Proton pump inhibitors (PPIs) have been in use for more than 2 decades and are proven useful as medications of choice for gastroesophageal reflux disease (GERD), and many other GI indications. A recent study of 758 hospitalized patients, mean age 80.3 years, revealed that 232 patients were receiving PPIs; 195 (84%) were prescribed inappropriately. After reviewing the comorbidity and prescribed medications, the only independent predictor of inappropriate PPI use was the total number of received medications.
Clinical Practice Guidelines (CPGs) on the appropriate use of PPIs and the duration of therapy when indicated are available through the American Medical Directors Association (AMDA). PPIs have an important role in the management of prophylaxis, and therapy. Acid suppression is clearly indicated for a certain duration of time for many disorders, however, the use of acid-blocking agents appears to be an answer to a lot of GI complaints without evidence for benefit although there is a potential for harm! The algorithm below is a guide to deprescribing that you should share with your medical director and attending physicians. Remember, first do no harm! Stay the course, stay well, mask up, get vaccinated, and stay tuned!