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Americans will spend $200 billion this year on medicines that are not meant for the conditions they’re trying to treat.

Among the most misused medications are heartburn medicines such as Prilosec, Nexium and Prevacid. These are part of a class of drugs called proton pump inhibitors, or PPIs.

PPIs come with rare but potentially life-threatening complications. Side effects range from bone fractures to heart attacks to kidney disease.

Still, 15 million Americans routinely take PPIs. As many as 10.5 million people take PPIs even when they shouldn’t.

Sammy Almashat

“The majority of people taking these drugs are getting little to no benefit but all the risks.”

Dr. Sammy Almashat, a research associate at Public Citizen, told Drugwatch
Americans have developed an unhealthy appetite for heartburn medication.

Taking the wrong drug for a condition like routine heartburn is part of a problem called “polypharmacy.”

“Polypharmacy wastes money, and taking medicines that aren’t very helpful really devalues the ones that are,” Dr. Daniel Freedberg, a PPI researcher at Columbia University Medical Center, told Healio in 2017.

Americans who are unknowingly misusing heartburn medicines will spend as much as $6 billion or more on them this year. That’s more than half of all PPI sales.

Illustration of spilled pill bottle

Ways People Overuse PPIs

People taking Prilosec, Nexium and other PPIs may not even know they are overusing these drugs or that they are taking them for the wrong reasons. They may also be unaware of warnings to limit how long they take the drugs.

Ways people unknowingly overuse PPIs can fall into four categories.

Illustration of the number one

Taking the Wrong Medicine for a Patient’s Condition

PPIs are approved to treat serious conditions such as gastric and peptic ulcers, and serious acid reflux. But many people use them to treat simple heartburn. Other medicines or even lifestyle changes may work better for most people taking these drugs.

When a PPI May Be Necessary
  • Heartburn at least twice a week for several weeks
  • Food often comes back into your throat
  • Heartburn continues after diet, exercise or other lifestyle changes
  • Heartburn continues when using other antacids or H2 blockers
When You Should Not Take a PPI
  • Heartburn every now and then
  • Heartburn after a big or spicy meal
  • When you need occasional, fast, short-term heartburn relief
  • When an antacid like Tums or Rolaids, or an H2 blocker like Pepcid or Zantac provides relief
Illustration of the number two

Continuing to Take Prescribed Drugs When a Condition No Longer Exists

Studies have estimated nearly half of all people hospitalized are routinely given some brand of PPI heartburn medicine during their stay. The idea is to prevent ulcers while a patient is bedridden.

“What happens is the patients are discharged and doctors automatically keep patients on PPIs. The patient doesn’t know why, and in many cases, the doctor hasn’t thought it through,” Almashat told Drugwatch. “That’s one category of overuse; patients don’t even know why they’re taking it.”

Illustration of the number three

Mistaking Over-the-Counter Drugs as Less Dangerous

Another reason these drugs are so widely used is because so many are available over-the-counter. But those OTC versions carry the same risks as their prescription kin.

“There is no biological difference between the OTC version and the prescription version — absolutely none,” Almashat said. “If you have mild heartburn and you take these drugs, especially without a doctor’s supervision, the real concern is they may interact with other drugs you’re taking or expose you to the same unnecessary risks of serious complications.”

Illustration of the number four

Taking Drugs at a Higher Dose or for Longer than Recommended on the Label

The FDA says over-the-counter PPIs should only be taken for a single 14-day treatment at a time. The agency warns people not to do more than three treatments per year.

But even as it cautions against overuse, the FDA acknowledges that people may not follow those instructions. As a result, thousands take these heartburn medicines every day – some for years.

“It’s very typical to see a patient who has a few episodes of reflux and is then put on a [PPI heartburn medicine] and a few years later are still taking it,” Dr. Ranit Mishori of Georgetown University told Kaiser Health News in 2017.

