2023-12-19 08:30:01
According to a press release from the High Authority of Health in November 2020, one in four French people would be treated with a proton pump inhibitor, medications used to combat gastric acidity. Is there overconsumption of these medications in France? What are their side effects? Santé Sur le Net looked at the use and risks linked to proton pump inhibitors.
One in four French people on proton pump inhibitors
Proton pump inhibitors (often noted IPP) constitute a class of drugs widely prescribed in the treatment of gastroesophageal reflux and peptic ulcers. In France, some of these medications are available without a prescription with packaging for a 7-day treatment, others require a medical prescription. Why are 16 million French people treated with a proton pump inhibitor? Do that many people suffer from ulcers or reflux?
Faced with this figure, public health authorities have looked into the contexts of prescription and use of these drugs and noted several misuse situations :
The systematic prescription of a PPI at the same time as a nonsteroidal anti-inflammatory drug (NSAID) in subjects not at risk of gastroduodenal complications; Too long a prescription duration, with the absence of a reassessment of the benefit of the treatment after 8 weeks; Too frequent prescriptions for infants, young children or the elderly.
Beyond the economic impact of these misuses, HAS is also concerned about the risks for patients’ health. Indeed, PPIs are not without side effects.
Read also – Statins, the truth and the falsehood about their side effects
Significant side effects in case of long treatment
Side effects of proton pump inhibitors are generally benign, but can sometimes be more serious, particularly during long-term treatment:
bacterial infections at the digestive level (infection with Clostridium difficile) or pulmonary (pneumonia); bone fractures; muscle and joint pain; a disturbance in blood levels of sodium, magnesium or calcium; kidney damage which can lead to chronic renal failure; an increase in mortality.
The risk is all the more marked as the treatment lasts. According to HAS figures in 2020, 4% of treated patients, or around 300,000 patients, had been taking treatment for more than 6 months. Furthermore, long-term use of a PPI may interact with the use of other medications, notably certain antiplatelet agents prescribed to prevent cardiovascular events.
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Limit misuse to maintain the clinical benefit of PPIs
Health Insurance estimates that 40 to 80% of patients taking PPIs misuse. In this context, the HAS has reassessed the place of these drugs in the therapeutic strategy. It issued several recommendations intended to limit the misuse of these medications to reduce the risks associated with side effects. HAS distributed to healthcare professionals a medication use sheet and an information document for patients. The bottom line is that proton pump inhibitors should be used only for their therapeutic indications, at the lowest doses, for the shortest possible duration and with gradual withdrawal in the event of long treatment.
For example, the co-prescription of a PPI with an NSAID should only be considered in people at risk (age over 65 years, history of gastric or duodenal ulcer, combination with an antiplatelet agent). And the PPI should be prescribed at half dose. It remains to be seen whether these recommendations for good use are indeed put into practice. In Quebec since 2017, the reimbursement period for PPIs has been reduced to 90 days per year in adults (excluding special situations) to encourage more reasoned use of this class of medications.
Read also – Proton pump inhibitors (PPI): an exploding drug prescription
Estelle B., Doctor of Pharmacy
Sources
– PPIs remain useful but must be prescribed less and better.www.has-sante.fr. Accessed December 4, 2023.
– Proper use of proton pump inhibitors (PPI) www.has-sante.fr. Accessed December 4, 2023.
– PROTON PUMP INHIBITORS, LONG-TERM RISKS. www.rfcrpv.fr. Accessed December 4, 2023.
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