Updated February 2026
Over 18,700 lawsuits have been filed against proton pump inhibitor manufacturers, resulting in more than $590 million in settlements as of early 2026. The lawsuits allege that PPI makers including AstraZeneca, Takeda, Procter & Gamble, Pfizer, and GlaxoSmithKline failed to adequately warn consumers about serious kidney damage risks associated with long-term PPI use. AstraZeneca alone settled approximately 11,000 Nexium and Prilosec cases for $425 million in October 2023.
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What Are the PPI Lawsuits About?
The PPI lawsuits are a mass tort litigation alleging that manufacturers of popular acid reflux drugs — including Nexium, Prilosec, Prevacid, Protonix, and Dexilant — knew or should have known about the risk of serious kidney damage from long-term use and failed to adequately warn doctors and patients.
Plaintiffs claim that PPI manufacturers:
- Knew about the link between PPI use and kidney disease but failed to include adequate warnings on drug labels
- Marketed PPIs as safe for long-term use despite evidence of serious adverse effects
- Continued to promote widespread use even as studies revealed increasing safety concerns
- Failed to conduct adequate post-market surveillance of kidney-related side effects
Key PPI Lawsuit Facts and Timeline
| Date | Event |
|---|---|
| 2010 | FDA issues first safety warning about fracture risk with PPIs |
| 2011 | FDA warns about hypomagnesemia (low magnesium) with long-term PPI use |
| 2012 | FDA warns about C. difficile infection risk with PPIs |
| 2014 | FDA updates fracture warning to include OTC PPIs |
| 2016 | JAMA study shows 20–50% increased CKD risk with daily PPI use; first PPI kidney lawsuits filed |
| August 2017 | PPI lawsuits consolidated into MDL No. 2789 in U.S. District Court, District of New Jersey (Judge Claire C. Cecchi) |
| 2017–2023 | Discovery, bellwether case preparation; thousands of additional cases filed |
| October 2023 | AstraZeneca announces $425 million settlement for Nexium/Prilosec claims (~11,000 plaintiffs), days before first bellwether trial |
| 2024 | Additional settlements reached with Takeda (Prevacid/Dexilant), GSK, Procter & Gamble, and Pfizer; total settlements exceed $590 million |
| 2025–2026 | Settlement payout distributions begin; remaining cases continue; total plaintiffs exceed 18,700 |
Which PPI Drugs Are Involved?
| Brand Name | Generic Name | Manufacturer | Status |
|---|---|---|---|
| Nexium | Esomeprazole | AstraZeneca | $425M settlement (Oct 2023) |
| Prilosec | Omeprazole | AstraZeneca / Procter & Gamble | Included in AstraZeneca settlement; P&G settled separately |
| Prevacid | Lansoprazole | Takeda Pharmaceuticals | Settled in 2024 |
| Protonix | Pantoprazole | Pfizer (originally Wyeth) | Settled |
| Dexilant | Dexlansoprazole | Takeda Pharmaceuticals | Settled in 2024 |
What Injuries Did PPI Users Claim?
The primary injuries alleged in PPI lawsuits involve kidney damage:
Acute Kidney Injury (AKI)
Sudden kidney damage that can develop within days to weeks of PPI use. Acute interstitial nephritis (AIN), an inflammatory kidney condition, is one of the most documented PPI-related kidney injuries.
Chronic Kidney Disease (CKD)
Progressive, long-term kidney damage. A 2016 JAMA study showed that daily PPI users had a 20–50% increased risk of CKD, with the risk increasing with longer duration of use. Patients taking PPIs twice daily were up to 46% more likely to develop kidney disease. For more on this research, see our article on PPIs and kidney damage.
End-Stage Renal Disease (ESRD)
The most severe outcome, requiring dialysis or kidney transplant. Long-term PPI users face a 35% elevated risk of end-stage renal disease according to observational studies.
Other Claimed Injuries
While kidney damage was the primary basis for the MDL, some individual lawsuits have also alleged:
- Bone fractures (hip, spine, wrist)
- Gastric cancer
- C. difficile infections
- Cardiovascular complications
Settlement Amounts and Payouts
Total Settlements: $590.4 Million
As of early 2026, plaintiff attorneys have secured settlements totaling approximately $590.4 million across all PPI manufacturers:
- AstraZeneca: $425 million (Nexium and Prilosec cases)
- Takeda, GSK, Procter & Gamble, Pfizer: Remaining ~$165 million in combined settlements
Individual Payout Estimates
Individual settlement amounts vary widely based on several factors:
- Severity of injury: Cases involving dialysis or kidney transplant are valued higher than CKD alone
- Duration of PPI use: Longer use strengthens the causal connection
- Documentation: Medical records proving both PPI use and kidney diagnosis
- Settlement tier: Cases are categorized into severity tiers with different payout ranges
- Attorney fees: Typically 33–40% of the settlement amount
Full payout distributions began in late 2025 and are expected to continue through 2026–2027.
