Do not continue proton pump inhibitor (PPI) therapy chronically beyond the indications specified in the product label (e.g., 4–8 weeks for the treatment of gastroesophageal reflux disease); instead, reduce the dose (for example, from twice daily to once daily) or discontinue the PPI and use it on an as-needed basis.

Oct 17, 2018

Do not continue proton pump inhibitor (PPI) therapy chronically beyond the indications specified in the product label (e.g., 4–8 weeks for the treatment of gastroesophageal reflux disease); instead, reduce the dose (for example, from twice daily to once daily) or discontinue the PPI and use it on an as-needed basis.

Type of practice

Drugs

Age

Adult, Geriatric, Pediatric

Topic Area

Clinical Pharmacy and Therapy
Proton pump inhibitors (PPIs) should be used for the shortest duration possible, as long-term use (over 4–8 weeks) has been associated with increased risks of: deficiencies in essential nutrients such as calcium and vitamin B12, bone fractures, gastrointestinal infections (e.g., Clostridioides difficile), potential liver and kidney damage, and drug dependence.
Evidence indicates that:
• continuing at a higher dose does not reduce the risk of symptom recurrence;
• only 1 in 10 patients who discontinue PPI therapy may experience a return of symptoms.
Based on systematic reviews evaluated using the GRADE methodology, this is considered a strong recommendation.

Sources

1. Yu EW, Bauer SR, Bain PA et al. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124:519-26. doi: 10.1016/j.amjmed.2011.01.007.
2. Kwok CS, Arthur AK, Anibueze CI et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107:1011-1019. doi: 10.1038/ajg.2012.108.
3. Lazarus B, Chen Y, Wilson FP et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016;176:238-46. doi: 10.1001/jamainternmed.2015.7193.
4. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011 ;56:931-50. doi: 10.1007/s10620-010-1560-3.
5. Danny Jenkins & Ines Modolell. Proton pump inhibitors. BMJ 2023;383:e070752. doi: 10.1136/bmj-2022-070752.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.