Farrell et al issued recommendations for deprescribing proton pump inhibitors (PPIs). This can help to reduce unnecessary therapy. The authors are from the University of Ottawa, University of Waterloo and Bruyere Research Institute in Canada.
Patient selection: patient receiving proton pump inhibitors
Outcome: decision to deprescribe PPIs if possible
Indications to consider for discontinuation - all of the following:
(1) mild to moderate condition (esophagitis, GERD, gastritis)
(2) resolved
(3) completed recommended course (usually 4 weeks)
Indications for continued therapy:
(1) moderate-to-severe to severe condition (including Grade C or D reflux esophagitis)
(2) bleeding peptic ulcer
(3) Barrett's esophagus
A patient's history may also affect decision-making.
Options:
(1) discontinue therapy usually by gradual tapering to avoid rebound symptoms
(2) reduce dose to lowest effective dose
(3) switch to on-demand (prn)
(4) switch to a histamine-2 receptor antagonist (H2-RA)
There should be follow-up of the patient (4-6 weeks and 6-12 months) to determine if decision (deprescription or continued therapy) has been effective.
Limitations:
• The quality of information.