Some things most people don't know about PPIs
  • PPIs are not meant to treat routine heartburn
  • PPIs cannot provide immediate heartburn relief
  • People should never take over-the-counter (OTC) PPIs for more than 14 days in a row
  • People should wait at least four months in between 14-day rounds of OTC PPIs
Suffering from complications after long-term PPI use? Get a Free Case Review
Megaphone illustration

Selling Americans on Heartburn Medicines They May Not Need

If PPI heartburn medicines don’t benefit most of the people taking them — but can increase the risk of serious injuries — why are people taking them? And why are health care providers so quick to prescribe or recommend them? Part of the reason is aggressive advertising and marketing.

A Culture of Quick Fixes

Advertising and marketing have convinced health care consumers – and their doctors – that even the hint of disease requires a drug to fix it.

“The question is where did people get that idea? They didn’t invent it. They were spoon-fed that notion by the culture that we’re steeped in,” Dr. Vinay Prasad, an assistant professor of medicine at Oregon Health & Science University, told Consumer Reports in 2017.

Read about about the effectiveness of PPIs. Learn More
Replay Video
Getting doctors to change a routine question sent PPI sales skyrocketing.

Direct-to-Consumer Advertising

Marketing research company Kantar Media reported that drug companies spent $6.4 billion on ads targeting consumers in 2016. That’s $1.3 billion more than the FDA’s 2017 budget.

“If you have an OTC drug advertised directly to consumers, pharmaceutical companies bypass the entire physician role in drug prescribing,” Almashat said. “That’s extremely dangerous with drugs that have potentially life-threatening risks.”

Marketing to Doctors

The Pew Charitable Trusts found drug companies spend more money to get the attention of doctors than they spend on direct-to-consumer ads. A total of $24 billion in 2012 alone was spent on ads in medical journals, face-to-face sales, free samples, and promotional and educational meetings.

The more gifts and payments doctors received from medical manufacturers, the more brand-name medicines they were likely to prescribe, according to a ProPublica analysis.

Did your doctor accept gifts and payments?
You can find your doctor’s history at the Centers for Medicare & Medicaid Services’ Open Payments Database.
Search The Database
Illustration of a chart showing company profits

Companies Profit When Dangerous Drugs Are Over-Prescribed

As of 2017, Nexium was the 10th best-selling drug of all time. It racked up $60 billion in sales from the time it first hit the market in 2001. That includes billions of dollars from consumers who received no benefit from PPIs.

Read about about the effectiveness of PPIs. Learn More
Replay Video
People who get no benefits from PPIs account for most of the medicines’ sales.

Drug companies make an average $1,700 profit from every patient taking prescription drugs, according to recent estimates.

But the total profit from PPIs is boosted from sales of the over-the-counter versions. Over-the-counter PPIs can cost $120 more a year than other heartburn medicines.

“Even if a doctor prescribes a PPI, if there’s a cheaper over-the-counter version, the patient is going to take that. The doctor may even encourage it,” Almashat said.

Illustration of magnifying glass on a human body

Where Does It Hurt? Potential Risks of Powerful Heartburn Medicines

Multiple studies have found long-term PPI use may increase health risks, such as kidney disease, fractures, heart attacks and strokes. Their use may even affect children later in life if a mother takes them during pregnancy.

Select a body part or condition to learn the possible effects of PPIs.

Illustration of pregnant woman with fetus inside

Studies have shown that children whose mothers took PPIs during pregnancy may be at an increased risk of certain conditions, including:

Long-Term Heartburn Drug Use Linked to Kidney Disease

When Diane* was diagnosed with Barrett’s esophagitis, her doctor had a simple solution.

Are you suffering from kidney injury after long-term PPI use? Get a Free Case Review

“I was told 22 years ago to take Prilosec every day for the rest of my life,” Diane told Drugwatch. “It’s a rock and a hard place. In order to prevent it from turning into cancer of the esophagus, [I had to take] the PPI.”

Today, Diane lives with chronic kidney disease, one of the complications that studies have since linked to long-term use of PPI heartburn medicines. When she first went on Prilosec, there was little information about kidney risks.

