How To Take Proton Pump Inhibitors?

Proton Pump Inhibitors

Did You Know?

Proton pump inhibitors are estimated to cost Americans 11 billion dollars each year.

Protonpump inhibitors (PPIs) are a group of drugs that are used to treat gastric issues. However, long-term usage of PPIs can lead to various side-effects. So it’s really important to take PPIs as recommended by your health care provider. Here are few things that you must need to know before using PPIs:

Which Conditions are Appropriate for Short-Term PPI Use?

Here are some conditions in which an individual can use PPI for short period of time.

a. GERD

  • An individual can go for an eight week PPI therapy course at an initial stage.
  • Individuals on long-term usage are recommended with a trial of lower dose, on-demand therapy, or intermittent therapy to minimize exposure.

b. Gastric and Duodenal Ulcers

An individual can be recommended with FDA approved regimens to heal ulcers. It might take 4-8 weeks of time to heal.

c. Pylori

Health care provider can recommend an individual with first-line PPI-containing regimens.

d. Stress Ulcer Prophylaxis

Reserve stress ulcer prophylaxis with PPIs for ICU patients with at least one of the following:

  • Coagulopathy (platelet count <50,000 mm3, INR >1.5, or aPTT >2 times control)
  • Mechanical ventilation for >48 hours
  • History of GI ulceration or bleeding within one year of admission
  • Thermal injury to >35% of body surface area
  • Multiple trauma
  • Hepatic failure
  • Partial hepatectomy
  • Glasgow Coma score ≤10
  • Transplantation preoperatively in the ICU
  • Spinal cord injury

Few of the side-effects an individual can experience are:

  • Occult bleeding lasting at least six days
  • Sepsis
  • ICU stay of more than one week
  • High-dose corticosteroids (>250 mg/day of hydrocortisone)

Which Conditions May Require Long-Term PPI Therapy?

Refractory GERD

An individual not responding to short term PPI therapy after 2-3 months, might need to under-go long-term PPI therapy.

  • An individual can be recommended to take H2 blocker as a bedtime dosage for nighttime symptoms.
  • Healthcare provider can change PPI, or may double the dose, or add Metoclopramide to individuals not responding to short term PPI.

Erosive Esophagitis

  • Health care providers might consider maintenance PPI therapy with continued symptoms after an 8 week trial of PPI. The dose and length of therapy is determined by the severity of disease and the specific PPI being used.
  • Doctors’ can recommend lowest effective dose, including on-demand or intermittent therapy during maintenance therapy.

Zollinger-Ellison Syndrome

  • Higher PPI doses at an initial stage. Doctors’ can lower the dosage as gastric output decreases.
  • If gastric output volumes are not an option, doctors’ might suggest using symptom control (e.g., pain, diarrhea) to monitor dosage titrations.
  • Recommend using the lowest effective dose.

NSAID-Induced Ulcers

  • Patients with ulcer history, might be recommended with PPI with an NSAID to reduce the incidence of recurrent bleeding by 4% to 6% over a six-month period.
  • Moreover, PPI use with COX-2 inhibitors decreases recurrent bleeds by almost 9% over one year.
  • Doctors’ can recommend PPIs with a COX-2 inhibitor for patients with a GI bleed history.

Chronic Anticoagulation After a GI Bleed

  • Recommend PPIs for patients on anticoagulants after an upper GI bleed.

Barrett’s Esophagus

  • Individuals suffering from Barrett’s esophagus are recommended with once-daily treatment with a PPI.
  • They may also reserve double daily dose for individuals with poor control on once-daily PPI therapy.

If you need more information on PPIs, you can contact us here!

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