Proton pump inhibitors: Are we still prescribing them without valid indications?

Akram, Farooq; Huang, Yu-Fang; Lim, Vivien K. G.; Huggan, Paul; Merchant, Reshma Aziz

doi:10.4066/amj.2014.2093

Cited by 26 publications

(20 citation statements)

References 23 publications

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“…Gastric acid suppressive agents were ceased in almost half of patients receiving them in the absence of a confirmed diagnosis of gastro‐oesophageal reflux or peptic ulcer disease, or because symptoms had long since resolved. Comparable rates of inappropriate overuse of proton pump inhibitors in hospitalised older patients have been described by others . This is of concern given the reported associations of increased risk of osteoporosis, Clostridium difficile colitis and community‐acquired pneumonia …”

Section: Discussionmentioning

confidence: 86%

A medication review and deprescribing method for hospitalised older patients receiving multiple medications

McKean

Pillans

Scott

2016

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 86%

A medication review and deprescribing method for hospitalised older patients receiving multiple medications

McKean

Pillans

Scott

2016

Internal Medicine Journal

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“…Another independent factor that was associated with guidelines non‐compliance in this study and reported by previous studies was prescribing of low‐dose aspirin . Low‐dose aspirin is routinely used in primary and secondary prophylaxis of cardiovascular events.…”

Section: Discussionmentioning

confidence: 51%

“…As in other studies, the main factor for guidelines non‐compliance was coprescribing of PPIs with NSAIDs . Indeed, physicians prescribe PPIs for GIBP among patients using NSAIDs as ‘just in case’ without stratifying their patients based on their risk for GI complications.…”

Section: Discussionmentioning

confidence: 87%

“…In addition, multimorbiditity and the use of three or more medications were among factors that were associated with guidelines non‐compliance in this study. However, the results from studies exploring the burden of multimorbidities on non‐compliant prescribing are inconsistent . This could be explained by the use of different methodologies and/or study populations.…”

Section: Discussionmentioning

confidence: 99%

“…Although gastrointestinal bleeding prophylaxis (GIBP) was reported to be the main indication for inappropriate PPI prescribing, outpatient studies that examined the use of PPI for GIBP are scarce. In Lebanon, prior studies have demonstrated over prescribing of PPIs in the non‐ICU inpatient setting .…”

Section: Introductionmentioning

confidence: 99%

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Prescribing of proton pump inhibitors for gastrointestinal bleeding prophylaxis in the Lebanese outpatient setting: patterns, compliance with guidelines and risks

Soubra

Issa

2019

International Journal of Pharmacy Practice

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Objectives To determine patterns of proton pump inhibitor (PPIs) prescribing for gastrointestinal bleeding prophylaxis (GIBP) in the Lebanese outpatient setting, to assess their compliance with guidelines for approved GIBP indications and to delineate independent factors that are associated with non‐compliance. Methods A community‐based multicentre cross‐sectional study was conducted. Eligible patients were those who presented to the community pharmacy setting with a PPI prescription for GIBP. Prescriptions were reviewed by a clinical pharmacist to ascertain their compliance with guidelines approved for GIBP indications. Several variables were tested to determine independent factors that were associated with guidelines non‐compliance. Key findings Of the 720 reviewed PPI prescriptions, 297 (41.25%) were found to be compliant with guidelines approved for GIBP indications. The presence of two or more comorbid conditions, prescribing initiated by a primary care physician, patients taking three or more medications, and prescribing of NSAIDs including low‐dose aspirin were found to be independent factors that were significantly associated with PPI prescribing non‐compliance (P ≤ 0.05). PPIs were also inappropriately coprescribed with corticosteroids (102 (24.1%)), selective serotonin reuptake inhibitors (SSRIs) (48 (11.4%)), amoxicillin‐clavulanic acid (20 (4.7%)) and bisphosphonates (13 (3.1%)) for GIBP. Conclusion This study demonstrated that PPIs were appropriately prescribed for GIBP in less than the half of the study patients. The need for improvement of clinical practice in this regard is therefore indispensable since inappropriate prescribing is costly and put the patient at risk for adverse health outcomes. Strategies to alter inappropriate prescribing may include education, guidelines awareness and decision support systems.

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Practice patterns of reflux medication prescriptions in otolaryngology compared to other specialties

Luetzenberg

Jiang

2019

The Laryngoscope

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Objectives/Hypothesis To describe the trends in proton pump inhibitor (PPI) prescription rates and durations and compare them to those of H2‐receptor antagonists (H2RAs) between 2013 and 2016 in otolaryngology, gastroenterology, and family practice, following the increasing publications on PPI adverse effects and inappropriate prescribing. Study Design Retrospective review of publicly available Medicare Part D prescribing data. Methods PPI and H2RA prescription and beneficiary data were obtained through the Centers for Medicare and Medicaid Services website. For prescription rates, 30‐day fill counts were analyzed nationally and regionally per 10,000 Medicare members. Days supply per beneficiary was examined to show average prescription durations. Results were compared between otolaryngology, gastroenterology, and family practice. Medication‐related economic burden per year was calculated based on reported drug cost. Results From 2013 to 2016, PPI 30‐day fill counts remained stable, whereas H2RA prescription rates increased by up to 62% per 10,000 Medicare beneficiaries. The South consistently prescribed two to three times as much antireflux medication as the lowest prescribing region over time and across all three specialties. The days supply per beneficiary remained stable and ranged from an average of 128 to 203 days depending on the specialty. Antireflux medication‐related healthcare cost decreased steadily. Conclusions Despite numerous publications describing a multitude of adverse events and inappropriate prescribing patterns of PPIs in the past decade, prescription rates and durations per beneficiary have remained stable in the fields of otolaryngology, gastroenterology, and family practice. Additionally, H2RA prescriptions have increased from 2013 to 2016. Level of Evidence NA Laryngoscope, 130:321–327, 2020

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Proton pump inhibitors: Are we still prescribing them without valid indications?

Abstract: Inappropriate prescribing of PPIs without documented valid indications was prevalent among elderly patients at our tertiary teaching hospital in Singapore, providing evidence that shows a similar trend to PPI prescribing to data from Western countries.

Cited by 26 publications

References 23 publications

A medication review and deprescribing method for hospitalised older patients receiving multiple medications

A medication review and deprescribing method for hospitalised older patients receiving multiple medications

Prescribing of proton pump inhibitors for gastrointestinal bleeding prophylaxis in the Lebanese outpatient setting: patterns, compliance with guidelines and risks

Practice patterns of reflux medication prescriptions in otolaryngology compared to other specialties

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