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Reducing adverse effects of proton pump inhibitors
Paul W Ament1, Daniel B Dicola, Mary E James
1Excela Health Latrobe Family Medicine Residency Program, Latrobe, PA, USA. pament@excelahealth.org
American Family Physician
|September 12, 2012
Summary
Proton pump inhibitors (PPIs) effectively treat acid-related conditions. However, long-term PPI use in older adults may increase risks for adverse effects, necessitating careful consideration of appropriateness and duration.
Area of Science:
- Gastroenterology
- Pharmacology
- Geriatrics
Background:
- Proton pump inhibitors (PPIs) are widely used for gastroesophageal reflux disease, erosive esophagitis, duodenal ulcers, and hypersecretory conditions.
- While effective for short-term use, long-term PPI therapy raises concerns regarding appropriateness, drug interactions, and potential adverse effects.
Purpose of the Study:
- To review the risks associated with long-term proton pump inhibitor use, particularly in elderly patients.
- To highlight the importance of judicious PPI use and discontinuation when appropriate.
Main Methods:
- Literature review and synthesis of existing evidence on proton pump inhibitor efficacy and safety.
- Analysis of adverse events associated with long-term PPI use, including fractures, cardiac events, and infections.
Main Results:
- Short-term PPI use is generally safe with few adverse effects.
- Long-term PPI use is linked to potential risks such as hip fractures, cardiac events, iron deficiency, Clostridium difficile infection, and pneumonia.
- Older adults (≥65 years) are more susceptible to these adverse effects due to comorbidities.
Conclusions:
- The long-term use of proton pump inhibitors requires careful evaluation for appropriateness and potential risks, especially in the elderly population.
- Discontinuation of PPIs for stress ulcer prophylaxis is recommended upon ICU discharge unless other indications persist.