In August 2017, a federal panel combined more than 160 lawsuits against makers of Nexium, Prilosec, Prevacid and Protonix into a single federal action in New Jersey. The order consolidating the cases predicted “hundreds or thousands” more lawsuits could be added to the action as people claim taking the drugs led to kidney injuries or wrongful deaths.
The lawsuits were combined in a multidistrict litigation (MDL), which combines similar lawsuits to reduce red tape, duplication and pre-trial costs. MDLs can allow large numbers of lawsuits to move more quickly through the courts.
The popular heartburn medicines are part of a class of drugs called proton pump inhibitors (PPIs). Since they first arrived on the market in 1989, multiple studies have shown an association between the drugs and serious kidney injuries. But labels for the drugs contained no warning of the conditions until 2014.
The people who filed the lawsuits say PPI use resulted in kidney conditions which included acute interstitial nephritis (AIN), chronic kidney disease (CKD), kidney failure or even death.
People who once turned to PPIs to help with their stomach-acid woes have taken legal action after experiencing other dangerous side effects associated with the medications, including bone injury and low magnesium levels.
PPI’s carry serious risks, and manufacturers have been accused of not always alerting consumers of all the possible dangerous health complications.
As a result, patients who have experienced adverse health effects with PPI use have filed lawsuits against manufacturers, seeking compensation for their pain, emotional distress and medical expenses. PPI manufacturers also have faced lawsuits over complaints such as misbranding, deceptive advertising and kickbacks.
Some of the complaints were brought forth as class action lawsuits; others were consolidated under a multidistrict litigation (MDL).
Popular PPIs and manufacturers named in litigation include:
|AstraZeneca||Nexium (esomeprazole magnesium)|
|Proctor & Gamble||Prilosec OTC (omeprazole magnesium)|
|Takeda Pharmaceuticals||Prevacid (lansoprazole)|
|Pfizer Inc.||Protonix (pantoprazole sodium)|
The first wave of individual lawsuits claimed PPIs such as Nexium had caused or contributed to bone fractures and other bone conditions. These followed studies showing PPIs can inhibit the body’s ability to absorb calcium and increase the risk of fractures. The U.S. Food and Drug Administration (FDA) issued a safety communication about the risk and ordered manufacturers to add the warning to prescription and over-the-counter (OTC) PPIs in 2010.
More recently, research has indicated PPIs increase the risk of serious kidney damage or injury. In December 2014, the FDA required PPI manufacturers to add warnings to their product labels about the risk of acute interstitial nephritis, a condition that could advance to permanent kidney damage or renal failure.
Since 2016, there have been multiple lawsuits claiming PPIs caused kidney damage and that manufacturers failed to warn people about the risk for years.
A Timeline of PPI Lawsuits
First Nexium lawsuit is filed against AstraZeneca, claiming it led to a woman’s bone fractures
Prevacid lawsuit filed against Takeda Pharmaceuticals claiming Prevacid use led to plaintiff’s bone fractures
The U.S. Judicial Panel on Multidistrict Litigation (JPML) combines 47 Nexium lawsuits in a single multidistrict litigation (MDL) in federal court
More than 500 plaintiffs file Nexium lawsuits in a California federal court over fractures or other bone conditions they claim were caused by Nexium
Pfizer pays $55 million to the U.S. government to settle claims the company promoted the PPI Protonix for unapproved uses
Massachusetts federal court approves a Nexium class-action lawsuit against AstraZeneca
Consumer group Public Citizen files federal lawsuit to force the FDA to add “black box warnings” of serious risks to all PPIs
AstraZeneca settles Nexium class action lawsuit for $20 million
AstraZeneca pays $7.9 million to the U.S. government to settle claims it engaged in a kickback scheme involving Nexium
Generic drug manufacturer Teva Pharmaceuticals pays $24 million settlement to plaintiffs who claimed it accepted money from AstraZeneca to keep a generic form of Nexium off the market
First Nexium kidney damage lawsuit is filed against AstraZeneca
JPML denies motion to combine 39 federal lawsuits against various PPI manufacturers into a single MDL
JPML reconsiders request to combine 163 lawsuits against various PPI manufacturers into an MDL
JPML centralizes 161 PPI cases into one action before U.S. District Judge Claire C. Cecchi in New Jersey
PPI Lawsuit Claims
Lawsuits against AstraZeneca, Pfizer, Wyeth and other defendants accuse the drug makers of being negligent; designing, manufacturing and selling defective products; and failing to adequately warn that taking prescription and over-the-counter PPIs could cause severe injuries to the kidneys and bones.
