Why no one should take Nexium and it should never have been approved

[salvorhardin]

I've never had a need for proton pump inhibitors, but if I did, I wouldn't have known that Nexium is, functionally, just double strength Prilosec.

What does this have to do with Nexium and why you shouldn't take it? The only active ingredient in Nexium is the exact same thing as the only active ingredient in omeprazole (Prilosec), a (now) generic drug made by the same company, which is over the counter and four to eight times cheaper. AstraZeneca just figured out how to purify out the active component from omeprazole, the S-enantiomer esoomprazole.

In clinical trials the only difference between Nexium and its off-patent parent drug are modest improvements in some symptoms at distant time points; however, it is standard in these trials to compare 20mg of Nexium to 20mg of Omeprazole. In other words, the trials that have justified the use of this drug compared to the generic only show that when two times the amount of the active compound is used (1 nexium = 2 omeprazole), a slight improvement in some symptoms (87% vs 90% for cure of gastroesophageal reflux disease at 8 weeks) is achieved.[1-2] This is a result that is certainly not worth 4-8 times the cost.

Based on patent law AstraZeneca should never have been able to patent esoomeprazole as a new drug since they had already patented the same active ingredient when they patented prilosec. They effectively patented the same drug twice, thus doubling the time their drug can avoid generic competition. However, in order for the scam to work they had to pull one over on the regulators (coincidentally they spent millions in lobbying congress the year before Nexium was approved), then advertise the hell out of Nexium to make it appear it was somehow superior to it's chemically identical sibling drug Prilosec.

The take home message? Buy prilosec/omeprazole. It's generic. It's over the counter. If you want your insurance to cover it have your doc write a prescription for a bunch of pills so it falls under your co-pay. Save the healthcare system 5 billion a year and ditch this scam of a pill.

Link: http://scienceblogs.com/denialism/2012/01/why_no_one_should_take_nexium.php

[Pab Sungenis]

1. This happens more often than you think.

One of the most commonly prescribed antidepressants today is Lexapro. (I was actually a participant in the clinical trial for it.) But what they don't tell you is that the active ingredient in Lexapro (escitalopram) is just a more concentrated form of the generic drug citalopram. 2x your Lexapro dosage of citalopram does the same work.

So you can spend $300.00 for a 30 day supply of Lexapro, or you can go to one of the discount generic drug places like Walmart (I'm all for anything that's a loss-leader for them) and spend $10.00 for what will turn out to be a 45-day supply if you get your doctor to write the prescription correctly.

It's a common scam and the FDA and patent office have been all too eager to go along with it for decades.

[laconicsax]

4. The difference between citalopram and escitalopram isn't concentration.

The effect is similar to increased concentration, but escitalopram isn't just a more concentrated version of citalopram. It's closer to being the exact same drug than that.

[Warpy]

5. The story of omeprazole is one of the worst out there

Prilosec had been a blockbuster drug for Astra Zeneca, so much so that they were loath to give up their profits when the patent expired. Generic drugs were prepared for the market. Astra Zeneca mounted nuisance lawsuit after nuisance lawsuit over different formulations (tablets instead of timed release caps), different excipients, different colors, et cetera ad nauseum. They delayed the generics for almost three years, extending their own profits for that long. As soon as the generic came out, the price almost as high as the Prilosec it replaced due to the cost of litigation, they lobbied to get it OTC and won.

You're correct that Nexium is a "me too" second generation drug. Some second generation drugs like statins and ACE inhibitors have been improvements over the initial NIH developed drug. Nexium does not fall into this category and the doubling of the active ingredient has been linked to the malabsorption of nutrients and other drugs.

[hedgehog]

7. Of course this is only anecdote, but I started out on Nexium and

switched to Prilosec because the Prilosec worked better!

[Celebration]

2. It would be a great start

If third party payers, including the government, would stop paying for this.

[Viva_La_Revolution]

3. even cheaper..

fix your diet, and slow down. I know some have actual medical conditions that cause heartburn, and stress is another cause we can't really control, but crappy food, eating too fast and too much are the leading causes, imho.

4 people in my house regularly went thru 2 bottles of antacids a week until about a year ago, when we finally got our 'new' eating habits established, now it only occurs on days like yesterday when someone gobbled 3 slices of takeout pizza in 10 min and wondered why he got cramps, lol.

[hedgehog]

6. Prilosec is no longer covered by my insurance, BUT

it is still cheaper if I get my doctor to give me a script. My druggist will sell me a bottle of pills for about half of what you'd pay for one of those blister packs. The bonus is that I don't have to deal with the blister packs!

[HuckleB]

8. Is your pharmacist one of the remaining small business pharmacists?

Anyway, that's a thumbs up for your pharmacy! Yeah, not so much for the insurance company.

[hedgehog]

9. You got it! As a matter of fact - he's a real pharmacist

who gives appropriate advice to his customers as to when an OTC product will work and when they need to check with their doctors.

[HuckleB]

10. Good for him and his customers!

Luckily, the docs at the clinic where I work are highly likely to recommend an OTC product when it's available. They focus on the full spectrum of care, including what their patients can afford.

[Kennah]

11. This was one of the good things, and perhaps the only good thing, of me being on private insurance.

I was taking Nexium for GERD, and when the price shot outta site, I started researching alternatives--which my GI doc never even discussed.

I asked my doc about omeprazole, they switched me from 40 mg Nexium (esomeprazole) to 20 mg omeprazole, and no ill effects from the switch. Oh, maybe 2-3 days of some mild stomach upset, but no problems since.

http://en.wikipedia.org/wiki/Nexium#Controversy

[jenniferdraper]

12. Spam deleted by Paulie (MIR Team)

[Fridays Child]

13. AstraZeneca came out with Nexium, as their right to exclusively...

...produce the wildly popular moneymaker omeprazole was nearing expiration. I've never believed that this was a mere coincidence.