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deprescribing proton-pump inhibitor (PPI)

Indications: - short-term use 8 weeks complete - no indications for long-term use > 8 weeks (see proton-pump inhibitor) Contraindications: - patients on multiple blood thinners or with prior GI bleeding Procedure: - PPIs can be tapered or stopped abruptly - high-dose PPIs can be stepped down to standard dosing - minimal evidence supports higher doses Complications: - rebound acid hypersecretion can last for weeks Management: - some rebound symptoms can be managed with histamine-2 blockers or antacids. Notes: - PPIs should be discontinued for lack of indication vs concern for adverse effects - no serious adverse effects demonstrated in randomized trials * other PPI deprescribing guidelines available - the U.S. Deprescribing Research Network website [5] has guidelines, algorithms, & videos for deprescribing of proton pump inhibitors [2] - Medscape has published on deprescribing proton pump inhibitors [3] - Deprescribing.org has developed deprescribing guidelines & algorithms for deprescribing proton pump inhibitors [4]

General

medication deprescribing

References

  1. Targownik LE et al. AGA clinical practice update on de-prescribing of proton pump inhibitors: Expert review. Gastroenterology 2022 Apr; 162:1334. PMID: 35183361 https://www.gastrojournal.org/article/S0016-5085(21)04083-X/fulltext
  2. Farrell B et al Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline Canadian Family Physician May 2017, 63 (5) 354-364; PMID: 28500192 PMCID: PMC5429051 Free PMC article https://www.cfp.ca/content/63/5/354
  3. Vega CP Continue, Stop, or Taper the PPI? Medscape - Oct 25, 2019. https://www.medscape.com/viewarticle/920314_2 - Vega CP Another Reason to Stop the PPI: Clinician Debate Medscape - Oct 13, 2020. https://www.medscape.com/viewarticle/938726
  4. Deprescribing.org Deprescribing Guidelines and Algorithms. https://deprescribing.org/resources/deprescribing-guidelines-algorithms/
  5. U.S. Deprescribing Research Network Resources for Clinicians https://deprescribingresearch.org/resources-2/resources-for-clinicians/