Nexium, Prilosec, and Prevacid were linked to kidney disease. MDL 2789 resolved with over $533 million in settlements to settle approximately 11,000 PPI claims. Learn what happened and why we are no longer accepting cases.
Proton pump inhibitor (PPI) kidney injury lawsuits targeted drugs like Nexium, Prilosec, and Prevacid — medications taken daily by millions of Americans to treat heartburn, GERD, and ulcers. Beginning around 2015, peer-reviewed research began linking long-term PPI use to serious kidney damage, triggering one of the largest pharmaceutical mass torts in the federal court system. The resulting litigation — MDL 2789 — consolidated more than 18,000 individual claims and ultimately resolved with settlements exceeding $533 million across all defendant manufacturers.
Proton pump inhibitors — commonly called PPIs — were among the most widely prescribed and over-the-counter drugs in the world. Sold under brand names including Nexium (AstraZeneca), Prilosec (AstraZeneca), Prevacid (Takeda Pharmaceuticals), Protonix (Pfizer/Wyeth), and Dexilant (Takeda), these medications suppress acid production in the stomach. Millions of Americans took them daily, often for years, trusting that a drug so accessible and widely recommended was safe for long-term use.
Beginning around 2015 and accelerating in the years that followed, peer-reviewed research published in top medical journals revealed a troubling pattern: patients who used PPIs for extended periods faced a statistically elevated risk of kidney damage. Studies linked long-term PPI use to acute interstitial nephritis — an inflammatory kidney condition — which in some patients progressed to chronic kidney disease (CKD) and, in the most serious cases, to end-stage renal disease (ESRD) requiring dialysis or transplant. The risk appeared to increase with the duration and frequency of use.
The lawsuits that followed did not dispute that PPIs were effective at managing acid-related conditions. What they alleged was that the manufacturers — AstraZeneca, Takeda Pharmaceuticals, Pfizer/Wyeth, Procter & Gamble, and GlaxoSmithKline — had access to scientific evidence connecting long-term PPI use to kidney harm, failed to adequately warn patients and prescribing physicians, and continued to market these medications for long-term use without disclosing what the emerging science showed about kidney risks.
The U.S. Food and Drug Administration has issued multiple drug safety communications since 2017 acknowledging the association between long-term PPI use and adverse kidney outcomes including acute interstitial nephritis, reinforcing the scientific basis of the plaintiffs’ failure-to-warn claims.
As PPI kidney injury lawsuits multiplied across the country, the U.S. Judicial Panel on Multidistrict Litigation (JPML) consolidated them into a single proceeding in August 2017. MDL 2789 — formally titled In re: Proton-Pump Inhibitor Products Liability Litigation — was assigned to Judge Claire C. Cecchi in the U.S. District Court for the District of New Jersey. At its height, the MDL encompassed more than 18,000 individual claims, making it one of the largest pharmaceutical MDLs in the federal system.
The litigation moved through an extended pretrial period that included significant battles over the admissibility of scientific expert testimony. Judge Cecchi held Daubert hearings to determine which expert evidence would be permitted at trial — a process central to pharmaceutical litigation, where the strength of epidemiological and medical causation evidence can determine the outcome of thousands of cases simultaneously. Bellwether cases were selected, prepared, and scheduled for trial, and the first scheduled bellwether trial ultimately served as the pressure point that brought the largest defendant, AstraZeneca, to the settlement table.
The PPI litigation resolved through a series of individual manufacturer settlements rather than a single global agreement. The total recovery across all defendants exceeded $533 million.
GlaxoSmithKline, Pfizer/Wyeth, and Procter & Gamble reached settlement agreements with plaintiffs during the pretrial phase for a combined total of approximately $108.5 million, resolving claims related to their respective PPI products, including Prilosec OTC and Protonix.
The largest and most significant settlement in the litigation was announced by AstraZeneca in October 2023, just days before the first bellwether trial was scheduled to begin. The $425 million agreement resolved approximately 11,000 claims involving Nexium (esomeprazole) and Prilosec (omeprazole) — claims filed both in MDL 2789 and in coordinated state court proceedings. The settlement covered the overwhelming majority of the most serious kidney injury claims in the docket.
