Notes for: Proton Pump InhibitorsLast edited [04/07/2012 10:38:40]Gastroprotection
1. The appropriateness of repeat prescribing of NSAIDs should be reviewed regularly.
2. For patients who are at high risk of developing serious GI complications (eg previously established acid peptic disease, frail elderly, concomitant oral steroids or anticoagulants): see BNF for options
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Last edited [05/08/2013 15:26:44]Caution
1. PPIs are not indicated for use in:
2. PPI should be reserved for patients:
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requiring eradication of Helicobacter pylori
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with a documented NSAID-induced ulcer who must unavoidably continue with NSAID therapy.
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with a documented gastro-intestinal ulcer.
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with severe gastro-oesophageal reflux disorder.
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co-prescribed with NSAIDs as per NICE osteoarthritis guidance.
3. Some patients (approximately 10%) require high doses of omeprazole capsules. The indications are:
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maintenance of remission in severe ulcerative oesophagitis
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prevention of recurrence of oesophageal stricture
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treatment of Barrett’s oesophagus
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treatment of reflux associated with scleroderma
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small minority of patients who are rapid metabolisers and need high doses to simply control symptoms
4. For patients with dysphagia or having tube feeding a dispersible preparation will be necessary. Dispersible preparations should not be prescribed in any other circumstances.Lansoprazole dispersible tablets are the first choice dispersible preparation.
5.Proton Pump Inhibitors may relieve or mask the symptoms from a malignant gastric ulcer and may even induce the healing of a lesion and therefore delay diagnosis.
6. The use of PPIs and histamine H2 receptor antagonists, which suppress gastric acid secretion, have been suggested to be a risk factor for the development of C difficile associated disease. PPIs should only be used where there is a clear indication.
7. Drug Safety Bulletin (April’12) information regarding PPIs and an association with hypomagnesia and also epidemiological evidence of increased risk of bone fracture.
NICE Clinical Guideline on Dyspepsia: Management of Dyspepsia in Adults in Primary Care (revised June 2005) gives advice on use of endoscopy and pharmacological interventions.