deprescribing proton-pump inhibitor (PPI)

Indications

• short-term use 8 weeks complete
• no indications for long-term use > 8 weeks (see proton-pump inhibitor)

Contraindications

• patients on multiple blood thinners or with prior GI bleeding

Procedure

• PPIs can be tapered or stopped abruptly
• high-dose PPIs can be stepped down to standard dosing
  • minimal evidence supports higher doses

Complications

• rebound acid hypersecretion can last for weeks

Management

• some rebound symptoms can be managed with histamine-2 blockers or antacids.

Notes

• PPIs should be discontinued for lack of indication vs concern for adverse effects
• no serious adverse effects demonstrated in randomized trials

* other PPI deprescribing guidelines available

• the U.S. Deprescribing Research Network website has guidelines, algorithms, & videos for deprescribing of proton pump inhibitors
• Medscape has published on deprescribing proton pump inhibitors
• Deprescribing.org has developed deprescribing guidelines & algorithms for deprescribing proton pump inhibitors

More general terms

• medication deprescribing