Last June we wrote about how Americans taking Nexium – AstraZeneca’s multibillion dollar proton pump inhibitor that treats gastro esophageal reflux disease (GERD) – were losing out on savings due to the FDA’s postponement of a generic version in the U.S. market. Well, it looks like they’re going to wait even longer to find generic copies of the Purple Pill at local pharmacies (and the generic versions probably won’t be purple!). Initially, Indian pharmaceutical company Ranbaxy held exclusive marketing approval to sell generic Nexium in the U.S., but they were banned from actually selling it due to poor manufacturing practices. Well, last week the FDA revoked both Ranbaxy’s approval and its marketing exclusivity for generic Nexium. That might be good for the Purple Pill’s profits (say it fast) – but it leaves consumers singing the blues.
Cash paying Americans are left with the following domestic options: Prescription-strength (40 mg), Nexium or Nexium OTC (20 mg). Prescription-strength Nexium will run you about $600 for 60 pills. That’s a ridiculous price. It’s only $70 to get 126 capsules of Nexium OTC! So, can you just buy Nexium OTC instead of prescription-strength Nexium and just take two pills?
You might be able to, but you need to ask your doctor, pharmacist, or other healthcare provider. I asked my local pharmacist if I could just take OTC Nexium instead, and without hesitation she said I could, but that it may not be as effective and that it comes as a tablet rather than a capsule. The OTC version also has different inactive ingredients, I was told, so if you are allergic to any of those, you should stick with the 40 mg version. She suggested OTC Nexium if I couldn’t make a trip to my doctor or if my insurance didn’t cover prescription Nexium. Even if Nexium is covered, it might be a tier 2 or 3 drug, which could result in your co-pay being higher than the OTC cost.
We’d feel remiss in not reminding you that there are a plethora of proton pump inhibitors on the U.S. market, many that come at a much lower price tag.
But if you need to stick with prescription-strength 40 mg Nexium, it is available from international online pharmacies: 60 pills would be about $50, so it’s actually a better deal than Nexium OTC in the U.S. It’s worth noting that just like the OTC 20 mg pill, the 40 mg purple pill is sold as a tablet, not a capsule, in many foreign markets. You can view our comparisons of Nexium prices.
Hopefully we see these delays sorted out, and a generic version of 40 mg Nexium finally come to market in America. Until then, Nexium OTC at your local drugstore or ordering from an international online pharmacy may be your best options to avoid the drug price blues.
It is hard to believe that a pharmacist said that the OTC 20MG Nexium is a tablet. I hAVE PURCHASED IT SEVERAL TIMES in CVS AND I CAN ASSURE YOU IT IS A SMALL PURPLE PILL WITH SOME YELLOW TRIM. I thought this was supposed to be a reliable source. I guess not.
TO: John Molinari –
Is the CVS version a capsule or not? When you say it’s a “pill,” it sounds like it could be a tablet. By definition, tablets can be cut into two, whereas capsules cannot. A capsule consists of powder or jelly enclosed in a dissolvable gelatin container. A tablet is a compressed powder in solid form, occasionally presented in the SHAPE of a capsule, but not to be confused with an actual capsule.
i have been buying nexium otc for a couple years and its always been capsule form..i just bought it today and its in tablet form and it actually works better! i looked up to see if they changed it for some reason and i cant find anything on it..i have terrible gerd to the point that my esophagus gets inflamed and it gets hard to breath..i’m really happy with these!
Hi Missy – That’s great news. From comments here and elsewhere, I’ve read the opposite as well: that the tablet does not work as well as the capsule. I’m not surprised that there is a variety in that some people prefer one or the other.
I recently bought the tablets and took my first one last night. I was up all night with indigestion. That never happened with capsules.
I can’t afford the 40mg nexium, can I take over the counter nexium, 20mg
Hi Pauline — If you have been taking prescribed Nexium, you would have to ask your health care provider as to the best route of drug therapy. If you have not been taking Nexium, you can start taking it OTC at the suggested dose.
Mine are tablets there are two types
No way, I was taking it long b/f
The OTC Nexium that I purchased is definitely in CAPSULE form. But taking two of them (20 mg each) does NOT equal one 40 mg prescription capsule. My insurance company quit covering the prescription medication due to the availability of the OTC drug; however, I am once again experiencing acid reflux and problems with my voice that I had not experienced since going on prescription Nexium several years ago. SO disgusted with insurance companies that think they know what’s best for your health.
yup the otc version x 2 dose not work very well,i have been taking the pres. 40 mg for years and was doing fine.the otc x 2 has my acid and girds flaring up.they look the same.it should be against the law as they are not even made by the same co.have saved a bunch of money buying the canadian ones and they work fine even though the are made abroad.
