Deprescribing: Focus on Proton Pump Inhibitors.
Posted 04/17/25
When to deprescribe Proton Pump Inhibitors
Optimizing a medication regimen through deprescribing can benefit patients in many ways, including decreasing medication burden and risk of side effects, improving quality of life, and saving money on drugs. Proton pump inhibitors (PPIs) are a medication class where deprescribing should be considered with long-term use.
The American Gastroenterological Association (AGA) best practices on deprescribing PPIs
- All patients on a PPI should have a regular review and documentation of the ongoing indications for use done by their primary care provider.
- All patients without a definitive indication for long-term PPI use should be considered for a deprescribing trial.
- Most patients with an indication for chronic PPI use who take twice-daily dosing should be considered for step down to once-daily dosing.
- Patients who stop long-term PPI therapy should be advised that they may develop rebound acid reflux.
Additionally, AGA best practice statements identify the following patients as not candidates for PPI deprescribing: patients with complicated GERD, such as those with a history of severe erosive esophagitis, esophageal ulcer, or peptic stricture, patients with known Barrett’s esophagus, eosinophilic esophagitis, or idiopathic pulmonary fibrosis, patients at high risk for upper gastrointestinal bleeding.
PPIs available OTC (Prevacid 24HR, Nexium 24HR, Prilosec OTC, Zegerid OTC) may be viewed as safe for your patients, but we recommend verifying all OTC items at each appointment and assessing how long they have been taking them and how often.
