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

Pharmacists' Role In Judicious PPI use

As members of the healthcare team, pharmacists have a vital role in educating patients on the proper use of PPIs. Approximately 50% of patients taking PPIs for nonerosive GERD still experience unresolved symptoms.[8] When symptoms persist despite the use of once-daily dosing, the American Gastroenterology Association and the American College of Gastroenterology practice guidelines recommend increasing to twice-daily dosing. Increasing the dose may be necessary for some, but it is not always the best course of action. PPIs require active proton pumps to establish binding and, therefore, make it essential for preprandial administration. Nearly half of patients taking PPIs do not take their dose before eating, thus leading to decreased binding and efficacy.[8] In order to reduce PPI use, steward-ship programs, managed by pharmacists, have been established to determine if use is necessary, educate patients on the proper administration, and discuss whether deprescribing is warranted.

Involving patients in the decision to deprescribe PPIs is vital for patient success. Patients who are educated on the risks associated with long-term therapy and possible side effects associated with PPIs are more likely to understand the reasoning for deprescribing and may experience better long-term outcomes.[25]