As Chris discussed Saturday the WSJ had a silly article in which a woman demands a prescription drug from a flight attendant, asking for the wrong drug to treat her problem acutely, and then shockingly was refused this service. Worse, Nexium is mentioned by name, multiple times, and Nexium is actually a drug which should never have even been approved by the FDA. It really is only prescribed because of intense marketing because, logically, it has no business on the market and is no different than an existing drug, prilosec. Why would doctors irrationally prescribe this drug then? Because advertising encourages irrational choices.
So why is Nexium such a scam? Read below the fold.
Prilosec is the original proton pump inhibitor, that functions by binding to, and disabling, the protein in your stomach that pumps H+ ions into gastric juices. When it originally came out it was a wonder drug, as previous drugs such as cimetidine or ranitidine would only change the pH of the stomach from 1 to 2. Whereas the PPIs can increase the pH of the stomach from 1 to 5, and remember, pH is a log scale. That means acid production is effectively ceased by these drugs. This made them wonder drugs in the treatment of acid reflux or heartburn.
One more little piece of chemistry, prilosec or omeprazole as it is known generically, is a racemic compound. That means it is a combination of two chemically identical compounds but one has a different chirality, or handedness, from the other. It just so happens that one of the enantiomers – or handed molecules – in prilosec is the active drug, and the other enantiomer is inert. It does nothing. Amazing isn’t it? That just changing a molecule to a it’s mirror reflection can make it so a drug is effective against it’s protein target or is totally worthless.
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.
1. Lind et al., Esomeprazole provides improved acid control vs. omeprazole in patients
with symptoms of gastro-oesophageal reflux disease. Alimentary Pharmacology and
Therapeutics 14.7: 861-67, 2000.
2. Kahrilas, P. J. et al., Esomeprazole improves healing and symptom resolution as
compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial.
Alimentary Pharmacology and Therapeutics 14.10: 1249-58, 2000.