Intended for healthcare professionals

Practice Change

Reduce unnecessary use of proton pump inhibitors

BMJ 2022; 379 doi: (Published 24 October 2022) Cite this as: BMJ 2022;379:e069211

Linked Editorial

Sustainable practice: what can I do?

  1. Barbara Farrell, senior scientist, assistant professor, adjunct assistant professor1 2 3,
  2. Elliot Lass, assistant professor, family physician4 5 6,
  3. Paul Moayyedi, assistant dean of research7,
  4. Deanna Ward, patient advisor with Choosing Wisely Canada,
  5. Wade Thompson, assistant professor8 9
  1. 1Bruyère Research Institute, Ottawa, ON, Canada
  2. 2Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
  3. 3School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
  4. 4Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
  5. 5Department of Family and Community Medicine, Baycrest Health Sciences, Toronto, ON, Canada
  6. 6Granovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, ON, Canada
  7. 7McMaster University Medical Centre, Hamilton, ON, Canada
  8. 8Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
  9. 9Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
  1. Correspondence to: W Thompson wade.thompson{at}

What you need to know

  • Proton pump inhibitors (PPIs) are effective and widely used, but often for longer than needed, adding to medication burden and resource waste

  • Discuss with patients reducing or stopping PPIs if they have been taken for longer than eight weeks unless there is a specific indication for long term use

  • PPI deprescribing options include dose reduction, stopping, switching to “on demand” use, and using alternative antacid medication with non-drug approaches to avoid or manage heartburn

  • A management plan for rebound heartburn after stopping a PPI is helpful, and may include returning to the original dose if symptoms are severe

Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs globally, often taken for longer than needed and at high financial cost to society. Among adults living in the community, the point prevalence of PPI use is 7-8% in the UK and Denmark,12 while rates of use of 40-50% have been reported in older people in Canada and in those living in residential care in Australia.3456 In England, more than 50 million prescriptions for PPIs were issued in 2015.7 While PPIs are effective for upper gastrointestinal disorders and may be continued long term (beyond 8 weeks)8 for specific conditions (box 1),11121314 people often continue taking them for years when guidelines recommend 4-8 weeks of treatment or, in the case of gastrointestinal bleeding prophylaxis for critically ill patients, cessation when the patient is no longer critically ill or the risk factor triggering prophylaxis is no longer present (box 2).9131516

Box 1

Indications for long term use (>8 weeks) of proton pump inhibitors (PPIs)910

  • Barrett’s oesophagus

  • Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) with moderate to high bleeding risk (for example, age ≥65 years, high dose NSAID use, history of uncomplicated ulcer, concurrent use of corticosteroids …

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