FDA says Pepcid and Prilosec do NOT contain carcinogen in Zantac

In the wake of Zantac recalls, the Food and Drug Administration (FDA) assured Americans that alternative heartburndrugs like Pepcid, Nexium, Prilosec and Prevacid are safe and do not contain cancer-causing chemicals, the agency said Wednesday. 

Last month, Zantac and its generic, ranitidine, tested positive for NDMA, a chemical linked to colon, gastric, kidney and liver cancers. 

Major retailers like Walmart, CVS and Walgreens quickly pulled the drugs from their shelves, and distributors outside the US voluntarily recalled the drugs in Europe and Asia. Its US maker, Sanofi, finally followed suit last week. 

In the wake of the findings, the FDA notified the Americans that five other popular over-the-counter heartburn drugs have been previously tested and do not contain NDMA – though some may carry other risks, including early death. 

The FDA advised that patients taking prescription Zantac or ranitidine should speak to their doctors about whether or not to switch to other drugs so that their physicians can help them weigh the benefits and risks of a change. 

On Wednesday the FDA advised that at least five alternatives to Zantac – including Pepcid, Tagamet and Prilosec are free of the cancer causing chemical in Zantac. But the other popular options may come with their own risks, including early death, if taken long term 

‘Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition,’ the agency wrote in a statement. 

‘FDA’s preliminary tests of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these tested medicines at this time.’


Zantac and ranitidine are known as H2 blockers, a class of heartburn drugs that have gained favor in the eyes of providers in recent years.  

Studies have suggested that one of the other main groups of heartburn medications – a class called proton pump inhibitors (PPIs) – may pose risks by disrupting the way the body absorbs certain nutrients. 

They’ve also been linked to higher risks for heart and kidney disease, stomach cancer and C diff infections in some patients. 

One recent Washington University, St Louis, study found that people who took PPIs for months or years were at a 17 percent higher risk of death compared to patients who took H2 blockers.  

PPIs, which include Nexium and Prilosec, work by suppressing the final stage of acid release in the stomach, where as H2 blockers prevent some acid from being released by interfering with receptors involved in the earlier stages of the digestion process. 

Aside from the potentially carcinogen-laced Zantac, other H2 blockers include nizatidine (Axid), fanotidine (Pepcid and Pepcid AC), and cimetidine (Tagamet and Tagamet HB). 

Axid was not mentioned by name in the FDA’s statement, but it confirmed that no NDMA has been found in the H2 blockers Pepcid or Tagamet, nor has the carcinogen been detected in several popular PPIs. 

It’s for patients and their doctors to weigh the risks and benefits of each of these drugs.  


NDMA is the acronym for N-Nitrosodimethylamine, a chemical byproduct of many industrial manufacturing processes. 

The compound can be disruptive to DNA, which may cause cancer. 

It doesn’t degrade, or break down, naturally in the environment or our bodies, meaning that it accumulates over time and our exposures only build up, earning it the nickname ‘forever chemical.’

NDMA is created in the production of rocket fuel, from which it has leached into our water supply. 

It’s also common in low quantities in many foods, such as cured or smoked meats, fish and beer as well as tobacco smoke. 

Animal studies have shown the chemical to cause colorectal, kidney, stomach and kidney cancers at high exposures. 

In humans, on the other hand, studies have only linked the chemical to higher risks of cancers. 

No human cases of cancer caused by NDMA have been reported, and the  World Health Organization (WHO) considers it a ‘probable’ human carcinogen. 

Earlier this year, it was found in an entire class of blood pressure drugs – the most widely known of which is valsartan – leading to worldwide recalls and shortages, despite the FDA’s statement that the drug poses limited risks. 

‘There have been no adverse events’ linked to Zantac, Dr Inna Hussain, head of laryngology at Rush University Medical Center told DailyMail.com. 

‘The concern is that at high enough doses, NDMA can be carcinogenic, but what does isn’t clear.’ 

We don’t know yet if NDMA got into ranitidine during its production or if the toxin is a byproduct of the drug itself. 

It could be that Zantac ‘is breaking down and becoming NDMA, which is much more concerning,’ said Dr Hussain. 

She notes that it’s those who use the drug continuously for the management of chronic heartburn who are likely to be at the greatest risk.  


Zantac and its active ingredient, ranitidine are members of a class of drugs called H2 blockers. 

In recent years, doctors have preferred to prescribe this group of this drugs for patients with less severe heartburn. 

Aside from ranitidine, or Zantac, patients can also take:

  • Nizatidine (known by the brand name Axide)
  • Famotidine (sold as Pepcid and Pepcid AC) and 
  • Cimetidine (sold as Taagamet and Tagemet HB)

These drugs all block certain receptors that trigger the release of stomach acid. 

Although the FDA is now investigating heartburn drugs broadly, there have not yet been reports of NDMA linked to any of the other H2 blockers. 

The other most commonly-used class of drug for heartburn is proton-pump inhibitors (PPIs). 

These include: 

  • The blockbuster ‘purple pill,’ Nexium (sold generically as esomeprazole magnesium)
  • Pirlosec (omeprazole) 
  • lansoprazole (Prevacid)
  • Pantoprazole (Protonix) 

PPIs block the final stage of acid production in the stomach, helping soothe symptoms for reflux sufferers. 

These are highly effective and are recommended for people with more severe acid reflux as they reduce the risks for developing complications, like esophageal cancer, that can arise if the condition persists, untreated. 

But they interfere with he way the body absorbs nutrients like magnesium and B12 and people that are on high doses for too long may be at higher risk for C diff infections and kidney disease. 

‘We need to take a step back and say “why are people on this any way when there are more natural ways to treat symptoms?”‘ said Dr Hussain. 

She noted that dietary changes, making sure to leave plenty of time between dinner and going to bed and wearing lighter, looser garments can help keep acid from pushing up from our stomachs. and causing heartburn. 

There’s even an all natural treatment that uses algae to fight heartburn, called Reflux Gourmet, which she suggests to many patients. 

And many don’t really need to treat a gastric issue, but simply the occasional symptoms.

‘There’s a different category of medications for active symptoms of heart burn, and the best thing is Tums because that works immediate, but you would take them to stop it, but not to prevent heartburn,’ said Dr Hussain.



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