“A lot of what we know about the risks of PPIs came after the drugs were already approved,” Almashat said. “The initial studies were very short. Now we have huge amounts of data on the risks of these drugs, especially when used for a long period of time.”

What Does “Long-Term Use” Mean?
“Long-term use” is as little as one year in many of the studies into potential PPI drug side effects. Few studies have looked at the risks of taking the medicines for more than five years.

After years of taking PPIs, they no longer work for Diane. She is planning esophageal wrap surgery to correct her condition.

“Just getting the information out there about the hazards of long-term use of PPI’s is good because I think people, and also doctors, need to know the risks that are coming out now after years of being on the market,” Diane said.

*Drugwatch is withholding this source’s identity to protect her privacy.

Illustration of warning sign

Warnings Reduce PPI Overuse and Side Effects

Something as simple as a warning on PPI labels may rein in overuse and prevent side effects.

In 2010, the FDA ordered PPI makers to add a drug label warning about increased bone fracture risks. It told doctors to recommend the lowest dose for the shortest duration. Researchers later examined at how millions of patients used PPIs. They looked at people who took PPIs in the three years before the change and the five years after.

In 2018, the researchers published their results in the journal Pharmacoepidemiology & Drug Safety. They found the average number of days patients took PPIs had dropped by 13 percent. The rate of bone fractures among PPI patients also fell 29 percent.

Illustration of prescription bottle with pills surrounding it

‘Deprescribing’ and Alternatives to Prilosec, Nexium & Other PPIs

Moving people who do not need PPI heartburn medicines off the drugs has been at the forefront of “deprescribing,” a relatively new idea in medical treatment.

Deprescribing seeks a safe approach to reduce the number of different kinds of drugs patients take and to properly adjust dosages of drugs they should keep taking. It also focuses on making sure patients receive the proper drug for their current condition.

It may seem simple to quit taking a drug, but safely moving off PPIs can be so complex that Canadian health professionals have actually created an algorithm to guide doctors through the process. The complexity may also be part of the reason doctors have not embraced deprescribing sooner.

Experiencing serious PPI side effects? Get a Free Case Review
Replay Video
Doctors describe why they don’t routinely review patients’ prescriptions.

Taking PPIs for just a few weeks makes it hard to stop. The drugs can cause a rebound effect where heartburn comes back worse than it originally was. It can take weeks or even months to safely stop taking PPIs. People stopping the drugs should only do so with a doctor’s supervision.

“I think there is some misinterpretation that when we say ‘deprescribing,’ we mean ‘completely stop the medication,'” Barbara Farrell, a pharmacist and professor of Family Medicine at the University of Ottawa, told Medscape in 2017. “But deprescribing is a variety of options. It could mean reducing the dose, using the drug only when you need it, or switching to a safer alternative.”

Possible Alternatives to PPIs

illustration of various antacids Take antacids or H2 blockers instead: Tums, Pepcid AC, Maalox or Zantac
Illustration of a balanced meal Eat smaller meals
Illustration of a greasy hamburger Avoid foods that can trigger heartburn, such as acidic or greasy foods
Illustration of a dumbbell Exercise and lose weight
Illustration of a baggy shirt Wear looser clothing
Illustration of a bed Wait at least 2 hours or more after eating before lying down

DISCLAIMER: Never stop or modify the dose of a prescription medication without consulting with your doctor or other health care provider.

Terry Turner
Written By Terry Turner Writer

Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:

  • American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member
  • Centers for Disease Control and Prevention Health Literacy certificates
  • Original works published or cited in Washington Examiner, MedPage Today and The New York Times
  • Appeared as an expert panelist on hernia mesh lawsuits on the BBC
Edited By
Emily Miller
Emily Miller Managing Editor
Medically Reviewed By
Venkatachala Mohan, MD
Dr. Venkatachala Mohan Internal Medicine, Gastroenterology

47 Cited Research Articles writers follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and interviews with qualified experts. Review our editorial policy to learn more about our process for producing accurate, current and balanced content.

