Proton pump inhibitors (PPIs) are a very commonly prescribed
class of drugs for patients with acid peptic disorders. They have been
generally regarded as safe and well tolerated. And, their long-term use is
common. However, recently, there have been concerns about the use of PPIs,
especially long-term use. PPIs have been linked to increased risk of
osteoporotic fractures, pneumonia, Clostridium difficile infection and rebound
acid hypersecretion, especially in the older population. Long-term use may also
affect patient compliance to the prescribed treatment. Evidence-based
recommendations published in the May 2017 issue of Canadian Family Physician to
help the physician decide when and how to safely stop the PPIs or reduce their
dose, called ‘deprescribing’ PPIs. This can be done in three ways:
• Reducing the dose by ‘intermittent’ use for a fixed
duration; ‘on-demand’ use or using a lower ‘maintenance’ dose.
• Stopping the drug can be done by abruptly discontinuing the
drug or via a tapering regime.
• Stepping down means abrupt discontinuation or PPI tapering
followed by an histamine-2 receptor antagonist (H2RA) These guidelines
recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks
of PPI treatment for heartburn or mild to moderate gastro=esophageal reflux
disease (GERD) or esophagitis, and whose symptoms are resolved.
• Decrease the daily
dose or stop and change to on-demand use. This has been given a strong
recommendation.
• Or, an H2RA can be considered as an alternative to PPIs.
This alternative has been given a weak recommendation due to the higher risk of
symptoms recurring.
These recommendations are not applicable to patients who
have severe esophagitis grade C or D, or a documented history of bleeding
gastrointestinal ulcers or have Barrett esophagus.
(Source: Can Fam Physician. 2017 May;63(5):354-364)
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