15 April 2009

In line with the latest NPS therapeutic program, health professionals are advised to step-down proton pump inhibitor (PPI) therapy and cease when appropriate.

PPIs are widely regarded as safe medicines, but evidence suggests they can cause serious adverse effects. For example, acute interstitial nephritis, a rare hypersensitivity reaction, has been reported following the use of all PPIs. Recent studies have also indicated that PPI use may increase the risk of Clostridium difficile infection and community-acquired pneumonia.

“Many patients with gastroesophageal reflux disease will not need continuous, long-term PPI therapy, so when patients present for review or request a repeat prescription, best practice would be to assess if ongoing therapy is still necessary,” NPS clinical expert, Education and Quality Assurance Program Manager, Ms Judith Mackson said.

“Patients on long-term PPI therapy may be reluctant to reduce or stop their medication because their reflux symptoms appear to be well controlled. They may not be aware that when less medicine is used, there is less risk of unwanted side effects and prescription costs could be lower.”

“By using a step-down approach, the beneficial effects of PPI therapy are retained and the risk of adverse effects is reduced. Patient symptoms can be controlled using a lower dose, either daily or when symptoms occur,” Ms Mackson said.

The NPS therapeutic program on PPIs reinforces the following:

• A 4–8 week course of standard-dose PPI therapy should be used to control symptoms of gastro-oesophageal reflux disease (GORD)
• A step-down approach should be adopted to reach the lowest dose and frequency of PPIs
• Serious PPI side effects can occur
• Lifestyle changes can help reduce the need for PPI therapy

“Lifestyle changes should also be encouraged at the same time as PPI therapy. If patients can avoid foods and drinks that exacerbate their dyspeptic symptoms, this will reduce reliance on PPIs,” Ms Mackson said.

As part of the therapeutic program, NPS also provides health professionals with:

• A hypothetical case to refine your skills: Case study (57): Proton pump inhibitors – appropriate and safe use
• GP Clinical Audit toolkit to Review proton pump inhibitor (PPI) prescribing (Enrol by 12 June)
• A desktop GP Clinical e-Audit: Review of proton pump inhibitor (PPI) prescribing (Enrol from Sept)
• A counselling resource kit for pharmacists: Pharmacy Practice Review: Quality use of prescription PPIs (Enrol by 26 June)
• Up-to-date information in Prescribing Practice Review (45): Proton pump inhibitors: step-down to symptom control

For more information visit www.nps.org.au, phone (02) 8217 8700 or email info@nps.org.au.

ENDS