Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in Canada and many are becoming available as over-the-counter medications. While generally safe and well-tolerated for short-term use as needed in the treatment of gastro-esophageal reflux disease, PPIs can cause a number of adverse effects which may increase with a patient’s age, long-term use or when the drug is inappropriately prescribed. Some adverse effects associated with long-term use of PPIs include increased risk of fracture, Clostridium difficile infection and diarrhea, community-acquired pneumonia (CAP), vitamin B12 deficiency, and hypomagnesemia. Guidelines indicate a preference for short-term use, H2-receptor antagonists or lifestyle changes over the chronic use of PPIs, and recommend discontinuing PPIs in adults who have completed a minimum of 4 weeks of treatment and whose symptoms have resolved. This does not apply to patients with Barrett esophagus, severe esophagitis grade C or D, or a documented history of bleeding gastrointestinal ulcers.
Sources:
Choosing Wisely Canada. Bye-bye PPI [Internet]. 2017 July [cited 2017 Jun 26].
Farrell B, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017 May;63(5):354-64. PMID: 28500192.
Rx Files. PPI Deprescribing: Approaches for stopping or dose reduction of PPIs in those who may not need lifelong treatment [Internet]. April 2015 [cited 2017 Jun 26].
Yu LY, et al. A review of the novel application and potential adverse effects of proton pump inhibitors. Adv Ther. 2017 May;34(5):1070-1086. PMID: 28429247.
Zagaria, ME. PPIs: Considerations and resources for deprescribing in older adults. US Pharm. 2016;12(41):7-10.