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Proton pump inhibitors (PPIs) are one of the most widely prescribed drugs on the planet. PPIs have alleviated the long since forgotten clinical challenge of antacid-resistant and H2-receptor agonist–resistant GERD or dyspepsia. Few of us may continue to “ramp up” GERD or dyspepsia treatment, settling instead on the PPI quick-fix so we can move onto other clinical issues. Based upon claims database data, patients who take prescription PPIs usually stay on therapy for an average of about 6 months. That’s all? Many clinicians have patients who are on these medications for years. With several PPIs now available in the generic form, it has become easier for us to maintain these medications. But what are the harms of this approach?
Last week, the Food and Drug Administration released a report that drew conclusions about data that have been accumulating for some time: PPIs are associated with an increased risk for Clostridium difficile-associated diarrhea.
The FDA reviewed data from the Adverse Event Reporting System (AERS) and the medical literature. The lion’s share of the cases involved older patients with chronic medical conditions or patients who were taking antibiotics. More compelling, perhaps, were the 23 studies demonstrating a higher risk with PPI use compared to no PPI exposure. Notably, this information adds to the labeling information for prescription PPIs, which also lists an increased risk for osteoporosis and bone fracture and hypomagnesemia.
So what does this mean for our practice? I think the onus is on us to assess patient need for PPIs in order to prevent unintended consequences from their long-term use in patients who may not need them. Clinicians should individualize the “need” assessment. This could be done on a trial basis with PPI discontinuation or use of a “step-down” medication such as an H2RA or antacid.
Proton pump inhibitors (PPIs) are one of the most widely prescribed drugs on the planet. PPIs have alleviated the long since forgotten clinical challenge of antacid-resistant and H2-receptor agonist–resistant GERD or dyspepsia. Few of us may continue to “ramp up” GERD or dyspepsia treatment, settling instead on the PPI quick-fix so we can move onto other clinical issues. Based upon claims database data, patients who take prescription PPIs usually stay on therapy for an average of about 6 months. That’s all? Many clinicians have patients who are on these medications for years. With several PPIs now available in the generic form, it has become easier for us to maintain these medications. But what are the harms of this approach?
Last week, the Food and Drug Administration released a report that drew conclusions about data that have been accumulating for some time: PPIs are associated with an increased risk for Clostridium difficile-associated diarrhea.
The FDA reviewed data from the Adverse Event Reporting System (AERS) and the medical literature. The lion’s share of the cases involved older patients with chronic medical conditions or patients who were taking antibiotics. More compelling, perhaps, were the 23 studies demonstrating a higher risk with PPI use compared to no PPI exposure. Notably, this information adds to the labeling information for prescription PPIs, which also lists an increased risk for osteoporosis and bone fracture and hypomagnesemia.
So what does this mean for our practice? I think the onus is on us to assess patient need for PPIs in order to prevent unintended consequences from their long-term use in patients who may not need them. Clinicians should individualize the “need” assessment. This could be done on a trial basis with PPI discontinuation or use of a “step-down” medication such as an H2RA or antacid.
Proton pump inhibitors (PPIs) are one of the most widely prescribed drugs on the planet. PPIs have alleviated the long since forgotten clinical challenge of antacid-resistant and H2-receptor agonist–resistant GERD or dyspepsia. Few of us may continue to “ramp up” GERD or dyspepsia treatment, settling instead on the PPI quick-fix so we can move onto other clinical issues. Based upon claims database data, patients who take prescription PPIs usually stay on therapy for an average of about 6 months. That’s all? Many clinicians have patients who are on these medications for years. With several PPIs now available in the generic form, it has become easier for us to maintain these medications. But what are the harms of this approach?
Last week, the Food and Drug Administration released a report that drew conclusions about data that have been accumulating for some time: PPIs are associated with an increased risk for Clostridium difficile-associated diarrhea.
The FDA reviewed data from the Adverse Event Reporting System (AERS) and the medical literature. The lion’s share of the cases involved older patients with chronic medical conditions or patients who were taking antibiotics. More compelling, perhaps, were the 23 studies demonstrating a higher risk with PPI use compared to no PPI exposure. Notably, this information adds to the labeling information for prescription PPIs, which also lists an increased risk for osteoporosis and bone fracture and hypomagnesemia.
So what does this mean for our practice? I think the onus is on us to assess patient need for PPIs in order to prevent unintended consequences from their long-term use in patients who may not need them. Clinicians should individualize the “need” assessment. This could be done on a trial basis with PPI discontinuation or use of a “step-down” medication such as an H2RA or antacid.