Takeda Pharmaceuticals ultimately settled its claims well after the other defendants had resolved their portions of the litigation. By early 2026, the overall docket was winding down, though a small number of individual cases that did not participate in any settlement remained pending.
Beyond the settlement figures, the PPI litigation contributed to a broader public health conversation about the long-term safety of drugs that had been marketed, prescribed, and purchased as essentially routine. The FDA’s safety communications since 2017 — acknowledging associations between long-term PPI use and both acute interstitial nephritis and chronic kidney disease — validated the scientific foundation of the plaintiffs’ warnings-based claims and have influenced how prescribers communicate PPI risks to patients.
The litigation also demonstrated the power of the MDL process to aggregate and efficiently move enormous volumes of pharmaceutical injury claims — and the way in which a scheduled bellwether trial can function as a forcing mechanism that brings reluctant defendants to the settlement table after years of pretrial proceedings.
MDL 2789 — formally titled In re: Proton-Pump Inhibitor Products Liability Litigation — was a federal multidistrict litigation consolidated by the U.S. Judicial Panel on Multidistrict Litigation in August 2017. It was assigned to Judge Claire C. Cecchi in the U.S. District Court for the District of New Jersey. At its peak the MDL included more than 18,000 individual claims alleging that long-term use of proton pump inhibitor drugs caused kidney damage, including acute interstitial nephritis, chronic kidney disease, and end-stage renal disease.
The lawsuits primarily involved Nexium (esomeprazole) and Prilosec (omeprazole) manufactured by AstraZeneca; Prevacid (lansoprazole) and Dexilant manufactured by Takeda Pharmaceuticals; Protonix (pantoprazole) manufactured by Pfizer/Wyeth; and Prilosec OTC sold by Procter & Gamble and GlaxoSmithKline. All were available by prescription, and most were also sold over the counter.
AstraZeneca agreed to pay $425 million in October 2023 to resolve approximately 11,000 claims related to Nexium and Prilosec — including claims filed in MDL 2789 and in coordinated state court proceedings. The settlement was announced just days before the first scheduled bellwether trial was set to begin and represented the largest individual settlement in the PPI litigation.
Research published in peer-reviewed medical journals identified three primary kidney conditions associated with long-term PPI use: acute interstitial nephritis (AIN), an inflammatory kidney condition that can develop suddenly; chronic kidney disease (CKD), a progressive loss of kidney function over time; and end-stage renal disease (ESRD), the most severe stage, which may require dialysis or a kidney transplant. The risk appeared to increase with the duration and frequency of PPI use.
The AstraZeneca settlement resolved approximately 11,000 enrolled claims, and subsequent settlements with the remaining defendants resolved the overwhelming majority of the MDL docket. If you were not enrolled in any settlement and have a kidney disease diagnosis linked to long-term PPI use, you may wish to consult a licensed attorney to determine whether any legal options remain available. Be aware that this litigation is substantially closed, statutes of limitations are an important consideration, and the window for new claims may be narrow or closed depending on your state and circumstances.
Most pharmaceutical mass tort cases settle before reaching a jury. In this litigation, the combination of AstraZeneca’s impending first bellwether trial in October 2023, the significant costs and risks of continued litigation for both sides, and the sheer volume of enrolled claims made a negotiated resolution the practical outcome for the large majority of plaintiffs. This pattern — years of pretrial proceedings followed by settlement as trial approaches — is common in large pharmaceutical MDLs.
A bellwether trial is a representative sample case selected from a large MDL docket and tried before a jury to help both sides assess the litigation’s overall strengths and weaknesses. Bellwether verdicts — or even the prospect of one — frequently prompt defendants to settle the broader docket rather than risk an adverse jury verdict that could set the tone for thousands of remaining cases. In the PPI litigation, AstraZeneca’s settlement announcement just days before its first scheduled bellwether trial is a textbook example of this dynamic.
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