George Mullen, for example, filed a lawsuit against AstraZeneca on May 19, 2017 over allegations that its PPI Nexium caused his chronic kidney disease.
Mullen’s suit (Mullen v. AstraZeneca Pharma) alleges he took Nexium “on numerous occasions” between September 2006 and September 2013. Mullen says he took the stomach-acid drug as prescribed by his doctor, and he read and followed the directions regarding the use of Nexium.
In 2008, Mullen suffered chronic kidney disease, for which he blames Nexium. Mullen would not have used the medication had he been “properly appraised of the risks associated with the use of Nexium,” according to his lawsuit.
Mullen claims AstraZeneca knew or should have known about the link between Nexium use and the significantly increased risk of chronic kidney disease, acute kidney injury and renal impairment. But the company failed to adequately warn against the negative effects and risks associated with Nexium, the suit alleges.
The lawsuit also accuses AstraZeneca of omitting, concealing and inadequately providing critical safety information regarding Nexium use to Mullen and his doctors in order to mislead them and sell the medication. It calls the company’s alleged conduct “fraudulent, unfair and unlawful.”
“Despite clear knowledge that Nexium causes a significantly increased risk of [chronic kidney disease, acute kidney injury] and renal impairment, defendants continue to market and sell Nexium without warning consumers or healthcare providers of these significant risks.”
- According to the lawsuit
Sherry Jackson and Janice Allen also sued AstraZeneca after taking Nexium. They filed their lawsuit in district court in Harris County, Texas along with about 35 other women who all claim to have suffered bone injuries caused by the PPI.
Jackson says she took Nexium every day for six years, beginning in 2004 until she was diagnosed with severe bone loss and osteoporosis. In 2007, Jackson suffered a debilitating back injury. Her vertebrae unexpectedly crumbled, requiring back surgery, according to the lawsuit.
Allen began taking Nexium every day in 2003, and as a result, she suffered numerous fractures, including two breaks in her left foot, two broken ribs, a broken right foot that required surgery and a broken left ankle, according to the lawsuit. She says a bone density scan from 2010 showed severe bone deterioration.
The women accuse AstraZeneca of being negligent in failing to properly educate health care providers regarding Nexium and its adverse effects on patients as well as failing to provide patients and health care providers with accurate product safety information, despite knowing the increased risk of osteoporosis and fractures associated with Nexium use. They also allege the company committed fraud, defectively designed and marketed Nexium and engaged in negligent misrepresentation by supplying consumers with false information.
Mullen, Jackson and Allen are among hundreds of people who have made similar claims against PPI manufacturers.
Plaintiffs allege PPIs caused:
- Kidney injury
- Acute interstitial nephritis
- Chronic kidney disease
- Renal failure known as end-stage renal disease
- Acute kidney injuries
- Bone injury
- Bone deterioration
- Loss of bone density
- Bone fractures
PPI manufacturers are accused of:
- Deceptive advertising
- Negligent misrepresentation
- Failure to warn of PPI side effects
- Accepting kickbacks
- Designing, manufacturing and selling defective products
Multidistrict Litigation: Proton Pump Inhibitor Kidney Injury
In 2016, PPI users who filed six lawsuits against the drugs’ manufacturers asked a federal judicial panel to consolidate all federal PPI kidney injury cases into a single multidistrict litigation (MDL). This centralization process is intended “to avoid duplication of discovery, to prevent inconsistent pretrial rulings and to conserve the resources of the parties, their counsel and the judiciary,” according to the U.S. Judicial Panel on Multidistrict Litigation (JPML). Such action is taken when civil lawsuits pending in different federal districts involve one or more common questions of fact.