Comment to Jean from last year
Exactly . I agree taking 2 otc did not equal the original purple pill. Me too
Sickish.. Now 2016 took new generic capsule Mylan Labs made in India .. Having horrible taste as this thing is apparently breaking down.. And didn’t feel gi tract working right after being on for couple weeks. I have hiatal hernia with moderate reflux.. And this condition is not going anywhere.. Temporarily am back on 300mg Zantac
Til I can figure out this nexium thing.. I want my brand name nexium 40 mg bid for $35 a month not 200
They are greedy .. Generics with inactive ingredients are sickening . These Mylan capsules are huge and horrible.. Ugh.. My orig nexium was so good…
I understand your stress. My insurance company stopped cover my Nexium as well. I am pissed. The 40 mg works just fine on me. I am going to try something from Canada that is generic but 40 mg and in a table form. If it does not work they will work with me.
What is your Canadian source…..what’s the cost for a 30-day or 90-day supply of the 40 mg? How much is shipping?
I had used Pantoprzole (generic) and it did me no good. Years before I had Nexium and it completely shut down my reflux. The last year I was able to get back to Nexium and again, it was working fine. Now the generic is Esomeprazole. I have no idea whether it will do any better than the Pantaprazole. Before this last regimen of Nexium, I would wake up in the middle of the night choking from time to time, and sometimes it took me as long as 45 minutes to breathe normally again. Those were rare, but frightening. I don’t want to return to those days ever again.
I can assure you that the OTC version of Nexium is not the same as the prescription which I have been on for 10 years. In cact if you go to purplepill.com and read the small print carefully they will tell you that, and that the indications are different. And the OTC version is only approved for a 14 day dose for heartburn, not acid reflux. Had to switch to the OTC version and it does not work at all. My throat is on fire because it does not control acid reflux like the prescription. I think Pfizer has intentionally mislead people and professionals on this. And some insurance companies will no longer pay for Nexium telling patients to buy it OTC. Shame on the FDA for allowing this deception.
You guy’s must be comfused. I switched to Nexium OTC as soon as it came out because my Medco co pays were higher then buying it from WalMart, Kroger, Walgreens, etc. It is made by Pfizer and comes in 20 mg capsules not tablets. You have to take two for it to work like the RX brand made by Astra Zenaca; if you have a GERD problem. I’ve taken Nexium since the day it came out and switched, about a year ago, and no issues with my GERD since day one. The key component that was in Nexium RX brand in in OTC. Hope this helps because GERD isn’t any fun.
READ the fine print. Nexium 24hr is NOT made by Pfizer but rather marketed by them. It is STILL made by AZ and licensed to Pfizer to market and sell it. Active ingredients are the same but vary in the non active ones. I will stick to my GENERIC OMEPRAZOLE 40mg. Works fine for me and keeps my severe GERD to a minimum.
I have asked two doctors, and 3 pharmacists, “What is the difference between 2x20mg OTC, and 1 x 40mg prescription. The clear consensus is “NONE”. However, the earlier comments based on (admittedly subjective) experience, worry me. I’ve been on 40mg prescription for years. With long persistent periods of self-testing I find that I have less tolerance to the tablets, than the capsules. Kind, fellow sufferers, can you point me at any written evidence. Not questioning anyone’s veracity, or sincerity one jot – just want to diligently follow your research trails.
I have been on the real Nexium, one 40mg. capsule once a day, for at least 15 years. It’s worked perfectly. I have horrendous GERD since about 10 yrs. old due to taking a medication that trashed my stomach..”Potassium Iodide”, an expectorant for bad asthmatics I was given as a toddler that tasted like I would imagine battery acid would taste like. I’m now in my late 40’s. Around early Summer I went to pick up my scripts and..no Nexium. I called thinking they made a mistake but they explained to me the generic came out and it’s called “Esomeprazole” and it’s the same thing. Cool, I didn’t think anything of it and tried it. It didn’t work even after taking it a Month. It was like throwing a handful of ice cubes at a burning building. I tried the OTC Nexium. I gave it a Month with the same result. I doubled the dose. Nothing. Mind you, I did all this without researching *any* info and people having the same problems with it, etc. so I was completely unbiased. Until now. The “generic” and the “real” Nexium are made in two different labs, two different companies. At least up here in New England. So no, they are NOT the same (again this is the 40mg. capsules). The active ingredient is, but the buffers and whatnot are different. Who knew but I guess this somehow matters. I’ve been begging my Primary Care Doc. and CVS to switch me back to Nexium. It’s now mid-Nov. and I finally have a letter saying i’m approved for Nexium (the real thing I guess) by my insurance co. BTW, in Canada the real Nexium (with a script) is far, far cheaper than in the U.S. I’m armed with a letter from my insurance Co. with “prior authorization #’s” and phone numbers to call if there’s a problem so i’m heading to CVS to fill it (as i’m now due for a refill) and i’m going inside with the letter (as opposed to the drive-thru) so i’ll keep everyone posted. Wish me luck
So how do you go about getting the real Nexium from canada?
