Written by Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP | Reviewed by Nicole Rowe, MD
Key takeaways:
Omeprazole (Prilosec, Prilosec OTC) is a proton pump inhibitor (PPI). PPIs treat gastrointestinal conditions such as heartburn and gastroesophageal reflux disease.
Research shows that PPIs like omeprazole are associated with short-term and long-term kidney damage. But the overall risk is still low.
You can lower your risk of kidney damage and other omeprazole side effects by only using omeprazole when it’s really needed and taking the lowest effective dose for the shortest amount of time possible.
Proton pump inhibitors (PPIs) are a group of medications that treat many gastrointestinal (GI) conditions. This includes heartburn and gastroesophageal reflux disease (GERD).PPIs are one of the most commonly used medications in the world. And omeprazole (Prilosec) is one of the most popular PPIs. If you’re taking omeprazole, you may be wondering about its possible side effects. And more specifically, you may be wondering about long-term risks like kidney damage. Here, we’ll cover what you need to know about omeprazole and its effect on your kidneys.
What is omeprazole?
Omeprazole is a PPI. PPIs are medications that lower the amount of acid in your stomach. This makes them particularly useful for conditions where your body makes too much stomach acid — like heartburn, GERD, and stomach ulcers.
Some omeprazole products are available over the counter (OTC) and some are prescription only. The OTC products include tablets, orally disintegrating tablets, and capsules. The prescription products include capsules and granule packets that can be mixed into water.
OTC omeprazole products are only FDA approved for heartburn. The product label states they should only be taken for up to 2 weeks (14 days). If you’re taking omeprazole OTC and feel you need it for longer than 2 weeks, check in with your healthcare provider. There are cases where your provider may recommend OTC omeprazole for longer than 14 days.
For prescription omeprazole, it’s often needed for 4 to 8 weeks for conditions like GERD and ulcers. And for some other GI conditions, you may need it even longer.
Does omeprazole harm your kidneys?
It’s possible that omeprazole can harm your kidneys. But the answer to this question isn’t as simple as it sounds, so let’s dig into the research.
Below, we’ll cover omeprazole and two possible types of kidney damage it can cause: short-term “acute” kidney injury, and long-term “chronic” kidney disease.
Omeprazole and acute kidney injury
PPIs like omeprazole have been associated with acute kidney injury (AKI). AKI is a sudden worsening of kidney function. Even though it’s often reversible, it can be dangerous. AKI can cause a build-up of waste products in the body, and affect other organs like the brain and heart.
There’s quite a bit of research on PPIs and AKI. Let’s review a couple studies and a meta-analysis conducted over the last two decades:
A 2019 study looked at over 90,000 adults with AKI and compared people taking PPIs to nonusers. The results showed that PPI use was associated with the development of AKI. Still, only a small number — less than 1% — of people taking a PPI in the study experienced AKI.
Another large study compared almost 300,000 PPI users to an equal number of nonusers. This study only included adults who were over 65 years old. The results showed that PPI users had a higher chance of being admitted to the hospital for AKI. But again, the risk of AKI from PPIs was less than 1%.
A 2017 meta-analysis — a review that combines the findings of many studies — of nine different studies found similar results: PPIs were associated with developing AKI. But the authors of this meta-analysis considered the “strength of the evidence” low. This means that the studies included in the review had limitations that could affect how accurate they are.
It’s important to note that all the studies discussed so far are observational studies. While observational studies are valuable pieces of research, they can only tell us so much. Observation studies can indicate “correlation,” or whether an intervention — such as taking a certain medication or changing your diet — might impact someone’s health. But these studies can’t prove that the intervention caused an outcome.
In this case, these studies can’t prove that PPIs cause AKI. Studies that establish cause-and-effect relationships — called randomized control trials (RCT) — are usually considered more valuable for determining findings.
