Thread by @Drug_Evidence

🧵 Reducing unnecessary use of proton pump inhibitors (PPIs)

1/ Many people take #PPIs but up to 50% don’t have a good reason to take them > 8 wks

Read on for tips on how you as a clinician can work together with pts to decide if/how to 🛑 or reduce PPIs

#MedEd #deprescribing

2/ Does this person need #PPIs long-term (> 8 wks)?
 
Find pts who might not need long-term PPI:
1⃣ Flag refill requests
2⃣ Use a poster or video in waiting room
3⃣ Run EMR report
 
This @bmj_latest article has more tips to help with #deprescribing PPIs: bit.ly/3fisHsT

3/ Indications for long-term #PPIs include:

Barrett’s esophagus, previous bleeding ulcer, chronic NSAID use w/ mod/severe bleed risk, severe esophagitis, Zollinger-Ellison syndrome
 
If no indication for long-term PPI + no ongoing upper GI symptoms, discuss poss #deprescribing

4/ Start by talking to pt about why PPI #deprescribing might be appropriate

▶️PPIs usually not needed long-term & you can help them take 1 less med 💊

▶️Acknowledge uncertainty of harms w/ lng-term PPI use

Examples of how to start conversations: bit.ly/3fisHsT #MedEd

5/ Review #deprescribing options for #PPIs

▶️People often worry about symptoms coming back (and for good reason!)

▶️Different options have different risks of symptoms returning

▶️Work together to review options & find best fit for patient

👉🏽bit.ly/3fisHsT #MedEd

6/ #Deprescribing options for #PPIs:

1⃣ Taper: gradually lower the dose with goal of 🛑 (lowest risk of symptoms coming back)

2⃣ 🛑 & take on-demand (daily PPI until symptoms go away, then stop again)

3⃣ Abruptly 🛑 (highest risk of symptoms coming back)

7/ PLAN - before stopping/reducing, review with ppl:

▶️ May have “rebound” heartburn when 🛑 or ⬇️ #PPIs
▶️ Usually better in a few days
▶️ Antacids or alginates can help

If symptoms really bother ppl, can restart or return to previous dose (can be very reassuring for people!)