NPS launches resource on proton pump inhibitors

PPIs: woman holds red throat

NPS MedicineWise has launched a new learning program and health professional tools on the use of proton pump inhibitors in the treatment of uncomplicated gastro-oesophageal reflux disease.

The program focuses on optimal use of PPIs and provides practice points and tools to facilitate step-down therapy in patients whose symptoms are well controlled.

The success of PPIs is reflected in the fact that over the last decade thy have been consistently listed in the 10 most commonly used PBS-subsidised medicines in Australia (based on defined daily dose, prescription count and cost to the government), says NPS MedicineWise.

Across the 2013–14 financial year there were over 19 million prescriptions for PPIs in Australia.

However, while reflux symptoms such as heartburn are common—about one in five Australian adults experience heartburn at least once a week—not everyone that has heartburn needs to be on prescription medicine, and not everyone that has been prescribed a PPI needs to take it on a regular, long-term basis.

“There is growing international concern over the increasing use of PPIs and about reports associating PPI use with serious, though rare, adverse effects,” NPS MedicineWise Clinical Adviser Dr Jeannie Yoo says.

“Especially in older people, PPI use has been associated with an increased risk of fractures, enteric infection, pneumonia, and vitamin B12, iron and magnesium deficiencies.

“Health professionals are aware that not all patients need to be on a PPI long term, but sometimes unnecessary long-term use can be missed; for instance, if the medicine has been started in a different environment like after surgery.

“When a patient with GORD is started on a PPI, it’s an opportunity to plan a date for review and for a discussion about stepping down therapy if their symptoms are well controlled.

“NPS MedicineWise tools such as the symptomatic management pad can make it easier to discuss recommendations with patients, including lifestyle modifications and options for stepping down therapy,” says Dr Yoo.

The program advocates the optimal use of PPIs, and focuses on when and how to review therapy:

  • Review patients taking a PPI long term to evaluate if the indication persists—daily, long-term use is only recommended in selected groups of patients.
  • Consider risks of PPI use particularly in higher-risk groups such as older people.
  • Discuss with patients the expected initial duration of PPI therapy and plans for stepping down.
  • Consider stepping down PPI therapy in GORD patients once symptoms are well controlled.
  • Review the use of concomitant medicines and advise patients about those that may exacerbate heartburn or reflux symptoms.
  • Encourage lifestyle modifications appropriate to the patient.

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