Reevaluating long-term PPI use

General
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Proton pump inhibitors (PPIs) are very effective for short-term treatment of acid-related disorders like GERD, ulcers, and H. pylori therapy — but their long-term use isn’t without risk and shouldn’t be assumed safe by default.

During clinical postings, one thing I keep noticing on many case sheets is this that PPIs continued for weeks or even months… without a clear reason.

It’s almost prescribed “routinely.”

But Proton Pump Inhibitors (PPIs) aren’t meant to be lifelong medications for everyone.

Several studies and reviews show associations between prolonged PPI use and potential harms when not clearly indicated:

:small_orange_diamond: Increased risk of infections and fractures: Long-term PPI use has been linked to a higher incidence of Clostridioides difficile infections and bone fractures of the hip, wrist, and spine due to changes in gastric pH and mineral absorption. These risks have been highlighted in multiple observational studies and even by regulatory safety advisories.

:small_orange_diamond: Micronutrient deficiencies and kidney effects: Chronic PPI therapy may contribute to deficiencies such as hypomagnesemia and vitamin B12 deficiency, and observational data suggest associations with chronic kidney disease and electrolyte imbalances.

:small_orange_diamond: Cautious use recommended: Reviews and guideline discussions emphasize that long-term PPI therapy should be regularly evaluated and continued only when there’s a clear indication, with deprescribing considered when appropriate.

PPIs are not meant to be “forever pills.” Regular review of ongoing need, shortest effective duration, and careful indication can prevent unnecessary exposure to these potential risks.

Small checks like these improve patient safety more than we realize.

How often do you see PPIs continued without indication in your postings?

MBH/PS

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Very true. PPIs are often continued by default without reassessment. Regular review, clear indication, and deprescribing when appropriate are essential for patient safety. This is an important point for everyday clinical practice

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Useful information on the use of PPIs.

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Prolonged use of any medication may lead to unforeseen and undesirable effects, and proton pump inhibitors are no exception. To mitigate such risks, physicians should adhere to rational prescribing practices, ensuring that PPIs are administered only when clinically necessary.

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Very often. Routine continuation without review is common, regular indication checks and deprescribing should become standard practice.

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Very often, PPIs are continued without a clear reason. They’re usually started routinely and not reviewed later. This shows the need for regular medication review and stopping PPIs when they’re no longer needed.

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Anything if consumed too much is not that much beneficial to the body as medicine. Understanding the cause and treating it from the root is the key.

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PPIs are the most misused drugs in india. People take these drugs without any doctor’s prescription for long and end up with potential side effects. People don’t correct their food habits but likes to depend on medicine.