Proton pump inhibitors: use, misuse and concerns about long-term therapy

Abstract

Proton pump inhibitors (PPIs) are widely used in acid-related disorders of the stomach and oesophagus. Treatment with PPIs is usually extended indefinitely for maintaining symptom control, putting the patient at risk of adverse effects. On the other hand, there is also a tendency for physicians to prescribe these drugs unnecessarily for minor dyspepsia. The use of these best-selling drugs is expected to increase further as they are now available over-the-counter in many countries . Several newer PPIs are now available on the market with claims of superior therapeutic efficacy which are also excessively prescribed without considering their cost-effectiveness. This article examines why PPIs are now the leading antisecretory drugs, clinical aspects to be considered when prescribing newer PPIs, indications and recommended duration of treatment in each situation, over-prescription of PPIs, and adverse reactions that can emerge with long-term use.

The dynamic gastric environment and its impact on drug and formulation behaviour

“…Therefore, drug-drug interactions may occur quite regularly in daily practice. One of the most prescribed drugs in this context are the acid secretion-inhibiting drugs, more specifically PPIs, which are prescribed for a multitude of indications (Haastrup et al, 2014;Heidelbaugh et al, 2012;Rakesh, 2011). These types of drugs inhibit gastric acid secretion via several different pathways.…”

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

“…The PPIs and H 2 RAs are extensively overprescribed in human primary and secondary care hospitals. Existing guidelines often are not followed . A similar practice of inappropriate prescription of acid suppressants is commonplace in veterinary medicine.…”

Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal

“…Treatment is often an empirical approach to symptom management rather than evidence based; pharmaceuticals are routinely prescribed without a definitive diagnosis to support GIP use [ 2 ]. Proton pump inhibitors (PPIs) are overprescribed and/or misused [ 3 , 4 , 5 , 6 , 7 ]. Although historically, the safety profile of PPIs has not been called into question, recent studies raise concerns that extended use, particularly when unwarranted, may be deleterious.…”