The development of these guidelines involved a team comprising a family physician, a gastroenterologist, 3 pharmacists, and 5 nonvoting members. 5 These guidelines used a systematic review of deprescribing trials and examined reviews regarding the harm associated with the continued use of PPIs. 3Įvidence-based guidelines to help clinicians deprescribe PPIs were published in the Canadian Family Physician journal in 2017. 3,5Īlthough there have been small studies that have demonstrated successful deprescribing methods, there had been no guidelines to describe the benefits and drawbacks of deprescribing until now. 5 Regardless of the approach, the overall goal of deprescribing is to avoid adverse effects, improve or maintain quality of life, and reduce inappropriate medicine use. There are several methods for deprescribing PPIs, including stopping (abrupt discontinuation or tapering), stepping down (ceasing taking medication, followed by H 2blocker therapy), and reducing (intermittent PPI use, on-demand PPI use, or lowering the dose).
In addition to nutrient depletion, PPIs have been linked to an increased risk of Clostridium difficile and pneumonia infections, kidney damage, and osteoporotic fractures. But long-term use of PPIs can lead to adverse effects, drug interactions, misuse or overuse, and prescribing cascades. It is common for PPIs to be continued for prolonged periods and, in some cases, indefinitely. 1įor details on other depletions induced by PPIs and H 2blockers, see the Table. In addition, the Natural Medicines Comprehensive Database rates dibencozide as a moderate depletion. 1 Suggested supplementation of vitamin B 12 is 25 to 400 μg/day. 1īecause gastric acid is needed to release vitamin B 12 from protein for absorption, PPIs can reduce the absorption of protein-bound (dietary) vitamin B 12. The good news is that vitamin B 12deficiency is expected to diminish after patients discontinue PPI therapy. Furthermore, vitamin B 12 deficiency is more likely in individuals taking high doses of PPIs. 1Unless PPI use is prolonged (2 years or more) or dietary vitamin intake is low, clinically significant vitamin B 12deficiency is unlikely.
Monitoring of vitamin B 12 is recommended, and some people may need a supplement. Second is vitamin B 12 rated as a moderate depletion. Suggested supplementation of magnesium is 250 to 400 mg/day. 1 Severe hypomagnesemia can potentially lead to serious adverse effects including arrhythmias, hypocalcemia, hypokalemia, hypoparathyroidism, muscle spasms, and seizures. 1 Results of studies suggest that PPIs inhibit active transport of magnesium in the intestine. Several reports have linked long-term PPI use with an increased risk of hypomagnesemia, especially over a year. Many medications can cause nutritional deficiencies, and proton pump inhibitors (PPIs) are no different.įirst is magnesium deficiency.