When plaintiffs requested the MDL transfer in October 2016, 15 actions asserting similar claims regarding PPIs were pending in 12 district courts. By February 2017, the number of related federal actions had more than doubled, reaching 39 actions. Complainants alleged they “suffered and continue to suffer from kidney injuries including but not limited to, acute interstitial nephritis, chronic kidney disease or renal failure known as end-stage renal disease, and acute kidney injuries” as a result of using PPIs, according to the motion.
They further alleged that AstraZeneca Pharmaceuticals LP, Takeda Pharmaceuticals USA Inc. and Pfizer Inc., along with others involved in the manufacturing of the drugs, failed to adequately warn about the risk of kidney injuries related to the use of Prilosec, Nexium, Prevacid and other PPIs.
“Given the widespread use of PPIs and their defective nature, it is likely that additional claimants will be harmed by the medications and additional similar actions will be filed in or removed to federal courts in the future,” Paul J. Pennock, Esq., of Weitz & Luxenberg, P.C., said in the plaintiffs’ motion.
In May of 2017, plaintiffs filed a new motion to consolidate over 170 lawsuits. All suits claim PPI manufacturers did not adequately warn of “irreparable harm” to the kidneys.
The JPML denied the MDL request in February 2017. In its order denying transfer, the panel said it recognizes the actions all arise from plaintiffs’ allegations that taking PPIs may result in various types of kidney injury, but the named defendants vary from action to action and are competitors. AstraZeneca is sued in most of the actions (37 actions), but Proctor & Gamble is sued in only eight, Takeda in four and Pfizer in two. The panel also took issue with the variety of kidney injuries alleged and the differences among the drugs, including the different FDA approval times and the fact some are available over-the-counter while others require a prescription.
On May 31, 2017, plaintiffs filed a new motion to consolidate pending lawsuits filed in 30 different federal courts in 21 states. All of the lawsuits claim PPI manufacturers failed to adequately warn that taking the drugs could cause “irreparable harm” to the kidneys. In the motion, plaintiffs asked the JPML to centralize the lawsuits under U.S. District Judge Claire C. Cecchi in the District of New Jersey. Judge Cecchi is already presiding over 62 of the 172 cases.
This time, the JPML agreed with the plaintiffs. On August 2, 2017, the panel ordered 161 PPI lawsuits into a single MDL under Judge Cecchi.
The panel cited the fact that even AstraZeneca and Pfizer agreed with people suing the companies that “the number of 4 involved actions, districts, and plaintiffs’ counsel has increased significantly” since the previous request. The JPML pointed to a growing number of state lawsuits over PPIs in reconsidering its earlier decision.
“Although several of the grounds on which we denied centralization in Proton-Pump I remain largely valid, we find that the significantly larger number of involved actions, districts, and counsel, the concomitant increase in burden on party and judicial resources, and the opportunity for federal-state coordination, coupled with most defendants’ change in position to now support centralization, tip the balance in favor of creating an MDL,” the panel wrote in its transfer order.
The JPML selected the New Jersey court because more than 60 of the cases in the MDL had already been filed there – more than any other federal district. It also pointed out that the location was conveniently located was supported by most plaintiffs and at least three of the defendants.
Nexium and Prilosec Lawsuits
AstraZeneca has paid tens of millions of dollars to resolve lawsuits filed over its PPIs Nexium and Prilosec. In fact, the company paid $20 million in 2015 to settle one class action lawsuit involving both drugs.
