Are PPIs Giving You Heartburn?
December 8th, 2016 | Pharmacy Pearls•GERDBy Matt Devine, D.O.
With all of the holiday food that we are preparing, this discussion is meant to inform all of us on our PPI therapy use. From review of our network’s Excellus commercial pharmacy data, we have confirmed that, like many systems around the country, we have a lot of adult patients in the network that are taking proton pump inhibitors (PPIs).
To learn more about this we have met extensively with Drs. Anil Sharma and Art DeCross who are gastrointestinal specialists for AHP. While they report that the scary days of bleeding ulcers have drastically improved, they both reminded us during these meetings that there are patients that have definite reasons to be on long-term PPIs. Indications for long-term therapy include GI prophylaxis, Barrett’s esophagus, non-healing PUD, non-remitting esophageal strictures/ Schatzki’s ring, erosive esophagitis, Zollinger-Ellison syndrome and refractory GERD. That noted, our specialists also agree that there is a substantial proportion of PPI users that do not have a clear indication for long-term therapy. In addition the media has gotten a hold of possible side effects and adverse effects, and patients are coming into their PCP’s office confused as to what to do in regards to their PPI use.
So after these discussions and reviews, it is possible that you may identify patients that do not need long-term therapy and discontinuation may be appropriate. If a plan is made to wean PPIs, please remember that the medications need to be tapered to avoid rebound hypersecretion. A wean that we have seen success with involves reducing the patient’s dose by 50% every two weeks and then to every other day for two weeks while using H2 blockers and antacids for breakthrough symptoms. It is also important to remember that patients should be advised that, even with a taper, breakthrough symptoms are common.
To help avoid creating “professional heartburn,” we have worked with two of our network pharmacists to create a patient and clinician handout that you can use in your practice along this journey. We will continue to work with our GI colleagues to provide updated pearls and education to help provide information that can help PCPs and others in this project.
Click here to download a Patient PPI handout
Click here to download a Clinician PPI handout
