PPI Risks Retail Clinicians Should Consider

While proton pump inhibitors (PPIs) are among the most commonly used medications for gastroesophageal reflux disease (GERD), retail clinicians looking to prescribe PPIs should make sure to weigh their benefits against potential risks.

A recent study published inJAMA Neurologysuggests that there may be a link between PPI use and an increased risk of dementia in older patients. This relationship was explored by a research team that examined data from 2004 to 2011 on 73,679 patients aged 75 years and older—29,510 of whom developed dementia during the study period.

Based on their analysis, the researchers determined that regular PPI users—defined as having at least 1 PPI prescription in each quarter of an 18-month interval—had a 44% increased risk of dementia compared with those who did not use PPIs.

“The avoidance of PPI medication may prevent the development of dementia,” the study authors concluded. “This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models.”

Although the study authors acknowledged that further research is needed to verify this connection, retail clinicians should be aware of other risks associated with PPI use, including chronic kidney disease (CKD).

Aseparate studypublished inJAMA Internal Medicinedetermined that PPI use is associated with a 20% to 50% increased risk of developing CKD, even after adjusting for variables such as demographics, socioeconomic status, clinical measurements, prevalent comorbidities, and concomitant medication use. Comparatively, the researchers found no link between CKD and the use of histamine-2 receptor antagonists.

Retail clinicians should also keep a lookout for anypotential interactions between PPIs and other medicationsthat their patients are taking.

According to Kristene Diggins, FAANP, DNP, MBA, DCC, CNE, NEA-BC, PPIs can elevate intragastric pH, which in turn reduces drug solubility and decreases the bioavailability of a number of medications. For instance, the use of PPIs has been associated with 50% reduction in the systemic clearance of diazepam and phenytoin.

Additionally, Dr. Diggins explained, PPIs interact with antiretroviral therapy, so chronic PPI use potentially can lead to inadequate drug exposure in HIV-infected patients. There are also possible interactions between PPIs and blood thinners such as aspirin and clopidogrel that cause adverse drug events, especially in older patients.

Dr. Diggins encouraged clinicians to play close attention to patients’ medication history and address their concerns about potential drug—drug interactions when recommending PPIs.

“In the convenient care setting, the clinician is perfectly situated to determine and address potential risks during an episodic visit,” she wrote. “By reviewing medication history with each and every patient, the convenient care clinician provides a safety net for both the patient and his or her primary care provider, ensuring that the patient’s medication and health promotion needs are addressed in an efficient and timely fashion.”