How Did Nexium Prilosec And PPIs Become So Massively Overprescribed?

Executive Summary

• Nexium and Prilosec were widely used for decades and were generally considered safe but had severe health implications.
• How did they become so overprescribed?

Introduction

• PPIs or proton pump inhibitors are directed at proton pumps in the stomach that produce stomach acid and inhibit their activity.
• PPIs are blockbuster drugs that have been overmarketed and overprescribed and taken for far too long a duration of treatment by many millions of people worldwide.
• PPIs ended up being included in a hospital admittance protocol.

We will cover how the use of PPIs got so out of hand.

Our References for This Article

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The History of PPIs

This video explains how information about highly problematic outcomes from this drug category has come to light. 

How PPIs Became Part of Hospital Admission Perscriptions

It became part of standard hospital admission to be placed on PPIs, as is explained in the following quotation.

Estimates vary, but anywhere from 20 to 70 percent of patients admitted to the hospital will be unnecessarily started on a PPI. This has become common practice in hospitals, where starting a PPI is as easy as checking a box on the admission checklist. And many, if not most, of these patients are continued on the drugs for no apparent reason after discharge. – Public Citizen

Broad Hospital Perscriptions of PPIs To Preventing GI Bleeding or Stress Ulcers?

A Major Reason for prescribing PPIs was to stop GI bleeding, as explained in the following quotation.

The use of proton pump inhibitors in the inpatient setting has become so pervasive, particularly among housestaff, that some liken it to a runaway train. While the drugs are presumably used to protect against GI bleeding, a number of studies show that the threat of GI bleeds outside the ICU is relatively rare. One study, in fact, found that up to 68 percent of patients in one hospital were receiving PPIs inappropriately.

That’s a problem for several reasons. For one, when patients leave the hospital with a PPI script in hand, their outpatient physicians continue the therapy, thinking that there must have been a good reason they received the drugs while in the hospital. In addition, the therapy has received little scrutiny because few contraindications have emerged in the wake of their widespread use in the outpatient setting,

Research into the association between PPIs and C. difficile suggest that because acid suppression, like antibiotics, disrupts normal intestinal flora, the decreased gastric acidity that results may create a potentially fertile breeding ground for C. difficile. And while the studies have not established a causal relationship, they’re helping physicians who are concerned about overuse of the drugs make a case for addressing the issue.

“The issues of potential infection risk and C. difficile are providing some evidence that PPIs might not be as harmless as people have thought,” says Daniel Brotman, MD, director of the hospitalist program at Johns Hopkins Hospital in Baltimore.

Prophylaxis with histamine-receptor antagonists (H2 blockers) or PPIs is well-established in the ICU because the drugs have been proven to reduce the incidence of stress ulcers. Strong data show that the drugs can help patients who have been on mechanical ventilation for more than 48 hours or who have been on anticoagulation. PPI prescribing took hold on the medicine wards, the thinking goes, when physicians thought the drugs would confer similar benefits for non-critically ill patients.

“Most doctors have not met a therapy they don’t like, and they think they’re being modern if they do these things,” explains California gastroenterologist Ronald Koretz, MD, a professor of clinical medicine at the University of California, Los Angeles. “Our housestaff generally put patients on PPIs, even intravenous PPIs, and if I ask why, they tell me it’s for stress bleeding. But when you look at the data, most people don’t have stress bleeding outside the ICU.”

The reality is that even in ICU patients, stress ulcers are relatively uncommon. Data from studies led by Canadian researcher Deborah Cook, MD, considered the guru of GI bleeding prophylaxis and treatment, put the ICU incidence at less than 3 percent. – Today’s Hosptialist

However, it means that PPIs’ highly problematic side effects will affect 100% of the people who address this less than 3% figure. This type of protocol is based on the idea that PPIs have very few side effects, which shows deep ignorance of the history of PPIs and how stomach acid works as part of the digestive process