Potential harms of proton pump inhibitor therapy: rare adverse effects of commonly used drugs

Benmassaoud, Amine; McDonald, Emily G.; Lee, Todd C.

doi:10.1503/cmaj.150570

Cited by 33 publications

(27 citation statements)

References 40 publications

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“…These interventions resulted in a 20.9% relative decrease in PPI use in Veterans after 12 months. More recently in Australia, Pharmacy News released a call for caution on the use of PPIs, emphasizing the lowest dose and shortest possible treatment time to avoid adverse effects, in response to a Canadian review . The Royal College of General Practitioners and NPS MedicineWise, as part of the “Choosing Wisely Australia” initiative, have identified issues that should be questioned by all GPs.…”

Section: Resultsmentioning

confidence: 99%

We have had a gutful: The need for deprescribing proton pump inhibitors

et al. 2017

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SummaryWhat is known and objective: Proton pump inhibitor (PPI) prescribing may often be inappropriate and expose patients to a risk of adverse effects, while incurring unnecessary healthcare expenditure. Our objective was to determine PPI usage in Australia since 2002 and review international studies investigating inappropriate PPI prescribing, including those that discussed interventions to address this issue. Methods: Australian Pharmaceutical Benefits Scheme (PBS) and RepatriationPharmaceutical Benefits Scheme (RPBS) data were analysed. A narrative literature review relevant to the objective was conducted. Time series analysis was also used to examine the trend of reported PPI appropriate use across the international studies included in this review. Results and discussion K E Y W O R D Sdeprescribing, gastro-oesophageal reflux, PPI, prescribing patterns, proton pump inhibitor

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Section: Resultsmentioning

confidence: 99%

We have had a gutful: The need for deprescribing proton pump inhibitors

et al. 2017

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“…The prevalence was similar to that found in recent studies in Australia and The Netherlands but definitely higher than in Finland, France, and the United States, where between 22% and 38% of NH residents were taking PPIs . This suggests an urgent need to avoid the increasing use of PPIs in NHs, optimizing their prescription, because their regular use in NHs has been associated with diarrhea and other adverse events and has heavy implications for drug costs …”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulants and corticosteroids were predictors of inappropriate PPI use: according to evidence‐based recommendations, only patients with a previous complicated peptic ulcer or a combination of risk factors (age > 65, previous uncomplicated ulcer, concurrent use of ASA, or NSAIDs) should receive long‐term PPI, but anticoagulants or corticosteroids alone do not call for gastroprotection . However, both corticosteroids and PPIs raised the risk of community‐acquired pneumonia, osteoporosis, and fractures …”

Section: Discussionmentioning

confidence: 99%

“…PPIs are frequently given in patients who do not meet the criteria for appropriate use or for nonevidence‐based indications; inappropriate prescriptions are of particular concern among elderly patients who normally have multiple comorbidities, take many drugs, and are at higher risk of adverse drug reactions . Although generally well tolerated, PPIs can in fact cause serious adverse reactions, such as community‐acquired pneumonia, Clostridium difficile diarrhea, loss of efficacy of clopidogrel, hip fractures, severe hypomagnesemia with acute neurological manifestations, and delayed diagnosis of gastric cancer, and have been reported to increase all‐cause mortality …”

Section: Introductionmentioning

confidence: 99%

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Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Pasina

Novella

Elli

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: To examine the prevalence of residents receiving proton pump inhibitors (PPIs) for evidence-based indications in a large sample of Italian nursing homes (NHs) and to assess the predictors of potentially inappropriate prescriptions.Methods: This study was conducted in a sample of Italian long-term care NHs. Information on drug prescription, diseases, and socio-demographic characteristics of NH residents was collected three times during 2018. Appropriate use of PPI was defined in accordance with the strongest evidence-based indications and the Italian criteria for PPI prescription.Results: Among the 2579 patients recruited from 27 long-term care NHs, 1177 (45.6%) were receiving PPIs; 597 (50.7%) were taking them for evidence-based indications. Corticosteroids, anticoagulants, and mean number of drugs were the most important predictors of inappropriate PPIs prescriptions. NH residents receiving ≥13 drugs had about 10 times the risk of receiving a PPI than those taking 0 to 4 drugs.Similarly, residents with more comorbidity had about 2.5 times the risk of receiving a PPI than those in better health. The prevalence of residents inappropriately treated with PPI in individual NHs varied widely, ranging from 22% to 63%.Conclusions: Number of drugs, comorbidity, corticosteroids, and anticoagulants are the most important predictors of the inappropriate use of PPI in NHs. The wide variability between NHs in the appropriate use of PPIs suggests the need for thorough drug review in this fragile and vulnerable population. Prescribing patterns linked to evidence-based guidelines and national recommendations are essential for rational, cost-effective use of PPIs. K E Y W O R D Snursing homes, overuse, pharmacoepidemiology, proton pump inhibitors

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“…1 In fact, overuse of PPIs has recently raised concern on their actual safety profile because of the unexpected occurrence of adverse events. 2 Their cardiovascular safety is debated, especially the risk of myocardial infarction in patients without prior history of cardiovascular diseases. 3 Although biological plausibility exists, 4 a causal association is unclear because of selection bias and residual confounders in observational studies.…”

Section: Association Between the Use Of Proton Pump Inhibitors And Camentioning

confidence: 99%

Association between the use of proton pump inhibitors and cardiovascular events: A note of caution

Raschi

Bianchin

Poluzzi

et al. 2017

Neurogastroenterology Motil

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Potential harms of proton pump inhibitor therapy: rare adverse effects of commonly used drugs

Cited by 33 publications

References 40 publications

We have had a gutful: The need for deprescribing proton pump inhibitors

We have had a gutful: The need for deprescribing proton pump inhibitors

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Association between the use of proton pump inhibitors and cardiovascular events: A note of caution

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