You can find Canadian-based online pharmacies that sell Nexium here: http://www.pharmacychecker.com/brand/price-comparison/nexium/40+mg/. If you want it from a Canadian pharmacy, make sure to specify your request.
My insurance actually took it own themselves to send me the generic form of Nexium. I had taken it for 3 days and was having heartburn, and nausea, even though I was being careful, as always with what I ate. So, it finally dawned on me, to check the bottle, and sure enough it wasn’t the Nexium but the generic. My dr. had to call, and confirm, that it couldn’t be substituted. Now months later, my insurance is requiring me to take another proton pump inhibitor, to see if it works, before they will dispense the Nexium. I’ve been on Nexium for 12 years and it doesn’t completely do away with the heartburn, so it’s going to be a big problem trying something else.
I’ve had a very similar experience as the rest of you. The difference is, my insurance company, the VA, would still pay a very small portion of the cost. Before, they covered a heck of a lot more. When the pharmacist called to tell me about the price change, I was floored!! I told him to go ahead and give me the generic. That was not a good idea. The first script wasn’t too bad. The second one was different than the first and didn’t work at all. Same problem I’ve had with other types the VA has sent. I did try, and am taking the OTC one and has helped a lot more than th generics. If the Canadian product is legit, I may just give it a try. More info, please, on the Canadian product. Thanks.
Prices for several version of Nexium and the generic Esomeprazole are available on PharmacyChecker.com.
I’ve been buying generic from Canada for about 6 years since I had to go on Disability and the government won’t cover it at all. Really nice huh? And then they don’t want me to go to Canada where its $44.00 for 200, 40 mg. caps instead of $600 for 60 here? Are they nuts? Who has that kind of money to donate to big Pharma?
Please share the email for the Canadian pharmacy that you are buying the 40mg Nexium from. Like most people contributing to this site, I took the 40mg for a very long time, prior to switching to the OTC 20mg. I take 80mg each day. I have ended up with pneumonia once and a severely infected throat once. The OTC is without a doubt less effective. I am spending $100. Each month on this OTC product. If I did not sleep with my head elevated, I could not stay on the OTC version.
I have gastritis due to h pilory and Im on the second treatment for it . Although I tested negative for h pilory after the first treatment my stomach still hurted like hell. My Dr put me on triple antibiotic therapy now with otc nexium 22.3mg twice a day. I’m on my last day of antibiotics and had to run to the pharmacy to get more nexium. I was taking capsules and was doing fine with it, but getting tablets by mistake was bad. The tablets version did not work for me, so got back to the pharmacy and noticed that besides having tablets insted of capsules wasn t the only problem. They have different composition… capsules has omeprazole and magnesium 22.3mg…. tablets only has omeprazole 20mg. I thing that the magnesium relieves my stomach better than only omeprazole.
From the Nexium Web site: The formulations of the 20mg OTC capsules (Nexium 24HR) and the prescription 20mg capsules (NEXIUM®) contain the same active ingredient, esomeprazole, although there are differences in indications and directions for use. Its the same stuff folks. Its true the OTC is not made by AZ so just like generic RX drugs affect people differently, so will the Pfizer made vs the AZ made. However for 95% of the population, taking two OTC vs one RX will have the same effect according to every pharmacist and doctor I have asked.
I found that taking two Nexium OTC Capsules (20 mg) works great for me. But I take one in the morning and one at bedtime, which gives you a more balanced level of the medication. I had been on the 40 mg prescription version but it was so expensive that I switched to OTC. It took a few days to start working but now works just as well as the prescription version.
I have been on brand name Nexium 40mg twice daily for longer than I can remember. My insurance will no longer pay for any PPI, brand or generic. It’s all on me now. There are two types of OTC Nexium: 20 mg tablets that are Esomeprazole, and 20mg capsules that are Esomeprazole Magnesium. Prescription Nexium is 40mg of Esomeprazole Magnesium. In theory, if you take Nexium capsules by prescription it should be the same as the OTC Nexium capsules, NOT the tablets, using two 20’s to equal the prescription 40. Will it work the same? Anybody’s guess. I am so sick of insurance companies and their stupid decisions about medications; treating esophageal cancer is more expensive than Nexium. I’m going to use the OTC Nexium capsules because I have to and it will be costly. If it fails I will go get Nexium 40mg capsules in Canada.
Hi Lisa –
You can find brand name Nexium 40mg at lower cost internationally from verified online pharmacies here: https://www.pharmacychecker.com/brand/price-comparison/nexium/40+mg/. For a full answer to your question, please see Ask PharmacyChecker’s answer: https://www.pharmacychecker.com/ask-pc/will-over-the-counter-nexium-work-as-well-as-the-prescription-nexium-/.