Evidence-based and unlicensed indications for proton pump inhibitors and patients’ preferences for discontinuation: a pilot study in a sample of Italian community pharmacies

Pasina, Luca; Urru, Silvana Anna Maria; Mandelli, Sara; Giua, Corrado; Minghetti, Paola

doi:10.1111/jcpt.12371

Cited by 17 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In Europe, the most common inappropriate use of PPI is for the prevention of gastric damage in co-therapy with agents that have a low gastrotoxicity, if any, or in patients without GI risk factors for significant gastroduodenal damage [30, 31, 425–427] as well as in the prevention of stress-induced bleeding [14, 428–430]. PPIs are often started as an inpatient treatment and continued (often long-term) on discharge for non-indicated reasons [14, 431, 432].…”

Section: Discussionmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

323

288

View full text Add to dashboard Cite

BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

show abstract

Section: Discussionmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

323

288

View full text Add to dashboard Cite

show abstract

“…This implies that once the medication has been on a patient's regimen for a protracted period of time, there appears to be no prompts to review the benefit of its continuation. A pilot study in a sample of Italian community pharmacies revealed that 16.2% and 24.6% of patients were on more than 3 years of PPI treatment for licensed and unlicensed indications, respectively . More recently, according to a multicentre observational study conducted in Germany, 42% of hospital‐initiated PPIs were continued by GPs after discharge .…”

Section: Discussionmentioning

confidence: 99%

“…Studies on PPI use in hospital patients from Spain, Italy, Jordan and Germany have found that 74%, 80%, 73% and 52% of patients, respectively, did not meet their country's recommended criteria for PPI use. In addition, a recent study of 260 PPI users in a community setting found that 30% of patients did not have a well‐defined duration of treatment or clinical endpoint …”

Section: Introductionmentioning

confidence: 99%

Appropriateness of proton pump inhibitor use in patients admitted under the general medical unit

Yap

Yip

Edwards

et al. 2019

Pharmacy Practice and Res

View full text Add to dashboard Cite

Background Proton pump inhibitors (PPI) are extensively prescribed internationally and in Australia. However, minimal information is available on the appropriateness of PPI use in the general medical population. Aim This study determined the proportion of general medical unit (GMU) inpatients taking a PPI on admission and evaluated the appropriateness of these PPI prescriptions. Methods A single‐centre prospective observational study was conducted from 6 June to 11 July 2016. Consecutive patients were screened, and those taking a PPI prior to admission were included, whereas those not taking a PPI formed the control cohort. Appropriateness of PPI use was evaluated by: (1) reviewing for concordance with the Australian Therapeutic Guidelines and National Prescribing Service Guidelines on PPI use in gastro‐oesophageal reflux disease; (2) assessment of indication, dose and treatment duration by an expert panel consisting of two general physicians and one senior pharmacist. Results Among 440 consecutive GMU patients, 198 (45.0%) were taking a PPI on admission. Of these, 66.2% had an inappropriate indication, dose or treatment duration. The largest category of inappropriate PPI use was excessive treatment duration (43.4%). In terms of comorbid conditions, PPI users had a higher prevalence of osteoporosis and/or history of fracture (42.9% vs 27.2%; p < 0.001) and hypomagnesaemia (10.6% vs 3.4%; p = 0.003). Conclusion Inappropriate PPI use is highly prevalent among GMU inpatients. Given the potential for adverse effects, unnecessary health expenditure and pill burden, strategies should be developed to aid clinicians to consistently consider the utility of continuing long‐term PPI prescriptions in each patient's situation.

show abstract

“…Moreover, some authors estimate that 25-81% of PPI users lack valid indication. Additionally, among patients with adequate diagnosis requiring PPI (e.g, Helicobacter pylori eradication), many continue PPI utilization despite the reason for it has disappeared meanwhile (6). Pharmacists should help to decrease the inappropriate medication use.…”

Section: Literature Overviewmentioning

confidence: 99%

“…One cross-sectional study recommended patients education about the proper drug cessation (e.g. PPI), particularly because the dose tapering is required to diminish the risk of rebound syndrome (6). It has been suggested that PPI dose should be diminished before cessation.…”

Section: Literature Overviewmentioning

confidence: 99%

Rebound Phenomenon – Important and Ubiquitous in Pharmacotherapy

Koraćević¹,

Lalić²,

Nedeljković³

et al. 2018

AMM

View full text Add to dashboard Cite

The rebound effect represents a common characteristic of the numerous classes of modern drugs and can result in serious and even fatal disorders. For example, prolonged administration of proton pump inhibitor (PPI) leads to moderate hypergastrinemia in 20-25%. This hypergastrinemia will result in rebound gastric acid hypersecretion in 30-40% of patients following the abrupt PPI discontinuation. PPIs are among the most widely used drugs worldwide.An abrupt cessation of chronic corticosteroid, beta blocker, or opioid treatment may also provoke rebound phenomenon. Even in heart failure patients, beta blocker withdrawal on admission resulted in a significant increase of the probability of in-hospital mortality. The incidence of a rebound phenomenon depends on numerous factors, including the intensity and duration of action of a particular drug and how long it has been applied; the susceptibility of an individual patient (regarding the comorbidities and the severity of the primary disease) and the related circumstances (e.g, co-therapy). The clinical importance of the rebound phenomenon varies from academic to lethal. Even rare rebounds found for some classes of drugs are becoming very important if the drug has been used often globally. Acta Medica Medianae 2018;57(4):148-152.

show abstract

Evidence-based and unlicensed indications for proton pump inhibitors and patients’ preferences for discontinuation: a pilot study in a sample of Italian community pharmacies

Cited by 17 publications

References 27 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Appropriateness of proton pump inhibitor use in patients admitted under the general medical unit

Rebound Phenomenon – Important and Ubiquitous in Pharmacotherapy

Contact Info

Product

Resources

About