An outpatient department based observational study to review the pattern of utilization of proton pump inhibitors for their co-relation with the indications in a tertiary care centre

Jayant Kumar Kairi, M. Fadil Salmani


Background: Proton pump inhibitors (PPIs) are one of the commonest drugs prescribed for a variety of indications. They are considered remarkably safe and prescribed liberally. However, on long term administration, they can cause a number of adverse effects. In a tertiary care hospital, where the patient numbers are large and many attending super speciality centre, a number of patients were observed to receive PPIs for approved and unapproved indications. It was therefore considered prudent to study the prescribed PPIs for a co-relation with their indications or otherwise so as to formulate corrective interventions.

Methods: The observational study was conducted in the dispensary of a tertiary care centre. The prescriptions of the patients were the study material. Prescriptions for a full week were taken in for consideration. A total of 4142 prescriptions were studied. All aspects related to PPIs were noted and analysed. Additionally, a note on prescribed calcium supplements, vitamins and antioxidants was made.

Results: Of all the prescriptions studied by us, 33% had PPIs in them. Omeprazole was the commonest PPI followed by pantoprazole. Almost half the patients prescribed PPIs, the duration of administration was over 30 days. 78% patients prescribed PPIs also had some or the other non-steroidal anti-inflammatory drug (NSAID) in their prescription. Over one fourth of the total patients also received calcium supplements, vitamins or anti-oxidants.

Conclusions: Proton pump inhibitors are very popular drugs and are being prescribed for approved and unapproved indications in the hope of providing relief to the patients. They are being advised quite liberally and more so if any NSAID has been co-prescribed. Even for prescriptions lasting for less than 5 days, PPIs have been included in the presumption to prevent gastritis due to NSAIDs. This practice is contrary to guidelines and also exposes the patients to avoidable adverse drug reactions.


PPIs, NSAID, Omeprazole, Overuse

Full Text:



National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD. Table 80; 2016:274.

Mejia A, Kraft WK. Acid peptic diseases: pharmacological approach to treatment. Expert review of clinical pharmacology. 2009;2(3):295-314.

McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. In: Katzung BG, eds. Basic and Clinical Pharmacology. 13th ed. New York, NY: McGraw-Hill; 2015:1052-83.

Wedemeyer RS, Blume H. Pharmacokinetic drug interaction profiles of proton pump inhibitors: an update. Drug Safety. 2014;37(4):201-11.

Wallace JL, Sharkey KA. Pharmacotherapy of Gastric acidity, peptic ulcers, and gastroesophageal reflux disease. In Brunton L, Chabner B, Knollman B, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill; 2011:1309-1322.

Heidelbaugh JJ, Kim AH, Walker PC. Overutilization of proton pump inhibitors: what the clinicians need to know. Ther Adv Gastroenterology. 2012;5(4):219-32.

Heidelbaugh JJ, Inadomi JM. Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-intensive care unit hospitalized patients. Am J Gastroenterol. 2006;101:2200-05.

Sturkenboom MC, Burke TA, Dieleman JP, Tangelder MJ, Lee F, Goldstein JL. Underutilization of preventive strategies in patients receiving NSAIDs. Rheumatology (Oxford). 2003;42(S3):23-31.

Laine L. Approaches to non-steroidal anti-inflammatory drug use in the high risk patient. Gastroenterology. 2001;120:594-606.

Shim YK, Kim N. NSAID and aspirin-induced peptic ulcer disease. Korean J Gastroenterol. 2016;67(6):300-12.

Bjarnason I. Ibuprofen and gastrointestinal safety: a dose-duration-dependent phenomenon. J R Soc Med. 2007;100(S48):11-4.

USFDA patient information advice hosted on US National Library of Medicine. Available at Accessed 26 June 2016.

UK Medicines and Healthcare Products Regulatory Agency (MHRA) approved Patient Information Leaflet. Available at Accessed 26 June 2016.

Valle JD. Peptic ulcer disease and related disorders. In Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill; 2015:1911-32.

Reimer C, Sondergaard B, Hilsted L, Bytzer P. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology. 2009;137:80-7.

Gray SL, LaCroix AZ, Larson L, Robbins J, Cauley JA, Manson JE, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women. Arch Int Med. 2010;170:765-71.

Haider SI, Johnell K, Thorslund M, Fastbom J. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 - 2002. International Journal of Clinical Pharmacology and Therapeutics. 2007;45(12):643-53.

Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289(13):1652-58.

Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691.

Bessell E, Jose MD, McKercher C. Associations of fish oil and vitamin B and E supplementation with cardiovascular outcomes and mortality in people receiving haemodialysis: a review. BMC Nephrol. 2015;16:143.