National Advertising Division Recommends Sanofi Discontinue “#1 Doctor Recommended” Claims for Zantac 360; Sanofi to Appeal

For Immediate Release
Contact: Abby Hills, Director of Communications, BBB National Programs

703.247.9330 /

New York, NY – July 13, 2022 – The National Advertising Division (NAD) of BBB National Programs recommended that Sanofi Consumer Healthcare discontinue “#1 doctor recommended” claims for its Zantac 360 heartburn medicine. Sanofi will appeal NAD’s decision. 

The claims, which appeared on Sanofi’s social media pages, the websites of third-party retailers, and in a television commercial, were challenged by Johnson & Johnson Consumer, Inc., manufacturer of competing Pepcid products.

The parties manufacture and market the leading brands of OTC heartburn medication in a category called Histamine-2 (H2) Blockers which prevent and relieve heartburn by reducing stomach acid. H2 blockers are indicated for mild to occasional heartburn or indigestion.

In 2020, Sanofi introduced Zantac 360, an H2 blocker formulated with the active ingredient famotidine - the same active ingredient used in the challenger’s Pepcid products.

NAD determined that one reasonable message conveyed by the challenged claims that Zantac 360 “contains the #1 doctor recommended medicine approved to both prevent and relieve heartburn” and “with the #1 doctor recommended heartburn medicine” is that Zantac 360 is the #1 doctor recommended product or brand to prevent and relieve heartburn. In so finding, NAD disagreed with the advertiser’s contention that the challenged advertising clearly refers to Zantac’s active ingredient.

NAD came to the same conclusion regarding the “#1 doctor recommended” claim in various iterations of the Google Ads appearing in search results for Zantac 360. NAD determined that in the absence of anything grammatically or syntactically tying “#1 doctor recommended” to the ingredient famotidine or otherwise qualifying the claim, one message reasonably conveyed by the Google Ads is that Zantac 360 is the #1 doctor recommended product for heartburn.

As support for its claims, the advertiser relied on the results of IQVIA survey data that documented physicians’ average weekly recommendations in the acid reducer category. Although NAD considered whether this data could substantiate modified claims that Zantac 360 contains famotidine which, among H2 blockers, is the #1 doctor-recommended ingredient to prevent and relieve heartburn, NAD concluded that it was inadequate support. NAD noted that ingredient-level data cannot be used to support product-level claims and that this same principle applies in reverse. NAD agreed with the challenger that although famotidine-based products received most doctor recommendations in the H2 category, these facts were not a viable substitute for an affirmative active ingredient recommendation and fell short of the evidence required to support a “#1 doctor recommended” claim. 

NAD also concluded that data from a single run question in the March monthly survey directed to active ingredient recommendations in the acid reducer category did not support claims that Zantac 360 contained the #1 doctor-recommended ingredient to prevent and treat heartburn. Although a majority of doctors who responded with an H2 blocker choice selected famotidine as the ingredient they recommend most, NAD noted the recommendations were expressly directed to “frequent heartburn” – a specific, clinically meaningful kind of heartburn and one that is distinct from the indication stated in the challenged claims, e.g., “to prevent and relieve heartburn.” 

For these reasons, NAD recommended that the advertiser discontinue the claims:

  • Zantac 360 “contains the #1 doctor recommended medicine approved to both prevent and relieve heartburn.”
  • “With the #1 doctor recommended heartburn medicine.”
  • “#1 Doctor Recommended.”


In its advertiser statement, Sanofi stated that it will appeal NAD’s decision because it “disagrees with NAD’s conclusions that the underlying IQVIA survey cannot substantiate doctor recommended ingredient claims” and because it “has concerns about the downstream industry-wide ramifications” of this finding. The advertiser further stated that although it “respectfully disagrees” with NAD’s conclusions regarding the “contains the #1 doctor recommended medicine” claim, it will “nevertheless take the NAD’s recommendations with respect to this ruling into consideration in future advertising.”

Appeals of NAD decisions are made to BBB National Programs’ National Advertising Review Board (NARB), the appellate-level truth-in-advertising body of BBB National Programs.

All BBB National Programs case decision summaries can be found in the case decision library. For the full text of NAD, NARB, and CARU decisions, subscribe to the online archive.

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