![]() Of seven studies including over 3,000 people found that PPIs provided better relief from heartburn than histamine H 2-receptorĪntagonists (relative risk = 0.66 95% confidence interval (CI) = 0.60–0.73). Relief from the symptoms of GORD and allow healing of any associated oesophageal lesions. four to eight weeks, is recommended to provide Typically, a short-course of treatment with a PPI, i.e. erosive oesophagitis, oesophageal stricture (narrowing of the oesophagus), Barrett’s oesophagus and oesophageal 8, 9 Older people are more likely to experience complications associated nausea, vomiting, anorexia, dysphagia, respiratory symptoms, belching, dyspepsia, heartburn and acid regurgitation, may be reduced in older people, while the presence ofĪtypical symptoms may be increased, e.g. ![]() nitrates,Ĭalcium channel blockers, benzodiazepines, anticholinergics and antidepressants. Sphincter, decreased salivary bicarbonate secretion or the use of medicines that affect sphincter tone, e.g. The prevalence of GORD increases with age, which may be explained by age-related functional changes to the lower oesophageal 6Įvidence-based indications for PPI use in older adults Gastro-oesophageal reflux disease (GORD) Prescriptions in people aged 65 to 69 years. Over 80 years, with 339 dispensed prescriptions per 1,000 registered patients in this group compared to 242 dispensed 6 The highest number of prescriptions for omeprazole were dispensed to people aged 6 Four times more prescriptions were dispensed for omeprazole than for pantoprazoleĪnd lansoprazole combined. In the 12 months from July, 2017 to June, 2018, approximately 243,000 people aged 65 years and older (34% of this population) In 2018, omeprazole was the third most commonly dispensed medicine in New Zealand, after paracetamol and atorvastatin. 1įor further information on the indications for a specific PPI, refer to the New Zealand Formulary: PPIs are widely used by older adults in New Zealand 4 The adverse effect profile is similarįor the different PPIs available in New Zealand. Zollinger-Ellison syndrome, in addition to their other indications. only omeprazole and pantoprazole are indicated for the prevention of NSAID-associated ulcers and the treatment of 2–4 There is some variability between the PPIs in terms of their indications,Į.g. Rabeprazole is also available with a prescription but is not subsidised.Īll of the PPIs available in New Zealand have a similar efficacy when used at the recommended dose for the treatment ![]() Omeprazole and pantoprazole can also be purchased in limited quantities as “Pharmacist Only” medicines at a maximum dose There are currently three fully subsidised PPIs available in New Zealand: omeprazole, pantoprazole and lansoprazole. Eradication of Helicobacter pylori (in combination with an antibiotic)įor further information on PPIs, see: Which PPIs are available in New Zealand?.Gastric and duodenal ulcers associated with non-steroidal anti-inflammatory drug (NSAID) treatment.erosive oesophagitis, Barrett’s oesophagus Gastro-oesophageal reflux disease (GORD) and associated complications, e.g.PPIs are indicated for the prevention and treatment of the following conditions related to gastric acid secretion: 1 the “proton pump”, in the parietal cells in the stomach. Triphosphatase (H +/K + ATPase) enzyme, i.e. Proton pump inhibitors (PPIs) prevent the final step of gastric acid secretion by blocking the hydrogen/potassium adenosine Patients should be warned about the possibility of rebound symptoms and how to manage these, when stopping PPIs.reduce the dose, use every secondĭay or as needed, and then stop completely If stopping the PPI is appropriate, a “step-down” approach is recommended, e.g.Regularly review PPI use to determine whether long-term treatment is still indicated, or whether a lower dose or.vitamin B 12, magnesium, iron) and increased susceptibility to some bacterial Long-term PPI treatment is associated with a small increase in the risk of adverse outcomes, including bone fractures,.Use of non-steroidal anti-inflammatory drugs (NSAIDs) or Helicobacter pylori infection gastro-oesophageal reflux disease (GORD), gastric and duodenal ulcers associated with Proton pump inhibitors (PPIs) are highly effective medicines for preventing and treating conditions related to gastricĪcid secretion, e.g.
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