Patients’ Knowledge and Pharmacists’ Practice Regarding the Long-Term Side Effects of Proton Pump Inhibitors; a Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 January 2024
,
Page e35
https://doi.org/10.22037/aaem.v12i1.2305
Abstract
Introduction: Proton pump inhibitors (PPI) are a commonly prescribed medication, but recent evidence suggests that their long-term use may lead to several adverse events. To address this issue, our study aims to assess patient awareness and pharmacist practices in educating patients about the potential risks associated with prolonged PPI use.
Methods: Two questionnaires were developed by researchers and administered in the United Arab Emirates from June to August 2021 to gather insights from patients and pharmacists about the use of PPIs, their knowledge of potential side effects, and their experiences and attitudes toward receiving education about PPI side effects. The patients' knowledge was evaluated based on their cumulative correct answers to questions related to PPI’s long-term adverse effects including increased fracture risk and hypocalcemia, vitamin B12 deficiency, hypomagnesemia, and the caution of abrupt withdrawal. All statistical analyses were conducted using SPSS 25.0 software.
Results: Overall, 348 participants with a median age of 40 years participated in the survey, among them, 91 (26.14%) used various forms of PPI with 38% of users taking PPI as over-the-counter drugs. Patients had low knowledge about PPI side effects and their proper discontinuation with a median knowledge score of 0 (Interquartile range: 0-2) and only 22.2% of patients were familiar with at least three out of five asked harms. Those with lower knowledge were more likely to be Emirati compared to other nations (p=0.004) and aged over 30 years compared to their younger counterparts (p = 0.016). Few patients have obtained the relevant information from their physicians (25%) or pharmacists (7%). Inquiring 136 pharmacists, it was shown that the most common education was concerning vitamin B12 deficiency (62.5%) followed by fracture risk (58.09%) yet less than half (48%) of pharmacists instructed patients about the potential risk of hypomagnesemia. Almost all pharmacists (99%) agreed that there is a requirement for additional education on the possible harmful consequences of PPIs.
Conclusion: The present study has established that a considerable proportion of PPI users in the UAE lack the necessary awareness about the potential adverse effects of PPI despite their extensive use in this country. The current pharmacist practice is inefficient for inculcating the potential harms of chronic PPI use and they are required to optimize their efforts to educate patients and bridge the knowledge gaps.
- Proton Pump Inhibitors
- Long Term Adverse Effects
- Micronutrients
- Pharmacists
How to Cite
References
Bashford JN, Norwood J, Chapman SR. Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. Bmj. 1998;317(7156):452-6.
Turshudzhyan A, Samuel S, Tawfik A, Tadros M. Rebuilding trust in proton pump inhibitor therapy. World J Gastroenterol. 2022;28(24):2667-79.
Johnson DA, Katz PO, Armstrong D, Cohen H, Delaney BC, Howden CW, et al. The Safety of Appropriate Use of Over-the-Counter Proton Pump Inhibitors: An Evidence-Based Review and Delphi Consensus. Drugs. 2017;77(5):547-61.
Eusebi LH, Rabitti S, Artesiani ML, Gelli D, Montagnani M, Zagari RM, et al. Proton pump inhibitors: Risks of long-term use. J Gastroenterol Hepatol. 2017;32(7):1295-302.
Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE. Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic Clin Pharmacol Toxicol. 2018;123(2):114-21.
Islam MM, Poly TN, Walther BA, Dubey NK, Anggraini Ningrum DN, Shabbir SA, et al. Adverse outcomes of long-term use of proton pump inhibitors: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(12):1395-405.
FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs): U.S. Food and Drug Adminitration; 2011 [updated 2017. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-low-magnesium-levels-can-be-associated-long-term-use-proton-pump.
FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors: U.S. Food and Drug Administration; 2011 [updated 2017. Available from: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-possible-increased-risk-fractures-hip-wrist-and-spine-use-proton-pump.
Kurlander JE, Kennedy JK, Rubenstein JH, Richardson CR, Krein SL, De Vries R, et al. Patients' Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation: A National Survey. Am J Gastroenterol. 2019;114(2):244-9.
Fossmark R, Johnsen G, Johanessen E, Waldum HL. Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. Aliment Pharmacol Ther. 2005;21(2):149-54.
Waldum HL, Qvigstad G, Fossmark R, Kleveland PM, Sandvik AK. Rebound acid hypersecretion from a physiological, pathophysiological and clinical viewpoint. Scand J Gastroenterol. 2010;45(4):389-94.
Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-42.
Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354-64.
Holtmann G, Bigard MA, Malfertheiner P, Pounder R. Guidance on the use of over-the-counter proton pump inhibitors for the treatment of GERD. Int J Clin Pharm. 2011;33(3):493-500.
Boardman HF, Heeley G. The role of the pharmacist in the selection and use of over-the-counter proton-pump inhibitors. Int J Clin Pharm. 2015;37(5):709-16.
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871-80.
The global, regional, and national burden of gastro-oesophageal reflux disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(6):561-81.
Aljahdli ES, Mokhtar AM, Aljehani SA, Hamdi RM, Alsubhi BH, Aljuhani KF, et al. Assessment of Awareness and Knowledge of Proton Pump Inhibitors Among the General Population in Saudi Arabia. Cureus. 2022;14(7):e27149.
Koggel LM, Lantinga MA, Büchner FL, Drenth JPH, Frankema JS, Heeregrave EJ, et al. Predictors for inappropriate proton pump inhibitor use: observational study in primary care. Br J Gen Pract. 2022;72(725):e899-e906.
Jarbøl DE, Lykkegaard J, Hansen JM, Munck A, Haastrup PF. Prescribing of proton-pump inhibitors: auditing the management and reasons for prescribing in Danish general practice. Fam Pract. 2019;36(6):758-64.
Soubra L, Issa M. Prescribing of proton pump inhibitors for gastrointestinal bleeding prophylaxis in the Lebanese outpatient setting: patterns, compliance with guidelines and risks. Int J Pharm Pract. 2019;27(4):386-92.
Schoenfeld AJ, Grady D. Adverse Effects Associated With Proton Pump Inhibitors. JAMA Intern Med. 2016;176(2):172-4.
Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W, Srivali N, Edmonds PJ, Ungprasert P, et al. Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies. Renal failure. 2015;37(7):1237-41.
Gray SL, LaCroix AZ, Larson J, Robbins J, Cauley JA, Manson JE, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med. 2010;170(9):765-71.
Long AN, Atwell CL, Yoo W, Solomon SS. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use. Diabetes Care. 2012;35(12):e84.
Nochaiwong S, Ruengorn C, Awiphan R, Koyratkoson K, Chaisai C, Noppakun K, et al. The association between proton pump inhibitor use and the risk of adverse kidney outcomes: a systematic review and meta-analysis. Nephrol Dial Transplant. 2018;33(2):331-42.
Xun X, Yin Q, Fu Y, He X, Dong Z. Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis. Ann Pharmacother. 2022;56(5):524-32.
Hafiz RA, Wong C, Paynter S, David M, Peeters G. The Risk of Community-Acquired Enteric Infection in Proton Pump Inhibitor Therapy: Systematic Review and Meta-analysis. Ann Pharmacother. 2018;52(7):613-22.
Tariq R, Singh S, Gupta A, Pardi DS, Khanna S. Association of Gastric Acid Suppression With Recurrent Clostridium difficile Infection: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(6):784-91.
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