Deprescribing proton pump inhibitors: why, when and how

The focus should primarily be on avoiding unnecessary long term prescribing of PPIs

For more than 25 years, proton pump inhibitors (PPIs) have been the mainstay of therapy for acid-related disorders, particularly peptic ulcer disease and gastro-oesophageal reflux disease (GORD). In recent decades, prescribing of PPIs has increased considerably around the world. According to a recent national drug utilisation study, prescribing of PPIs increased fourfold in Denmark between 2002 and 2014, with the increase particularly marked among older patients; 7% of all adults and 14% of adults over 60 were covered by PPI prescriptions.1 The increased prescribing of PPIs is driven primarily by the accumulation of existing users rather than by new users; inappropriate prescribing and long term use, rather than genuine clinical need for ulcer prophylaxis, appear to underlie the high prevalence of PPI prescribing.2 Changes to public subsidisation of PPI costs and interventions for improving adherence to guidelines and promoting the rational use of PPIs have not had a substantial influence on prescribing patterns.