Mark Mercure, Pharmacist

Home Health Care Pharmacy

One out of two Canadian seniors use at least one potentially inappropriate medication. Continuing to take these risky medications can lead to falls, fractures, hospitalizations, and loss of independence.

Reducing or stopping these risky medications (with the help of a doctor, pharmacist, or nurse practitioner) can lead to improved health outcomes for older adults. One of the more common medications that can be reduced or stopped are a group of drugs called Proton Pump Inhibitors or PPI for short. PPIs are often used to treat heartburn or acid reflux.

Why are these medications considered risky? Although relatively few people will experience bothersome side effects from these medications, there are risks that can show up with long term use. Taking a PPI for longer than 12 weeks has been linked to a higher risk of hip fractures, pneumonia, infections with a bacteria called Clostridium difficile which can cause severe diarrhea and be quite serious, a higher risk of kidney problems, and occasionally cause deficiencies in vitamin B-12 and magnesium.

PPIs are effective in the short term, but many people end up taking PPIs for longer than they need to, and these risks may start to outweigh the benefits.

Besides heartburn, PPI medications are also used to treat more serious conditions. If you take a PPI for a condition called Barrett’s esophagus, for severe inflammation of the esophagus, or a history of bleeding ulcers, it may be safer to stay on a PPI medication long term.

For people who are bothered by heartburn, many non-drug alternatives exist to help control heartburn. Avoiding alcohol, fried or spicy food, garlic, onions, citrus, chocolate, peppermint, and tomatoes will help prevent heartburn. Eating smaller meals and avoiding meals right before bed will also help. If you are a smoker, quitting will reduce heartburn symptoms, and losing weight can also be very beneficial for those who are overweight.

When talking to your health care provider about a plan to discontinue, keep in mind there are various strategies that can be used to safely stop the medication. Reducing the prescribed dose of the tablet, changing the dosing schedule, or replacing with an on-demand acid reducer are all strategies that may be tried to taper off of your PPI . Do not stop your medication abruptly without discussing it with your healthcare provider. Keep in mind that PPI tablets cannot be cut in half, and that stopping a PPI medication too abruptly can lead to a condition called rebound hyperacidity.

Older adults are especially vulnerable to the effects of medications which may no longer be needed. Your pharmacist is a great resource who can help you save money on your meds which may no longer be necessary.

This self-assessment questionnaire may help you determine whether or not you still need to be taking your PPI. Always consult a physician or pharmacist before discontinuing any medication.

Mark Mercure is a Certified by the Board of Pharmacy Specialties in Geriatrics. He offers comprehensive medication reviews to help ensure that older adults are getting the most from their medications. He practices at Home Health Care Pharmacy in Brandon, MB.