The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, When Less is More - Deprescribing Proton Pump Inhibitors, can be viewed here. For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/

1. When Less is More: Deprescribing Proton Pump Inhibitors
Introduction:
• PPIs are one of the most commonly prescribed medications
• Effective and generally safe for the symptomatic management of acid-mediated
gastrointestinal disorders.
• But increasingly being used for long periods, often without a proper indication for
their use.
• Use linked to increased risk of fractures, pneumonia, enteric infections, vitamin and
mineral deficiencies, and acute interstitial nephritis, particularly among older people
who make up the largest proportion of PPI users, amongst other possible side effects.
• When an ongoing indication is unclear, the risk of side effects could outweigh benefit.
• Several algorithms exist to aid deprescribing
Outcomes:
Case 1: CB 85yr 👨🏻‍🦳 5yrs GORD on 2 PPI, no OGD – arranged – NAD – stopped 1 PPI (1
remained for ticagrelor cover)
Case 2: AS 96yr 👩🏻‍🦳 on PPI since 2019 , no ulcer, contributing to ACB ( falls / confusion)
trial off PPI 1/12
Case 3: JC 84 👩🏻‍🦳 admitted asymptomatic renal failure – stopped PPI –> renal function
normal.
Case 4: MK 94 👩🏻‍🦳 on PPI since 2003 for GORD, also HF/ AF/ CKD. Recent
hyponatraemia – switched PPI to famotidine – improved na+
Case 5: EF 85👩🏻‍🦳 on PPI for 20yrs +, GORD, stopped PPI
Dr Priti Kadoo – Frailty Hub GP Surrey
p.kadoo@nhs.net
Conclusion:
• Action learning sets aid awareness & importance of polypharmacy & deprescribing.
• Increased awareness in the importance of deprescribing PPI medications.
• Many possible side effects of PPI, particularly in long term use & in older adults.
• Resources available to support deprescribing.
• Focussed medication reviews are possible within current consultation times.
• This process has changed my practice which has improved patient care.
• Most patients were keen to reduce their medication burden & active shared decision
making occurred.
ALWAYS THINK – WHY IS THIS PATIENT TAKING A PPI?
Act
Successful to
deprescribe PPI.
Aim to present
to prescribing
colleagues
Plan
Review
medication list &
opportunistically
deprescribe PPI
Do
Deprescribing.org
algorithm for PPIs
used for
appropriate
patients
Study
5 patients
reviewed where
PPI
deprescribing
considered
What
matters to
you?
References
• hiips://deprescribing.org/wp -content/uploads/2018/08/ppi-deprescribing-algorithm_2018_En.pdf
• hiips://www.primaryhealthtas.com.au/wp -content/uploads/2018/09/A-Guide-to-Deprescribing-
Proton-Pump-Inhibitors-2019.pdf
• hiips://www cureus com/articles/50133 -adverse-effects-associated-with-proton-pump-inhibitor-use
• hiips://www.acbcalc.com/
Contribution to
Anticholinergic
burden
Side
effects
associated
with PPIs
January 2023