129: Let’s Take It Down a Notch: Deprescribing PPIs

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 20 April 2021

⏱️ 40 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In episode 57, we had in depth discussion of safety issues, general use and recommendations for PPI therapy. In this episode, we briefly review PPI safety concerns and focus on strategies to deprescribe proton pump inhibitors.

Key Concepts

PPIs are approved as acid-reducing therapies to treat various conditions related to decreased gastric pH, however, undocumented use of PPI has increased over the years.
For indicated conditions, PPI should be used at lowest dose for shortest duration possible.
When used for longer than intended duration, PPIs may cause long-term issues such as hypomagnesemia, low vitamin B12 levels, low iron levels, anemia, C. difficile-associated diarrhea (CDAD), chronic kidney disease (CKD), and hypergastrinemia causing rebound acid hypersecretion.
Options for limiting PPI use are: abrupt discontinuation, dose reduction, on-demand dosing, slow deprescribing, or switching to alternate therapy. Abrupt discontinuation leads to rebound hypersecretion due to high gastrin levels.
There is lack of substantial evidence for what deprescribing strategy is better, but decreasing from multiple times a day to single daily dose, reducing the single daily dose, and switching to every other day are all appropriate strategies.

References

Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline. Can Fam Physician. 2017 May; 63(5): 354–364.
https://deprescribing.org/resources/deprescribing-guidelines-algorithms/ - Specific recommendations for deprescribing certain medications or medication classes

Transcript

Click on a timestamp to play from that location

0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not
0:22.0	professional advice and should not be used in lieu of obtaining advice from a qualified
0:26.0	health care provider. And now on to the show. Welcome to Helix Talk episode 129. I'm your
0:34.7	co-host Dr. Kane. And I'm Dr. Patel.
0:43.0	And in today's episode, let's take it down a notch, deprescribing PPI's.
0:51.0	We're going to get into discussing how we have some strategies and what kind of evidence we have behind decrease the use of proton pump inhibitors when it's not necessary.
0:55.2	You remember in our episode 57, we kind of had this entire discussion on safety issues and
1:01.9	what are the general use and recommendations for the PPI therapy. Setting that ground in this
1:07.6	episode, we're focusing more on how exactly to deprescribe these agents.
1:14.3	Perfect. Well, Dr. Mattel, why don't we get into a patient case to kind of set the tone?
1:18.3	And I think that inpatient pharmacists and other health care providers, those on the outpatient
1:23.5	side, I think really everyone can identify with a patient who's on a PPI and maybe it's
1:29.6	time to start thinking about whether it's appropriate to get rid of that PPI or not.
1:33.5	We'll go through kind of the thought process there.
1:35.2	So why don't you give us like a sample patient that I think many people could identify with.
1:40.4	Dr. Kane, you said it so right.
1:42.3	I feel like it's my subtle mission in the clinic whenever I spot
1:46.9	unwarranted use of PPI to make sure the patients are, you know, taken off of them. And this is what
1:53.7	we're going to talk about, how to take him off of them. So kind of patient case that I've encountered
1:59.0	in the clinic, wanted to kind of provide that in this ficto patient case.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Sean P. Kane, PharmD, BCPS, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Sean P. Kane, PharmD, BCPS and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.