Proton pump inhibitors are among the most commonly used medications in Slovenia. Their use is often outside treatment guidelines, being used without a valid indication and longer than recommended. Unnecessary use represents a financial burden, a risk of long-term side effects, and potential drug interactions.
Our study aimed to describe the characteristics of treatment with proton pump inhibitors in adult medical patients, hospitalised at the University Clinic Golnik, assess the possibilities of deprescribing, and evaluate clinically important drug interactions with proton pump inhibitors. Patient data were obtained from the hospital information system and patients' medication history. Drug interactions were searched in drug interaction databases (Drugs.com and Lexicomp), and their clinical significance was assessed by an expert panel of clinical pharmacists.
Of the 555 patients screened, 227 received proton pump inhibitors (40.9%). From these 227 patients, 73.1% received pantoprazole, often as a double dose (52.9%), used it regularly (87.7%) and for over one year (74.4%). The most common indications for proton pump inhibitors’ use were gastroesophageal reflux disease (37.4%) and prevention of gastrointestinal ulcers while on non-steroidal anti-inflammatory drugs (32.2%). In the majority of patients (74.2%) treatment was not in line with guidelines, allowing drug deprescribing in 60.0% of patients, by either discontinuation (38.3%) or dose reduction (21.7%). In total, 2102.01EUR could be saved every year if said changes were implemented. At least one interaction was detected in 85.5% of patients, with a median of 2 interaction per patient. Overall, 76 different interactions were detected, and 3 were identified by the expert panel as clinically very important. These were the interactions between clopidogrel and esomeprazole/omeprazole, and rifampicin and omeprazole.
Many patients are prescribed proton pump inhibitors, and drug deprescribing is possible in over half of these patients. Drug interactions with proton pump inhibitors are common, however only rarely clinically important.