Pharmacists Skilled at Reducing Inappropriate PPI Use

Patients frequently overuse proton pump inhibitors (PPIs) for unapproved indications in place of more expensive and powerful agents, but this inappropriate PPI use can increase the risk of community-acquired pneumonia, Clostridium difficile diarrhea, hip fractures, and severe hypomagnesaemia.

Patient-centered interventions, such as patient-mediated interventions, educational materials, face-to-face interventions with prescribers, reminders to prescribers, and regulatory interventions, are some effective ways to discontinue PPIs safely. An article published ahead-of-print in the Journal of Clinical Pharmacy and Therapeutics indicates that pharmacists can reduce inappropriate PPI use and help patients discontinue unnecessary PPIs through these interventions.

The Study Group of Community Pharmacists used 9 geographically distinct community pharmacists to assess PPI appropriateness. Each pharmacist enrolled the first patient he or she encountered each week who was using PPIs during the study period. Ultimately, 260 patients were enrolled.

Approved indications for PPIs include the management of gastroesophageal reflux disease, esophagitis, gastric ulcer, bleeding peptic ulcer, eradication of Helicobacter pylori, dyspepsia, Zollinger—Ellison syndrome, and prevention of gastrointestinal toxicity due to nonsteroidal anti-inflammatory drugs (NSAIDs).

Patients commonly remain on PPIs unnecessarily after NSAID therapy is finished or H. pylori is eradicated. The study found that 48% of enrolled patients were using PPIs for an unapproved use (eg, polypharmacy or unknown gastroprotection).

Almost half of patients were considering discontinuation, but only half of those patients had talked to their prescribers about it. Patients without an approved indication were overwhelmingly more likely to have talked to their prescribers about discontinuation (75%), and the predominant recommendation was abrupt discontinuation.

Patients with long-term use should be gradually discontinued (halved dose for 4 to 8 weeks or step down to a H₂RA) to avoid rebound hyperacidity.

Pharmacists were able to provide specific information to patients and encourage them to taper therapy. They also were ideally placed to collaborate with physicians and effectively discontinue patients’ inappropriate PPI use.

Community pharmacists can help patients safely discontinue and reduce PPI overuse. Past studies have shown collaborative practice with general practitioners promotes and improves appropriate drug use.

Lack of access to medical records, possible selection bias, and excluding past users of PPIs limited this study.