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

Deprescribing PPIs

In 2017, guidelines for deprescribing PPIs were published in Canadian Family Physician. A team of healthcare professionals, including three pharmacists, collaborated to establish the evidence-based clinical practice guideline.[25] Deprescribing is defined as reducing the dose, stopping, or using "on-demand" dosing. The guideline recommends deprescribing PPIs in adults who suffer from heartburn and who have completed a minimum treatment of 4 weeks in which symptoms are relieved. These recommendations do not apply to patients with Barrett's esophagus, severe esophagitis, or patients with a history of bleeding gastrointestinal ulcers.[8] Per the published guidelines, an algorithm can be used in determining when and how PPIs should safely be deprescribed. For patients needing occasional symptom relief, OTC antacids or H2 receptor antagonists (H2RA) may be used on an as-needed basis. H2RAs may be used on a daily basis, although the recommendation only proves to have moderate-quality evidence.[25] Patients should also be educated on the nonpharmacologic approaches to minimize symptoms of heartburn, dyspepsia, regurgitation, and epigastric pain. Patients should be counseled to avoid meals 2 to 3 hours before bedtime, avoid dietary triggers, and address whether weight loss is required.[25]