HelixTalk Episode #57 - Kicking acid, taking names ... the story of PPI use and abuse

Date posted: February 28, 2017, 6:00 am

In this episode, we discuss the overuse of proton pump inhibitor (PPI) therapy and several concerns regarding chronic use of this medication class, including hypomagnesemia, fracture risk, low serum B12 levels, anemias, and increased risk of certain infections.

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Key Concepts

1. Proton pump inhibitor (PPI) overuse is very common and becoming more concerning as evidence suggests there may be rare but serious long-term adverse effects from this drug class.
2. Inappropriate continuation of stress ulcer prophylaxis during hospital discharge is very common and one of the leading reasons for PPI overuse without a clear indication.
3. Chronic, long-term use of PPIs has been associated with hypomagnesemia (refractory to magnesium supplementation), osteoporosis and fracture risk (especially in patients > 50 years of age taking PPIs for more than a year), decreased levels of vitamin  B12 (leading to macrocytic anemia and paresthesias), and infection (particularly pneumonia and Clostridium difficile-associated diarrhea).
4. Omeprazole may impair the biologic activation of clopidogrel (Plavix).  Other PPIs, such as pantoprazole, have not been shown to possess this interaction.
5. For patients on chronic, long-term PPIs therapy, consider using the minimum effective dose for the shortest period of time to avoid the risk of these potential adverse effects of PPI therapy.