Canadian researchers have proposed new guidelines for deprescribing proton pump inhibitors. Their recommendations, which were published this month in Canadian Family Physician, come amid growing concern that long-term proton pump inhibitor use may result in kidney failure and other serious renal complications.
Proton pump inhibitors are indicated for the short-term treatment of GERD and peptic disorders. The class includes the following prescription and over-the-counter medications:
In 2013, more than 15 million Americans were prescribed proton pump inhibitors, at a cost of more than $10 billion. However, it has been estimated that between 25% and 70% of these prescriptions have no appropriate indication.
“When PPIs are inappropriately prescribed or used for too long, they can contribute to polypharmacy with its attendant risks of nonadherence, prescribing cascades, adverse reactions, medication errors, drug interactions, emergency department visits, and hospitalizations,” the authors of the new guidelines wrote.
Current proton pump inhibitor guidelines call for a short course of treatment, and recommend that clinicians either then discontinue their use or prescribe the lowest possible dose. However, they provide no advice on how clinicians can deprescribe the medications.
“This guideline recommends deprescribing PPIs (reducing dose, stopping, or using “on-demand” dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved,” the authors write. “The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers.”
A growing number of proton pump inhibitor lawsuits have been filed in U.S. courts by individuals who allegedly developed kidney failure and other renal complications due to long-term treatment with these medications. Plaintiffs claim that the manufacturers of Nexium, Prilosec, Prevacid, and other drugs in this class have been aware for years that their products could potentially harm the kidneys, yet failed to issue appropriate warnings to doctors and patients. Plaintiffs further assert that they could have avoided their injuries had proper notice been provided by the drugs’ manufacturers.
Earlier this year, the U.S. Judicial Panel on Multidistrict Litigation (JPML) denied a petition to centralize all federally-filed proton pump inhibitor lawsuits in a single U.S. District Court. However, the kidney litigation involving these medications continues to grow, and for now cases will progress through courts on an individual basis.