How To Take Proton Pump Inhibitors?

Did You Know?

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

Proton–pump 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.

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