Community pharmacist, Care First Pharmacy and Wellness Pharmacy Group, Vancouver, British Columbia, Canada.
Therapeutics Initiative, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Drug Saf. 2024;19(2):244-247. doi: 10.2174/1574886318666230726124540.
Proton pump inhibitors (PPIs) are one of the most used classes of drugs. For most indications, PPIs are only recommended up to 8 weeks duration. However, PPI use continues to expand. Regular and prolonged use of PPIs should be avoided because of the risk of adverse events.
The main objective of this study was to (1) investigate the extent of PPI usage in people aged 65 or older in the province of British Columbia (BC), Canada, (2) provide an overview of the harms associated with the long-term use of PPIs.
We examined utilization trends of the PPIs in BC since the year 2009 using PharmaNet, BC's medication dispensing database where the information is accessible to community pharmacists. We performed a comprehensive literature search for relevant reviews reporting harms associated with long-term use of PPIs. A search was conducted from January 2014 to June 2022.
Between 2000 and 2018 BC's population grew by 20%, but the use of PPIs escalated to 257%. Of these older British Columbians, 62% had a cumulative exposure exceeding 2 years and 42% exceeded 5 years. This is alarming because the recommended treatment duration is 4-12 weeks for common indications including reflux esophagitis, and duodenal and gastric ulcers. Only 13.5% were dispensed PPIs for 90 days or less. Patients on long-term PPI therapy should be reassessed. Adverse events of PPI use are common among older adults. We identified over 217 systematic reviews published during the last 8 years of specific harms associated with long-term daily usage of PPIs. These harms include increased risks of death, cardiovascular disease, acute renal injury, chronic kidney disease, dementia, fractures, hypomagnesemia, iron deficiency, vitamin B12 deficiency, enteric infection (including ), pneumonia, and neoplasia (gastric cancer, carcinoids, and colon cancer), and drug interactions.
This study revealed a high prevalence of PPI use among elderly populations in BC, Canada. The overutilization of PPIs is often a result of failure to re-evaluate the need for continuation of therapy. Published studies identified signals of serious harm from long-term PPI exposure. Healthcare providers with patients can reverse the relentless expansion of long-term PPI exposure by discussing the expected benefits and potential harms.
质子泵抑制剂（PPIs）是使用最广泛的药物类别之一。对于大多数适应证，仅推荐使用 PPI 8 周。然而，PPI 的使用仍在不断扩大。由于不良反应的风险，应避免常规和长期使用 PPI。
本研究的主要目的是：（1）调查加拿大不列颠哥伦比亚省（BC）65 岁及以上人群中 PPI 的使用情况；（2）概述长期使用 PPI 相关的危害。
我们使用 PharmaNet 审查了 2009 年以来 BC 地区 PPI 的使用趋势，PharmaNet 是一个社区药剂师可访问的药物配药数据库。我们对报告长期使用 PPI 相关危害的相关综述进行了全面的文献检索。检索时间为 2014 年 1 月至 2022 年 6 月。
在 2000 年至 2018 年期间，BC 的人口增长了 20%，但 PPI 的使用增加到了 257%。在这些年长的不列颠哥伦比亚人中，62%的人累计暴露时间超过 2 年，42%的人超过 5 年。这令人担忧，因为对于包括反流性食管炎、十二指肠和胃溃疡在内的常见适应证，建议的治疗时间为 4-12 周。只有 13.5%的人开具了 90 天或更短时间的 PPI。接受长期 PPI 治疗的患者应重新评估。老年人中 PPI 使用的不良反应很常见。我们确定了过去 8 年中与长期每日使用 PPI 相关的 217 项特定危害的系统评价。这些危害包括死亡、心血管疾病、急性肾损伤、慢性肾脏病、痴呆、骨折、低镁血症、缺铁、维生素 B12 缺乏、肠道感染（包括艰难梭菌感染）、肺炎和肿瘤（胃癌、类癌和结肠癌）以及药物相互作用的风险增加。
本研究揭示了加拿大不列颠哥伦比亚省老年人中 PPI 使用的高流行率。PPI 的过度使用通常是未能重新评估继续治疗的必要性的结果。已发表的研究确定了长期 PPI 暴露的严重危害信号。有患者的医疗保健提供者可以通过讨论预期的益处和潜在危害来逆转长期 PPI 暴露的无情扩张。
