Long-term use of proton pump inhibitors (PPIs) in adults

The efficacy and availability of proton pump inhibitors (PPIs) has led to overuse in both outpatient and inpatient settings. Long-term regular PPI therapy is only recommended for a limited number of indications. PPI therapy should be stopped if there is no ongoing indication.

Although PPIs are generally considered safe, there have been reports of serious adverse effects with both short-term use (eg interstitial nephritis) and long-term use (eg hypomagnesaemia, increased risk of pneumonia, Clostridioides difficile [formerly known as Clostridium difficile]Perry, 2020 and other gastrointestinal infections, impaired nutrient absorption, risk of fracture), as well as possible interactions with thienopyridines (eg clopidogrel)Yildiz, 2014 Niu, 2017 or increased risk of cardiac eventsShiraev, 2018. The strength of evidence for these adverse effects is variable and comes mostly from observational studies (which may not have controlled for all covariables), in vitro data or experimental dataKatzka, 2020Perry, 2020. The absolute risk of any of these events is low; however, careful prescribing is advised to reduce risk, particularly with long-term use. Reconsider the indication for PPI therapy regularly, particularly on discharge from hospital.