Veterans taking big doses of reflux drugs

NORTHWESTERN (US) — Veterans diagnosed with gastric reflux are often prescribed high doses of proton pump inhibitors and take them for too long, a new study shows.

The doses of proton pump inhibitors (PPIs), such as omeprazole (commonly known by brand names such as Prilosec), tend to be much higher than recommended.


“It seems that once these veterans are prescribed a PPI, they are rarely taken off of it,” says Andrew Gawron, first author of the study and a fellow in the division of gastroenterology and the Center for Healthcare Studies at Northwestern University Feinberg School of Medicine.

“Two years after their initial prescription, most are still on the drug.” He says the study, which appears in the Journal of General Internal Medicine, highlights the importance of ensuring appropriate use of PPIs in all patients after they are initially prescribed.

PPIs are among the most widely used drugs in the nation, resulting in more than $11 billion in annual direct health care costs in the US PPI overuse has been documented in previous studies, but this is the first study to examine initial prescriptions given to veterans with a new GERD diagnosis.

“We should always have a reevaluation after an initial prescription and ask, ‘Does this patient need to be on this medication?'” says Gawron.

“Proton pump inhibitors are provided ubiquitously in medicine, and although they provide relief for many patients, optimal prescribing is important to avoid prolonged, unnecessary use and cost.”

The researchers evaluated more than 1,600 Veterans at the Edward Hines, Jr. VA Hospital in Hines, Illinois, from 2003 to 2009. Here are the major findings, which highlight the potential problems:

  • The majority of patients received more than a three-month initial supply of medication.
  • Almost 25 percent of patients were given high total daily dose prescriptions.
  • Very few patients who started on high dose therapy had reductions in dosing more than two years after their initial prescription.

It is recommended that PPIs be prescribed at the lowest effective dose for four to eight weeks to treat GERD. If symptoms persist after eight weeks, efforts should be made to evaluate other potential causes of symptoms and alternative approaches to therapy.

This approach is a top priority in the “Choosing Wisely” campaign initiated last year by the American Board of Internal Medicine and the American Gastroenterology Association.

Veterans Affairs Health Services Research and Development Service funded the research.

Source: Northwestern University