News
Assessment of Proton Pump Inhibitors (PPIs) for Ambetter
Date: 12/02/19
Ambetter from Superior HealthPlan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all members. This includes the treatment of gastroesophageal reflex disease and other acid-related conditions using Proton Pump Inhibitors (PPIs).
There are a variety of medication options within the PPI class and the majority of the medications are now available in a generic formulation. Please review the information below regarding the long-term concerns for using PPIs and some suggested treatment options in long-term therapy is needed.
PPIs have proven to have a remarkable tolerability profile in adults, but recent studies have shown that long-term use of PPIs can increase the risk for the serious side effects. Long-term use of PPIs have been associated with an increased risk for:
- Clostridioides (formerly Clostridium) Difficile–Associated Diarrhea (CDAD)
- Clostridioides (formerly Clostridium) Difficile (C.DIFF.)
- Decreased Absorption of Vitamins and Minerals
- Dementia
- Drug Interactions
- Fracture/Osteoporosis
- Hospital and Community Acquired Pneumonia
- Recurrent Infections
- Reduced Renal Function
Assessment Questions
- Was therapy initiated during a hospitalization to prevent a stress ulcer? If yes, consider discontinuation unless there was an additional diagnosis for the drug.
- What is the PPI being used for?
- When was the last time a dose reduction was tried?
- Is it appropriate to transition to an H2 antagonist (if acid reduction is appropriate)?
Clinical Considerations
The American Geriatrics Society’s Beers Criteria (AGS Beers) note that long-term use of PPI is potentially inappropriate for patients 65 years and older and recommends avoiding treatment duration exceeding 8 weeks unless benefits outweigh risks1.
PPIs have shown a reduction in risk for NSAID-induced ulcers. Please assess the NSAID, alternatives, and dosing before changing the PPI.
Lower risks and medical costs are also associated with lowering PPI overutilization.
Please review the short-term indications, appropriate long-term use and suggested cost-effective options:
- Short-Term Indications
- Helicobacter pylori (H. pylori) eradication to reduce the risk of Doudenal Ulcer (DU) recurrence, in combination with antibiotics.
- Short-term and maintenance treatment for an ulcer.
- Appropriate Long-Term Use
- Healing of or maintenance of healed Erosive Esophagitis (EE).
- Treatment of Gastroespopageal Reflux Disease (GERD).
- Risk reduction of Gastric Ulcer (GU) associated with NSAID use.
- Pathological hypersecretory conditions, including Zollinger-Ellison (ZE) syndrome.
If PPI therapy is to be continued for medical purposes, please consider the following cost-effective options:
Proton Pump Inhibitor (PPI):
- Omeprazole
- Pantoprazole
H2 Antagonist:
- Ranitidine
- Famotidine
If an H2 antagonist is more appropriate, please consider one of the following cost-effective options:
Please direct any questions to the Superior Pharmacy department at 1-800-218-7453, ext. 54019