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Proton pump inhibitors: avoid unjustified risks, and know how to "deprescribe"

It is better to be aware of the harms of prolonged use of proton pump inhibitors (drugs for gastrointestinal disorders), and to avoid prescribing or advising these drugs too readily.

Proton pump inhibitors (PPIs) reduce the secretion of gastric acid by the gastric wall. The PPIs currently available are esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole. They are authorised for use in oesophagitis, gastroesophageal reflux disease and peptic ulcer disease.

When a PPI is withdrawn after a few weeks of treatment, acid rebound can occur, resulting in acid regurgitation and heartburn, encouraging continued PPI use. It is therefore worth using an antacid after stopping a PPI, during the period when rebound acid hypersecretion could occur. The use of an antacid can also enable patients to avoid starting PPI therapy in the first place.

Prolonged PPI use can cause a range of sometimes serious adverse effects, such as: bacterial infections of the digestive tract or lungs; bone fractures, muscle and joint pain; reduced levels of sodium, magnesium and calcium in the blood; kidney problems; and an increased death rate.

PPIs are heavily prescribed around the world and commonly used in ways for which they are not licensed: prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with no risk factors for peptic ulcer disease; at doses exceeding the maximum officially recommended doses; and for long-term treatment by one-fifth of patients.

France’s National Authority for Health is encouraging healthcare professionals to deprescribe PPIs, a welcome initiative for patients.

©Prescrire 1 July 2021

Source: "Proton pump inhibitors: know how to avoid unjustified risks and how to “deprescribe”" Prescrire International 2021; 30 (228): 186-187. Subscribers only.

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