Can Omeprazole Cause Kidney Problems?

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. Some omeprazole products are available over the counter (OTC) and some are prescription only. If you’re taking this medication, 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 if omeprazole is bad for your kidneys and how to lower your risks.

Is omeprazole bad for your kidneys?

It’s possible that omeprazole can harm your kidneys. But the answer to whether omeprazole causes kidney problems isn’t as simple as it sounds. 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.

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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 what we know:

• A 2019 study looked at over 90,000 adults with AKI. 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. Only adults over 65 years old were included. The results showed that PPI users had a higher chance of being admitted to the hospital for AKI. But again, this occurred in less than 1% of PPI users.

• A 2017 review of nine studies, and a 2023 review of 12 studies, found that PPIs were associated with developing AKI.

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It’s important to note that all the studies discussed above are observational studies. Observation studies can tell us whether there’s a “correlation” between an intervention and an outcome. For example, whether taking a PPI like omeprazole (the intervention) makes you more likely to have kidney problems (the outcome).

But these studies can’t prove that the intervention caused an outcome (causation). So the research above can’t prove that PPIs cause kidney damage. Studies that establish cause-and-effect relationships — called randomized control trials (RCT) — are more valuable for determining causation.

Omeprazole and chronic kidney issues

Chronic kidney disease (CKD) is the gradual decline of kidney function over time. CKD can be dangerous because it can lead to end-stage renal disease. In severe cases, dialysis or a kidney transplant may be necessary.

Several observational studies have evaluated whether taking PPIs is linked to a higher risk of developing CKD. In the same 2017 meta-analysis discussed above, PPI use was also linked to CKD. But again, the studies included in the analysis had limitations that make the results less certain.

The only currently available RCT studying PPI use and CKD showed that the PPI pantoprazole (Protonix) didn’t increase the risk of CKD in people with heart disease.

Weighing the risks vs. benefits of omeprazole on the kidneys

While it’s possible that omeprazole can cause kidney injury, the overall risk is low. And if you do experience AKI, kidney damage from PPIs is usually reversible. However, AKI may cause other health problems that aren’t always reversible. 

Still, 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:

• Why you’re taking omeprazole: Make sure you understand why you’re taking omeprazole (or any PPI). Ask your HCP if a PPI is the best option for you and how long you’ll need it for.

• How long you’ve been taking omeprazole: 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 HCP or pharmacist about your omeprazole dose. 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 medications that can harm the kidneys, it may be a good idea to avoid omeprazole or use a lower dose.

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 professional (HCP) may recommend avoiding omeprazole. It will likely depend on how severe your kidney damage is, and how much a PPI is expected to help you. For example if you’re treating heartburn or GERD, your provider may recommend another medication like a histamine-2 antagonist (H2 blocker).

Are H2 blockers like famotidine (Zantac 360) safe for your kidneys?

Histamine-2 antagonists (H2 blockers) is another common medication group that treats heartburn and GERD. Examples of H2 blockers include famotidine (Zantac 360, Pepcid AC) and cimetidine (Tagamet HB).

H2 blockers are considered less likely to cause kidney problems than PPIs. But if you have existing kidney damage, you may need a lower dose. This is because the kidneys are responsible for getting rid of H2 blockers from your body. If your kidneys aren’t working as well as they could, H2 blockers can build up in the blood. This increases your risk of H2 blocker side effects, such as headache and dizziness. More seriously, high levels of H2 blockers can cause confusion and liver damage.

Are antacids safe for your kidneys?

Antacids are a common OTC option for treating heartburn. Examples include calcium carbonate (Tums), calcium carbonate / magnesium hydroxide (Rolaids), and magnesium hydroxide (Milk of Magnesia).

Calcium and magnesium levels in the body are regulated by the kidneys. So if someone has lowered kidney function, calcium and magnesium levels can build up in the blood. In this case, you may need a lower dose of your antacid.

Additionally, it’s possible that antacids containing calcium can cause 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.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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