  1. Carr, T. (2017, August 3). Too Many Meds? America’s Love Affair with Prescription Medication. Consumer Reports. Retrieved from
  2. Durand, C., Willett, K.C., and Desilets, A.R. (2012, October 15). Proton Pump Inhibitor Use in Hospitalized Patients: Is Overutilization Becoming a Problem? Clinical Medicine Insights: Gastroenterology. Retrieved from
  3. Schroeder, M.O. (2015, December 17). Drug Routinely Prescribed to Hospitalized Patients May Raise Risk of Dying. U.S. News & World Report. Retrieved from
  4. (2013). Prilosec OTC TV Commercial, “Picnic” Featuring Larry the Cable Guy. Retrieved from
  5. Levine, H. (2017, November 27). Should You Stop Taking That Medication? Consumer Reports. Retrieved from
  6. Leitenberger, A. (2017, December). Evidence of PPI Risks Weak, But Overuse Remains a Problem. Healio Gastroenterology. Retrieved from
  7. Imhann, F., et al. (2015, December 9). Proton Pump Inhibitors Affect the Gut Microbiome. Gut (BMJ Journals). Retrieved from
  8. Dennis, B. (2015, November 3). Nearly 60 Percent of Americans – the Highest Ever – Are Taking Prescription Drugs. Washington Post. Retrieved from
  9. Carr, T. (2016, June 24). When to Consider PPI Drugs for Heartburn. Consumer Reports. Retrieved from
  10. Fikes, B.J. (2017, July 3). Popular Stomach Acid Blockers Linked to Higher Death Rates. San Diego Union-Tribune. Retrieved from
  11. Boodman, S.G. (2017, December 12). An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs. Kaiser Health News. Retrieved from
  12. Shah, N.H. (2015, June 10). Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLOS One. Retrieved from
  13. Lazaro, A.M.P., et al. (2017, January 19). Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease. PLOS One. Retrieved from
  14. Sehested, T.H., et al. (2016, November 11). Abstract 18462: Proton Pump Inhibitor Use Increases the Associated Risk of First-Time Ischemic Stroke. A Nationwide Cohort Study. Circulation (American Heart Association). Retrieved from
  15. Sukhovershin, R.A. and Cooke, J.P. (2017, June 1). How May Proton Pump Inhibitors Impair Cardiovascular Health? American Journal of Cardiovascular Drugs. Retrieved from
  16. Metz, D.C. (2011, December). Examining the Potential Relationship Between Proton Pump Inhibitor Use and the Risk of Bone Fracture. Gastroenterology & Hepatology. Retrieved from
  17. McDonald, E.G., et al. (2015, May). Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium Difficile Infection. JAMA Internal Medicine. Retrieved from
  18. Cheung, K.S. (2017, October 31). Long-Term Proton Pump Inhibitors and Risk of Gastric Cancer Development After Treatment of Helicobacter pylori: a Population-Based Study. Gut (a BMJ Journal). Retrieved from
  19. Lazarus, B., et al. (2017, February 1). Proton Pump Inhibitor Use and Risk of Chronic Kidney Disease. JAMA Internal Medicine. Retrieved from
  20. Antoniou, T., et al. (2015, April 2). Proton Pump Inhibitors and the Risk of Acute Kidney Injury in Older Patients: A Population-Based Cohort Study. CMAJ Open. Retrieved from
  21. Xie, Y., et al. (2016, March 14). Proton Pump Inhibitors and Risk of Incident CDK and Progression to ESRD. Journal of the American Society of Nephrology. Retrieved from
  22. Sampathkumar, K., et al. (2013, July). Acute Interstitial Nephritis Due to Proton Pump Inhibitors. Indian Journal of Nephrology. Retrieved from
  23. Devine, R.E., et al. (2017, June). Acid-Suppressive Medications During Pregnancy and Risk of Asthma and Allergy in Children: A Systematic Review and Meta-Analysis. Journal of Allergy and Clinical Immunology. Retrieved from
