Heartburn drugs prescribed inappropriately
Common drugs to treat heartburn and ulcers are often inappropriately prescribed to patients undergoing surgery and in general practice, according to two new studies by Irish doctors.
Medical researchers from Wexford General Hospital said 70% of patients had been prescribed proton pump inhibitors (PPIs), which prevent gastrointestinal bleeding, without clinical justification.
The survey, of 89 surgical patients at Wexford General Hospital, found 73% were on PPI therapy, but in only 30% of those cases was the prescription in line with recommended use.
Although the inappropriate use rate of 70% was high, the report’s main author, Lauren O’Connell, from the Department of General Surgery in Wexford General Hospital, said it was “in line” with other similar studies.
She described the overuse of PPIs in both community and acute hospital settings as “significant”.
In contrast, she said cases where PPIs were inappropriately not administered to patients were rare.
“There is, therefore, a need for ongoing education of non-consultant hospital doctors, with regard to appropriate indications of PPI use,” said Dr O’Connell.
A similar study, by two GPs, on the use of PPIs at a medical centre in Drogheda, found they were prescribed without clear indication in 40% of cases.
The class of drugs accounted for 20% of all prescriptions issued over a four-week period.
The overwhelming majority of patients on PPIs had been taking them for over 12 months, with 60% taking them for at least five years.
The two studies, which have been published in the Irish Medical Journal, coincide with publication of a US study that warned the long-term use of PPIs, even in low doses, had been associated with an increased risk of premature death.
Researchers from Washington University said there was evidence of links between PPIs and the risk of developing fatal conditions like heart disease and stomach cancer.
Dr O’Connell said the development of PPIs had revolutionised the treatment of gastrointestinal disorders, but that their prescribing rates were continuing to increase out of proportion to the known prevalence of such conditions.
PPIs accounted for 7% of all prescriptions under the General Medical Scheme in 2016, with current expenditure on such drugs estimated at over €40m per annum.
However, recent studies have shown that PPIs have become associated with adverse effects, including an increased risk of clostridium-difficile associated diarrhoea, pneumonia, and chronic kidney disease.
The most common PPI used in Wexford General Hospital was esomeprazole — otherwise known under the brand name Nexium — which was prescribed to 72.3% of patients.
Dr O’Connell said it was interesting that despite recommendations by the HSE that lansoparazole was the drug of choice in the PPI class, esomeprazole was by far the drug most commonly prescribed.
She claimed the recommendation was primarily based on cost, as there was a price differential of €16.72 per pack between the two drugs.
