A new report says while proton pump inhibitors (PPIs), like Nexium, are proven medications of choice for gastroesophageal reflux disease (GERD) and other disorders, the significant increase in the use of PPIs for ill-defined indications over the years has been associated with adverse outcomes and increased health care costs.

The findings in a study in the January issue of JAMDA suggests that provider awareness of best practice guidelines on PPI use, along with a focus on patient education, may help promote safe and effective use of this treatment.

In “The Use and Misuse of Proton Pump Inhibitors: An Opportunity for Deprescribing,” the author, T.S. Dharmarajan, MD, said PPIs are valuable, irreplaceable drugs in the prevention and treatment of certain disorders for specific durations of time.

The catch is that he cited evidence suggesting that excessive and inappropriately prolonged PPI use is associated with various adverse effects. These include allergic reactions, acute interstitial nephritis, chronic kidney disease, poor cardiovascular outcomes, dementia, and drug interactions.

In addition, the report said there are potential complications due to gastric acid inhibition, such as gastrointestinal infections, pneumonia, nutrient deficiencies, fractures, spontaneous bacterial peritonitis, and small intestinal bacterial overgrowth.

Dharmarajan concluded that education of providers and patients, stewardship, and motivation are key to appropriate use of PPIs for the right indications. He said efforts at deprescribing a PPI “may be attempted following discussion with the patients.” Deprescribing approaches include stopping the drug, reducing the dose, or using “on-demand” therapy after completing the course of treatment for the specific indication.

Follow-up is recommended, he observed, for “recurrence of manifestations.” In the event of recurrence, he said, the PPI may need to be reinstituted.

Researchers at the Montefiore Medical Center, Wakefield Campus, Bronx, N.Y., conducted the study. Click here for more information on the details about the study.