The Scientific Evidence Behind the Lawsuits
The PPI lawsuits were built on a growing body of scientific research linking PPI use to kidney damage. Key studies cited in the litigation include:
- Lazarus et al. (2016, JAMA Internal Medicine): Analyzed over 10,000 participants from the ARIC study. Found a 20–50% increased risk of CKD with PPI use.
- Xie et al. (2016, JAMA Internal Medicine): VA database study of 173,000+ PPI users. Found significantly increased risk of CKD, AKI, and ESRD.
- Xie et al. (2017, Kidney International): Follow-up study confirming dose-dependent kidney damage risk.
- 2024 Biomedicines meta-analysis: Confirmed the PPI-CKD association and identified mechanisms including gut microbiota changes, nutrient malabsorption, and direct tubular toxicity.
- 2025 BMC Nephrology cohort study: Retrospective analysis of 122,606 acid-suppressing users providing further evidence of kidney damage association.
For a complete review of the current safety research, see: Is Long-Term PPI Use Safe?
PPI Lawsuits vs. Zantac Lawsuits: What’s the Difference?
| Factor | PPI Lawsuits | Zantac Lawsuits |
|---|---|---|
| Drug class | Proton pump inhibitors | H2 blocker (ranitidine) |
| Primary allegation | Kidney damage from chronic use | Cancer from NDMA contamination |
| Mechanism of harm | Pharmacological side effects of acid suppression | Chemical contamination (NDMA, a probable carcinogen) |
| Drug still available? | Yes — PPIs remain on market | No — ranitidine recalled in 2020 |
| MDL status | MDL 2789, NJ; $590M+ in settlements | MDL 2924, FL; largely dismissed (Daubert ruling excluded plaintiff expert testimony) |
| Outcome | Major settlements achieved | Federal cases largely dismissed; state-level cases continue |
What This Means for Current PPI Users
The PPI lawsuits underscore a broader message: PPIs were never intended for indefinite daily use. The FDA approved OTC PPIs for no more than three 14-day courses per year, yet millions of Americans take them daily for years or decades. The litigation has brought increased awareness to the importance of:
- Using PPIs only when medically necessary and for the shortest effective duration
- Regular kidney function monitoring for anyone on long-term PPI therapy
- Discussing alternatives with your healthcare provider, including H2 blockers and natural supplements
- Exploring non-pharmaceutical approaches like natural remedies, dietary changes, and lifestyle modifications
D-Limonene offers a fundamentally different approach to acid reflux — protecting the esophagus without suppressing stomach acid and without the kidney, bone, and infection risks that have driven billions of dollars in PPI litigation. Orange Burps delivers 1000 mg of pharmaceutical-grade D-Limonene per softgel. For a detailed comparison, see: D-Limonene vs PPIs.
Frequently Asked Questions
How much are PPI lawsuit settlements worth?
Total PPI settlements have exceeded $590 million as of early 2026, including a $425 million AstraZeneca settlement for Nexium and Prilosec cases. Individual payout amounts vary based on injury severity, duration of PPI use, medical documentation, and settlement tier. Cases involving dialysis or kidney transplant are valued higher. Payouts began in late 2025 and continue through 2026–2027.
Can I still file a PPI lawsuit?
Following the major settlements in 2023–2024, many law firms have stopped accepting new PPI cases. However, eligibility depends on your state’s statute of limitations, when you were diagnosed with kidney problems, and specific case circumstances. If you believe you have a claim, consult with a mass tort attorney to evaluate your individual situation.
Which PPIs are involved in the lawsuits?
The lawsuits involve all major PPI brands: Nexium (esomeprazole), Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Dexilant (dexlansoprazole). Defendants include AstraZeneca, Takeda Pharmaceuticals, Procter & Gamble, Pfizer, and GlaxoSmithKline. All have reached settlements.
What kidney problems do PPIs cause?
PPI lawsuits have alleged acute kidney injury (including acute interstitial nephritis), chronic kidney disease (CKD), and end-stage renal disease (ESRD) requiring dialysis or transplant. Research shows PPI users face a 20–50% higher risk of CKD, with the risk increasing with longer duration and higher doses. More than half of patients who develop kidney damage from PPIs have no warning symptoms beforehand.
Are PPIs still safe to take?
PPIs remain FDA-approved and available both by prescription and over the counter. They are effective and appropriate for short-term treatment of specific conditions (erosive esophagitis, ulcers, Barrett’s esophagus). However, the FDA recommends using them at the lowest effective dose for the shortest necessary duration. Long-term daily use without a clear medical indication carries documented risks. Discuss alternatives with your healthcare provider.
