What is the equivalent dose of omeprazole (generic name for Prilosec) for esomeprazole (Nexium) 40mg?

From the Guidelines

To convert from esomeprazole 40mg to omeprazole, use omeprazole 64mg once daily, as 20mg esomeprazole is equivalent to 32mg omeprazole, and thus 40mg esomeprazole is equivalent to 64mg omeprazole, based on the relative potency of proton pump inhibitors (PPIs) 1. When switching between these medications, it is essential to consider the potency and dosage of each PPI.

• Esomeprazole is the S-isomer of omeprazole and is approximately 1.6 times more potent than omeprazole, as indicated by the fact that 20mg esomeprazole is equivalent to 32mg omeprazole 1.
• The recommended dosage for esomeprazole is 20-40mg twice daily, while omeprazole is recommended at a minimum dose of 40mg twice daily or equivalent 1.
• Given the potency difference, a direct conversion from esomeprazole 40mg to omeprazole would require a dose of omeprazole that is approximately 1.6 times higher than the esomeprazole dose, which is 64mg once daily.
• It is crucial to monitor for symptom control after switching, as individual responses may vary, and consult with a healthcare provider if symptoms worsen after switching to omeprazole.
• No tapering is required when switching between these medications, and the change can be made directly.
• Both medications are proton pump inhibitors (PPIs) that work by blocking the enzyme system responsible for acid secretion in the stomach.
• The choice of PPI and dosage should be based on the individual patient's needs and medical history, as well as the specific treatment goals, such as the eradication of Helicobacter pylori infection 1.

From the Research

Comparison of Esomeprazole and Omeprazole

• Esomeprazole is the S-isomer of omeprazole, and it has been shown to have a higher potency than omeprazole 2, 3.
• Both esomeprazole and omeprazole are proton pump inhibitors (PPIs) that are effective in the treatment of acid-related gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and peptic ulcer disease 4, 5.
• Esomeprazole has been shown to have a faster onset of action and a longer duration of action than omeprazole, which may make it more effective in some patients 3.
• The antioxidant effects of esomeprazole and omeprazole have been compared, and both drugs have been shown to have antioxidant properties, although esomeprazole may have a slightly higher antioxidant activity than omeprazole 6.

Efficacy and Safety

• Esomeprazole has been shown to be at least equivalent in safety and efficacy to other PPIs, including omeprazole, in the treatment of GERD and peptic ulcer disease 2, 3.
• The most common adverse effects of esomeprazole are headache, respiratory infection, and abdominal symptoms, which are similar to those of omeprazole 3.
• Esomeprazole has been shown to be effective in the treatment of erosive esophagitis, the maintenance of healing of erosive esophagitis, and the treatment of signs and symptoms of GERD 3.

Dosage and Administration

• The recommended dosage of esomeprazole is 20 or 40 mg orally every day, which is similar to the recommended dosage of omeprazole 3.
• Esomeprazole can be administered once daily, and it has been shown to maintain intragastric pH at a higher level and above 4 for a longer period than other PPIs 3.