Omeprazole and long-term kidney damage
PPIs like omeprazole have also been linked to chronic kidney disease (CKD). CKD is a gradual decline of kidney function over time. When your kidneys don’t work as well as they should for 3 months or more, you may be diagnosed with CKD. CKD can be dangerous because it can lead to end-stage renal disease. Severe kidney disease can be life-threatening if it isn’t treated. In severe cases, dialysis or a kidney transplant may be needed.
Several observational studies have evaluated whether PPIs are linked to CKD. For example, in the same 2017 meta-analysis of nine studies discussed above, PPI use was not only linked to AKI, but also CKD. But again, the studies included in the analysis had limitations that make the results less certain.
Another meta-analysis of 10 studies found that PPIs were linked to the development of CKD. But again, the researchers considered the evidence weak since most of these studies on CKD were observational studies. The only currently available RCT on PPI use and CKD showed that the PPI pantoprazole (Protonix) didn’t increase the risk of CKD in people with heart disease
It’s possible that antacids containing calcium can lead to kidney stones if you take too much. This is because calcium can build up in the kidneys. But at normal doses, this isn’t usually a concern.
H2 blockers aren’t known to cause kidney problems. But if you have existing kidney damage, your dose may need to be lowered. This is because your kidneys are responsible for getting rid of H2 blockers. If your kidneys aren’t working as well as they could, H2 blockers can build up in the body. This can cause confusion, heart problems, and other brain-related side effects.
Can you take omeprazole if you have existing kidney problems?
Possibly. You don’t necessarily have to avoid omeprazole if you have existing kidney problems. For example, a large observational study of over 25,000 people found that when people with CKD took PPIs, their CKD didn’t get worse. And though some studies link worsening CKD to PPI use, there’s not much evidence for this.
Still, if you have existing kidney damage, your healthcare provider may recommend avoiding omeprazole. It will likely depend on how severe the kidney damage is, and how beneficial a PPI would be for you. For example if you’re treating heartburn or GERD, your provider may recommend another medication like an H2 blocker.
So, what’s the verdict? Can omeprazole hurt your kidneys?
Yes, it’s possible that omeprazole can cause kidney injury. Still, the overall risk is low.
But given the potential risks of omeprazole, it’s important to consider whether you really need a PPI, and for how long. Some research estimates that over 70% of people taking PPIs may not really need them. Here are some things to consider when contemplating whether you need a PPI:
The reason you’re taking omeprazole. Make sure you understand why you’re taking omeprazole (or any PPI). Ask your healthcare provider if a PPI is the best option for you and how long you need to take it.
How long you’ve been taking omeprazole. The research is mixed on whether kidney damage from PPIs is more likely with long-term use. But some research does show that the longer you take them, the greater your risk.
How high your dose is. The risk of kidney problems may be greater with higher doses. Talk to your provider or pharmacist about the dose of your omeprazole. Make sure you’re on the lowest effective dose.
Your medical history and other medications you take. If you have existing kidney problems, or if you take other medications that can harm the kidneys, it may be a good idea to avoid omeprazole or use a lower dose.
Possible “rebound effect” when you first stop taking a PPI. There’s a well-documented phenomenon that heartburn and acid reflux symptoms may actually worsen when you stop taking omeprazole. But there are ways to discontinue your PPI safely.
The bottom line
Omeprazole is a PPI medication that treats conditions like heartburn and GERD. Research has shown it may be linked to AKI and CKD. But the overall risk is still low. The risk may be greater, though, with higher doses, long-term use, or in people who have existing kidney problems. Taking omeprazole with other medications that can harm the kidneys can also raise your risk of kidney damage.
If you’re prescribed omeprazole (or taking it OTC), make sure to take the lowest effective dose for the shortest amount of time possible. If you have questions about why you’re on omeprazole and how long you’ll need it for, talk to your healthcare provider.
References
Antoniou, T., et al. (2015). Proton pump inhibitors and the risk of acute kidney injury in older patients: A population-based cohort study. CMAJ Open.
Cheema, E. (2019). Investigating the association of proton pump inhibitors with chronic kidney disease and its impact on clinical practice and future research: A review. Journal of Pharmaceutical Policy and Practice.
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