Appropriate Use and Stewardship of Proton-Pump Inhibitors

Dylan Ren, 2020 PharmD Candidate; Erin Gurney, 2020 PharmD Candidate; Jaime R. Hornecker, PharmD, BCPS, CDE, DPLA


US Pharmacist. 2019;44(12):25-31. 

In This Article

Abstract and Introduction


Proton-pump inhibitors (PPIs) are commonly prescribed to patients or used for self-treatment for a variety of gastrointestinal complaints. While they are very effective, their use does not come without risk, especially when taken long-term. The pharmacist plays an important role in the judicious use of PPIs, particularly in educating patients on appropriate use to maximize their effectiveness and assisting with deprescribing PPIs, when possible.


More than 25% of the population are affected by acid-related conditions, such as dyspepsia or gastroesophageal reflux disease (GERD).[1] A high number of these individuals turn to and depend upon pharmacologic options for symptomatic relief and disease-state management. Since their introduction in 1989, proton-pump inhibitors (PPIs) have become one of the most commonly utilized medications worldwide, accounting for over $11 billion in expenditures annually.[2,3] In the United States alone, it is estimated that over 100 million PPIs have been prescribed per year for the past 5 years.[4] Currently, PPIs remain one of the top-selling drug classes in the country.[5]

An estimated 113 million PPI prescriptions are filled globally every year.[5] With their various indications, efficacy, and applicability for use in both ambulatory and inpatient settings, as well as with their availability as both OTC and prescription drugs, it is easy to see why PPIs have become a mainstay of pharmacotherapy for the management of acid-related disorders. Their versatility and profound use have ultimately led to their inclusion on the World Health Organization list of essential medications.[6]

There are currently six FDA-approved PPIs available on the market. Given their clinical effectiveness and cost, they remain a top choice among patients and providers as a therapy option for a multitude of indications.[7]