  24. Rhim, A.D., et al. (2010, May). Maternal Use of Proton Pump Inhibitors (PPI) During Pregnancy Is Associated with an Increased Risk for Cardiac Birth Defects: Analysis of 208,951 Pregnancies from the GPRD/THIN Database. Gastroenterology. Retrieved from
  25. American Academy of Pediatrics. (2017, May). Infants Prescribed Antacids for Reflux have Increased Risk of Bone Fractures. AAP News. Retrieved from
  26. Dobrow, L. (2016, March 23). Ironwood’s McCourt Bets Big on Data and the Patient-Physician Dialogue. Medical Marketing and Media. Retrieved from
  27. Ornstein, C., Jones, R.G., and Tigas, M. (2016, March 17). Drug-Company Payments Mirror Doctors’ Brand-Name Prescribing. NPR Morning Edition. Retrieved from
  28. Ornstein, C. and Jones, R. G. (2015, January 8). Companies Pay Millions to Promote Some of Their Most Unremarkable Drugs. ProPublica. Retrieved from
  29. U.S. Department of Health & Human Services. (n.d.). Open Payments Data. Centers for Medicare & Medicaid Services. Retrieved from
  30. Williams, S. (2017, March 13). The 19 Best-Selling Prescription Drugs of All time. The Motley Fool. Retrieved from
  31. Miller, Andrew. (2016, November). Drugging America for Profit. The Trumpet. Retrieved from
  32. Statista. (2014, February). Top Proton Pump Inhibitors Based on U.S. Revenue Market Share in 2013. Retrieved from
  33. Park, A. (2017, July 5). These Heartburn Drugs Are Linked to a Higher Risk of Early Death. Time Health. Retrieved from
  34. Choosing Wisely. (2012, May). Treating Heartburn and GERD. Retrieved from
  35. Gawande, A. (2015, May 11). Overkill. The New Yorker. Retrieved from:
  36. Wallis, K.A., Andrews, A., and Henderson, M. (2017, July). Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice. Annals of Family Medicine. Retrieved from
  37. Annals of Family Medicine. (2017, July). Table 2; Primary Care Physician’s Views on the Barriers to and Facilitators of Deprescribing in Everyday Practice. Annals of Family Medicine. Retrieved from
  38. Forgacs, I. and Loganayagm, A. (2008, January 5). Overprescribing proton pump inhibitors. Retrieved from:
  39. Leitenberger, A. (2017, December). Evidence of PPI Risks Weak, But Overuse Remains a Problem. Healio Gastroenterology. Retrieved from
  40. Choosing Wisely. (2012, May). Treating Heartburn and GERD. Retrieved from
  41. Carr, T. and Skinner, G. (2017, August 3). 12 Times to Try Lifestyle Changes Before Medication. Consumer Reports. Retrieved from
  42. Brookes, L. (2017, July 6). Deprescribing PPIs: An Algorithm. Medscape. Retrieved from
  43. (2016, September). Proton Pump Inhibitor (PPI) Deprescribing Algorithm. Retrieved from
  44. Brusselaers, N., Engstrand, L. and Lagergren, J. (2018, April). Maintenance Proton Pump Inhibition Therapy and Risk of Oesophageal Cancer. Cancer Epidemiology. Retrieved from
  45. Mezher, M. (2018, February 13). Researchers Investigate4 the Effect of Labeling Changes on PPI Use in Sentinel. Regulatory Focus. Retrieved from
  46. U.S. Food and Drug Administration. (2017, August 3). FDA Drug Safety Communication: Possible Increased Risk of Fractures of the Hip, Wrist, and Spine With the Use of Proton Pump Inhibitors. Retrieved from
  47. Soebel, R.E., et al. (2018, February 2). Do FDA Label Changes Work? Assessment of the 2010 Class Label Change for Proton Pump Inhibitors Using the Sentinel System’s Analytic Tools. Pharmacoepidemiology & Drug Safety. Retrieved from
View All Sources
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