NEW RISKS OF PROTON PUMP INHIBITORS

There has been extensive evidence to support using proton pump inhibitors (PPIs) for short term use only. Unfortunately, in the long term care setting, most patients take PPIs due to being discharged on one from the hospital. Part of the job of the pharmacist consultant is to keep patients safe and this includes requesting that PPIs like Prilosec and Protonix are used for the shortest duration possible when appropriate.
The evidence supporting adverse events such as increased risk of infections from Clostridium difficile, increased events of osteoporosis, electrolyte imbalances and B12 deficiency has brought this class of medication to be on the BEERS list, or the list of medications that are potentially inappropriate for use in the elderly. Recently a new adverse event was identified.
Recent investigations have suggested an association between PPI use and an increased risk of dementia. While the increase was seen in all types of dementia, Alzheimer’s disease was specifically identified. Several studies have been conducted to try and find the cause.
Gomm et al, provided evidence of a link between PPI use and dementia.1 The study looked at over 70,000 participants over 75 years of age and who were free of dementia. The participants were followed for 7 years and were divided into 2 groups; those who took PPIs and those who did not.
After adjusting for other risk factors, the PPI users were found to be 44% more likely to be diagnosed with dementia. While an absolute causation has not been established, best practice would be to minimize the use of the PPI class of medications in the elderly.
1. Gomm W, Klaus von H, Friederike T et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims analysis. JAMA Neurol 2016;73:410-6.
Christy Ledger, PharmD, MS, BCGP, is a consultant pharmacist with Holladay Healthcare Pharmacy. 

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