In February 2015, AstraZeneca was found liable for promoting Nexium as more effective in treating acid reflux than its cheaper and nearly identical sister drug, Prilosec. The litigation for this claim lasted 10 years and came to an end with the $20 million settlement. The class action lawsuit proved AstraZeneca had attempted to “evergreen” the drug. This means that AstraZeneca allowed its patent on Prilosec to run out and then created Nexium — a new, nearly identical drug that was much more expensive — to replace it.
AstraZeneca spent $260 million marketing Nexium to American consumers, who in turn launched several lawsuits against AstraZeneca when it was discovered the two drugs were almost chemically identical. In that class action lawsuit, consumers alleged the company’s marketing campaign tricked consumers into buying the more expensive Nexium rather than Prilosec, even though the drugs have the same effect.
In 2008, the pharmaceutical company won a similar case over the Prilosec and Nexium marketing in which pharmacies like Walgreens and Rite Aid sued it for violating antitrust laws. The U.S. District Court for the District of Columbia dismissed the complaints and ruled that the pharmacies did not show that AstraZeneca violated antitrust laws by how it marketed Nexium. “The court said AstraZeneca was within its rights to market Nexium to the detriment of Prilosec,” according to a Reuters report.
AstraZeneca also has faced several lawsuits claiming the company did not warn its customers against all of the possible side effects and produced a defective product. Patients who developed bone fractures and low magnesium levels joined class action lawsuits against the pharmaceutical company, many of which resulted in updated warning labels.
Today, AstraZeneca continues to fight claims over Prilosec and Nexium brought by federal and state governments and by consumers.
Nexium Kick-Backs, Pay-for-Delay and Underpaid Rebates
In 2015, AstraZeneca said it would pay the U.S. government $7.9 million to resolve kickback allegations involving Nexium. The federal government alleged AstraZeneca agreed to pay pharmacy-benefit manager Medco Health Solutions in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco lists that give details of medicines that may be prescribed. The government further alleged that AstraZeneca provided some or all of the payment to Medco through price concessions on drugs including Prilosec, Toprol XL and Plendil.
“Hidden financial agreements between drug manufacturers and pharmacy benefit managers can improperly influence which drugs are available to patients and the price paid for drugs,” then-Deputy Assistant Attorney General Joyce R. Branda said in a U.S. Justice Department press release.
“Hidden financial agreements between drug manufacturers and pharmacy benefit managers can improperly influence which drugs are available to patients and the price paid for drugs.”
— Joyce R. Branda, Former Deputy Assistant Attorney General
In addition to kickbacks, AstraZeneca is accused of participating in a pay-for-delay scheme, which is when a pharmaceutical company pays another drug manufacturer to hold off on selling a generic version of a particular drug. AstraZeneca was the focus of a class action lawsuit that claimed the company essentially paid off Teva Pharmaceuticals to delay its release of a generic version of Nexium. Teva paid a $24 million settlement to the U.S. government, freeing itself from the case. In January 2015, Teva announced that the FDA had approved its generic equivalent of Nexium.
Also in 2015, AstraZeneca agreed to pay the U.S. government and several states $26.7 million plus interest to settle claims that the pharmaceutical company underpaid rebates owed under the Medicaid Drug Rebate Program, according to the U.S. Justice Department.
Class-Action Nexium Marketing Lawsuits
Class action lawsuits over Nexium accuse AstraZeneca of using billions of dollars in advertising, promotions and other marketing to persuade consumers to choose Nexium over much cheaper options like generic drugs and Prilosec. Complainants allege the company wrongfully and deceptively presented Nexium as more effective in treating acid reflux. In one example of a class action lawsuit, 512 people from across the U.S. filed a case against AstraZeneca in U.S. District Court in 2012.
