whole group, PPIs have a number of common side effects associated with their use. Esomeprazole and omeprazole share similar common side effects: 

  • Constipation, diarrhoea, flatulence 
  • Abdominal pain
  • Headache 
  • fundic gland polyps (benign) – stomach polyps

For a list of all (less common side effects), please read the product information leaflet. 

Conclusion

Esomeprazole and omeprazole belong to the same class of drugs. Although very similar in many aspects, esomeprazole may be a more effective treatment option in the management of gastro-intestinal reflux related conditions as confirmed by a number of studies.

Although esomeprazole is more expensive (to the NHS) as compared to omeprazole, the use of esomeprazole should be promoted in patients who failed to respond to other PPIs. 

Patients need to remember that self-treatment with over the counter esomeprazole or omeprazole is limited usually to two weeks. Patients who have not achieved symptom relief during that time or who need ongoing treatment of over two weeks need to speak to their GP. 

Related posts that may interest you. 

References: 

Dent (2003). Review article: pharmacology of esomeprazole and comparisons with omeprazole. Available at: https://doi.org/10.1046/j.1365-2036.17.s1.2.x Accessed on 16/11/2020

Johnson TJ, Hedge DD. Esomeprazole: a clinical review. Am J Health Syst Pharm. 2002 Jul 15;59(14):1333-9. doi: 10.1093/ajhp/59.14.1333. PMID: 12132559. Available at https://doi.org/10.1093/ajhp/59.14.1333 Accessed on 16/11/2020

Jones R, Patrikios T. The effectiveness of esomeprazole 40 mg in patients with persistent symptoms of gastro-oesophageal reflux disease following treatment with a full dose proton pump inhibitor. Int J Clin Pract. 2008 Dec;62(12):1844-50. doi: 10.1111/j.1742-1241.2008.01923.x. Erratum in: Int J Clin Pract. 2009 Jun;63(6):977. PMID: 19166433; PMCID: PMC2680259. Available at: https://doi.org/10.1111/j.1742-1241.2008.01923.x Accessed on 17/11/2020

Scott LJ, Dunn CJ, Mallarkey G, Sharpe M. Esomeprazole: a review of its use in the management of acid-related disorders in the US. Drugs. 2002;62(7):1091-118. doi: 10.2165/00003495-200262070-00006. Erratum in: Drugs 2002;62(15):2183. PMID: 11985491. Available at: https://doi.org/10.2165/00003495-200262070-00006 Accessed on 16/11/2020

Teng M, Khoo AL, Zhao YJ, Lin L, Lim BP, Wu TS, Dan YY. Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection. J Clin Pharm Ther. 2015 Aug;40(4):368-75. doi: 10.1111/jcpt.12277. Epub 2015 Apr 20. PMID: 25893507. Available at: https://doi.org/10.1111/jcpt.12277 Accessed on 16/11/2020

                    

   

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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