Proton pump inhibitors (PPIs) are among the most frequently prescribed medications in Slovenia. However, their use is often not in accordance with clinical guidelines, as they are often prescribed without a clear indication or continued longer than recommended.
The aim of this study was to describe the patterns of PPI use in patients undergoing rehabilitation, to assess the appropriateness of treatment according to clinical guidelines, and to identify opportunities for deprescribing PPIs and evaluating clinically relevant drug interactions with concomitantly prescribed medications.
In this observational prospective study, 97 patients over 18 years of age, hospitalized at the University Rehabilitation Institute of the Republic of Slovenia Soča between May and October 2025, and receiving PPIs, were included. Data on patients and their pharmacotherapy were obtained from the hospital information system and patient interviews. Appropriateness of treatment was assessed based on indication, dosage, and duration of therapy, while drug interactions were evaluated using the UpToDate Lexidrug and Drugs.com databases.
At admission, 58.1% (97/176) of all hospitalized patients were receiving a PPI, with a median age of 59 years and a higher proportion of men (55/97, 56.7%). The most prescribed PPI was pantoprazole (90/97, 92.8%), predominantly at double doses (65/97, 67.0%) and as regular therapy (91/97, 93.8%). The most common indications were prevention of adverse effects associated with antiplatelet and anticoagulant therapy (26/97, 26.8%), gastroesophageal reflux disease (GERD) (13/97, 13.4%) and prevention of adverse effects of nonsteroidal anti-inflammatory drugs (11/97, 12.4%). In 35.1% (35/97) of patients, no clear indication for treatment could be identified. Overall, treatment was fully guideline-compliant in only 23.8% (15/63) of patients, with the greatest deviations observed in dosing (appropriate dose: 32/63, 50.8%) and duration of therapy in patients with GERD (4/13, 30.8%). At discharge, a reduction in treatment intensity was proposed for 67.0% (65/97) of patients, including gradual discontinuation of PPIs in 49.5% (48/97) and dose reduction in 17.5% (17/97). Of these, 67.7% (44/65) were fully accepted by physicians. No clinically significant interactions between PPIs and other active substances were detected.
The results indicate that the use of PPI is often irrational, as treatment is frequently continued without reassessment of its indication and necessity. Therefore, regular evaluation of the need for therapy and active deprescribing strategies are essential to ensure safer and more rational use of these medications.
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