The case makes several claims against the pharmaceutical company, including:
AstraZeneca did not use “ordinary care” when manufacturing and selling Nexium, which caused the plaintiffs’ injuries. The lawsuit states AstraZeneca failed to carry out health and safety inspections, adequately warn future users of harmful side effects, use care when labeling and selling the product, and advise future users how to properly use the drug.
AstraZeneca did not disclose the harmful side effects of Nexium, therefore misrepresenting its product as safe. According to the suit, the company failed to disclose the harmful side effects, explain protocol for taking Nexium, and disclose to medical professionals Nexium’s clinical evidence and product safety profiles.
AstraZeneca financially benefited from intentional misrepresentation of its product by making unsubstantiated claims to persuade the plaintiffs to buy Nexium.
AstraZeneca “defectively designed, manufactured, and marketed Nexium,” and because of these defects the plaintiffs suffered.
Nexium Bone Injury Lawsuits
Hundreds of consumers have filed lawsuits against AstraZeneca, alleging Nexium caused bone deterioration, loss of bone density and bone fractures.
In 2011, Ginny Begin of Toledo, Ohio, filed a lawsuit against AstraZeneca. According to the complaint, Begin had been taking Nexium when she broke a bone in her leg during everyday activities. Two years later, the same bone broke — along with two others — as she was descending the stairs. Begin’s attorneys claim that the pharmaceutical company was aware of the risk of fractures but did not inform Nexium users.
Attorneys claim that AstraZeneca was aware of the risk of bone fractures but did not inform Nexium users.
Also in 2011, more than 30 Texans filed a Nexium bone fracture lawsuit. Several plaintiffs shared their story with the local NBC TV news station, Local 2. The lead plaintiff, then-49-year-old Natalie Stempfer, said she fractured a bone in the middle of her foot while walking in the mall. She told the news outlet her doctors had never seen that type of fracture before, and it has since led to the development of a chronic pain condition that requires her to wear a boot.
Another plaintiff in the case, then-47-year-old Cindy Davidson, said she broke her leg when roller skating with her daughter. According to court documents, the only male injured in the case — then-9-year-old Cole Williams — fractured his right hand after taking Nexium for a year and a half. The plaintiffs charged AstraZeneca with negligence. They alleged the company failed to warn users of side effects, misrepresented the drug, committed fraud and produced a defective product.
Nexium Bone Injury MDL
In December 2012, the U.S. Judicial Panel on Multidistrict Litigation created an MDL in the Central District of California to merge Nexium bone-injury lawsuits representing more than 1,000 plaintiffs. In October 2014, U.S. District Judge Dale S. Fischer granted a defense motion to exclude plaintiffs’ general causation expert and granted summary judgment. The court said it questioned the reliability of the expert testimony and said without it, the plaintiff’s cannot establish their cases. The court then entered judgment in favor of defendants AstraZeneca and McKesson Corporations and against all plaintiffs. In its order, the court said the plaintiffs shall recover nothing and the defendants shall recover their costs of suit.
The federal plaintiffs appealed the judgment, and the Ninth Circuit affirmed the dismissal of about 270 claims. About 40 plaintiffs who assert Nexium caused bone injury appealed the dismissal of their claims to the California Second Appellate Division, which also affirmed the district court’s judgment. The MDL, known as MDL-2404 IN RE: Nexium (Esomeprazole) Products Liability Litigation, officially closed on January 4, 2017, according to the U.S. Judicial Panel on Multidistrict Litigation website.
Still, many plaintiffs found success in these cases, including a class action suit from 2014 that forced the FDA to require stricter warnings on the labels of Nexium and other proton pump inhibitors. Because of this case, Nexium labels now clearly state reduced bone density and risk of bone fractures is a possible severe side effect.
Nexium Kidney Injury Lawsuits
A Nexium patient who developed chronic kidney disease and received a kidney transplant filed the first federal kidney disease case against AstraZeneca in May 2016. The suit alleges the pharmaceutical company received complaints about Nexium’s link to kidney injury as early as 2004, yet continued to market the drug aggressively without adjusting its warning label.
