July 2019 Newsletter

Proton Pump Inhibitors

The medications known as proton pump inhibitors (PPIs) have been a part of therapy for conditions such as gastroesophageal reflux disease and other acid related disorders of the gastrointestinal tract (oesophagus, stomach and intestines) since the early 1990s.

PPIs have effectively and safely managed reflux, healed gastric ulcers and reduced the incidence of non-steroidal anti-inflammatory induced inflammation.

In the last few years, PPIs have become available over the counter from your pharmacy due to their safety and efficacy profile. In Australia, the commonly prescribed PPIs include esomeprazole (Nexium), pantoprazole (Somac), rabeprazole (Pariet), omeprazole (Losec) and lansoprazole (Zoton). There are also generic brands of all of these available on the Australian market.

Until May this year, PPIs were prescribed routinely to treat acid related conditions without restriction. In the meeting of PBAC (Pharmaceutical Benefits Advisory Committee) in July 2018, the decision was made to increase the restrictions on the prescribing of these medications and to effectively promote the use of lower effective doses.

Over the last couple of months, many patients who had been prescribed these higher doses have been prescribed lower doses as a trial. If successful, the patient can maintain therapy at the lower dose. If the symptoms return, there are mechanisms for your doctor to be able to prescribe the higher doses.

Though PPIs have been prescribed safely for many years, there has been growing concern of the potential of side effects with long term therapy including an increased risk of pneumonia, rebound hyperacidity with the potential increase in the risk of gastric cancer and dementia. These potential serious side effects from PPIs are based on studies that have generally been of an observational nature which means that there is no proof of cause and effect.

Unfortunately, some unscrupulous reporters in the media grab onto these and make big headlines without being backed up by strong scientific evidence. This creates unnecessary and unfounded fear of PPI therapy in many patients.

With over 21 million prescriptions of PPIs being filled every year in Australia, PPIs are extensively used and have proven to be very safe for the majority of people.

Though these restrictions have been added, patients will still have access to PPI therapy but may need to try a trial of a lower dose of their medication.

If you would like to know more, ask your pharmacist or doctor.