Proton pump inhibitors
Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with ‘alarm features’ and in such cases gastric malignancy should be ruled out before treatment. Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, and, if necessary, receive other preventative therapy.
Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.
In those at risk of ulceration when taking NSAIDS (over 65 and/or history of ulceration, a proton pump inhibitor can be considered for protection against gastric and duodenal ulcers associated with non-selective NSAIDs. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.
Severe hypomagnesaemia may occur in patients treated with PPIs, although the exact incidence is unknown. Where this is a clinical concern, prescribers may also decide to use a magnesium containing product such as magnesium hydroxide (not suitable for patients with short bowel syndrome) or Mucogel (see previous page)[/stextbox] [stextbox id=”info”] Deprescribing guidance. Decision guides on whether PPIs can be deprescribed can be found on the medicines management deprescribing page [/stextbox]