Harry Mason from Madison County, Illinois, filed the lawsuit against AstraZeneca in the U.S. District Court, Southern District of Illinois. Mason claimed that he began taking Nexium in 2006, which led to chronic kidney disease and kidney failure. He was able to survive only after undergoing a kidney transplant. His complaint stated that he was seeking actual and compensatory damages and punitive or exemplary damages. Mason voluntarily dismissed his lawsuit in March 2017, court records show.
Prilosec OTC Class Action Lawsuit
Thomas Mitchell began taking Prilosec OTC in July 2008 at the advice of his physician. On October 1, 2008, Mitchell attended a buffet-style dinner party after which he became ill. The next day, Mitchell visited his physician with complaints of diarrhea, night sweats and fever. Mitchell’s physician prescribed an antibiotic.
According to the class action complaint filed, “Defendants marketed and sold Prilosec OTC but failed to adequately warn users of certain dangers which defendants knew or should have known were the result of using Prilosec OTC.”
In May 2009, Mitchell initiated a class action against Proctor & Gamble and AstraZeneca PLC in the U.S. District Court for the Southern District of Ohio. The class action alleged that the manufacturers failed to warn consumers that Prilosec OTC can increase the chances of contracting food poisoning.
The district court dismissed the case without prejudice in March 2010 to allow Mitchell to plead his claims under the Ohio Product Liability Act.
Nexium is not the only PPI named in bone-injury lawsuits. In 2012, David S. Tatum of Philadelphia, Pennsylvania, sued Prevacid manufacturer Takeda Pharmaceuticals, claiming that the company failed to warn him about the drug’s ability to weaken his bone structure and cause fractures. As a result of taking Prevacid, Tatum’s bones weakened so much that he required a hip replacement, according to the complaint. A judge dismissed the case in March 2014, stating the issues between the parties had been settled.
Pfizer Inc. agreed to pay a $55 million settlement plus interest to the U.S. government, which alleged that the drug maker misbranded its PPI, Protonix. The government says Pfizer’s sales force promoted Protonix to physicians for unapproved uses. Sales reps were only supposed to market the drug for specific forms of GERD. However, the company trained its salespeople to push Protonix for treatment of all forms of the condition, according to the U.S. Justice Department. The Justice Department announced the settlement Dec. 12, 2012.
Potential for Future Proton Pump Inhibitor (PPI) Lawsuits
In addition to bone injury, kidney injury and low magnesium levels, PPIs have been linked to an increased risk of dementia, stroke and heart attack. Researchers found patients who regularly used PPIs were 44 percent more likely to develop dementia and 21 percent more likely to have a stroke. They also found a 16 to 20 percent increase in heart attack incidence among PPI users. As further PPI research emerges, attorneys say more people injured by these drugs may file lawsuits. Recent PPI Side Effect Studies
|Study Date||Investigated Side Effect||Findings Among PPI Users|
|April 2015||Acute Kidney Injury||Rate of acute kidney injury more than doubled|
|June 2015||Heart Attack||Heart attack rate increased 16 to 21 percent|
|February 2016||Chronic Kidney Disease||20-50 percent higher chronic kidney disease risk|
|February 2016||Dementia||44 percent increased dementia risk|
|November 2016||Stroke||21 percent increased stroke risk|
Emily Miller holds five Health Literacy certificates from the Centers for Disease Control and Prevention as well as a Bachelor of Science in Journalism from the University of Florida. She was diagnosed with a chronic illness as a child and has firsthand experience with many of the topics she writes about as a member of the Drugwatch team. Emily is an award-winning journalist who has reported on health and legal news for reputable organizations, including the South Florida Sun Sentinel, San Antonio Express-News, UF Health News and Reporters Committee for Freedom of the Press. She draws on her background as both a patient and a journalist to help readers understand complex health and legal topics.