AGA clinical practice update: De-prescribing PPIs reduces costs, risks for adverse events
Click Here to Manage Email Alerts
The AGA has issued a clinical practice update on de-prescribing proton pump inhibitors, according to an article in Gastroenterology.
“Although PPIs are the treatment of choice for the management of acid-mediated upper gastrointestinal conditions, these agents are being used increasingly for less clear indications and for indeterminate durations,” Laura E. Targownik, MD, MSHS, a gastroenterologist at Mount Sinai Hospital and associate professor of gastroenterology and hepatology at the University of Toronto, and colleagues wrote. “As PPI use has become more common, the emerging literature has identified several adverse effects potentially linked to these drugs. ... This concern may promote inappropriate discontinuation of PPIs when a strong indication for use exists.”
In addition to the risks associated with long-term PPI use, researchers noted that over-prescription contributes to polypharmacy and increases economic cost and pill burden.
Under the guiding principle that no patient should be prescribed any medication when there is not a reasonable expectation of benefit, Targownik and colleagues created 10 best-practice advice statements for PPI de-prescription, which fall under the key domains of PPI indication documentation, identification of suitable de-prescription candidates and optimized de-prescription success.
Highlights of the advice statements include:
- All patients taking PPIs should undergo regular review for their ongoing indication for use; those without a definitive indication for ongoing use should be considered for de-prescribing.
- Most patients on twice-daily PPI dosing may be decreased to once-daily dosing.
- Patients who should not be considered for PPI de-prescribing include those with complicated GERD; a known case of Barrett’s esophagus, eosinophilic esophagitis or idiopathic pulmonary fibrosis; and patients at high risk for upper GI bleeding.
- Both dose tapering and abrupt discontinuation can be considered as PPI de-prescribing methods.
- Prescribers should advise patients that discontinuation may lead to development of transient upper GI symptoms.
- The decision to discontinue PPIs should be based on lack of indication for use, not concern for PPI-associated adverse events.
“The decisions about PPI discontinuation are complex and nuanced, and consequences for inappropriate or poorly considered discontinuation can be significant. Conversely, the unchecked use of PPIs in situations when indications are absent or murky is a major contributor to health care costs, and even a small risk of medical harm is significant in the complete absence of benefit,” Targownik and colleagues concluded. “We are hopeful that these best practice advice statements will be valuable to the clinician and patient in providing guidance for approach and decision-making about this issue.”
Collapse
Read more about
Click Here to Manage Email Alerts