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Paediatric reflux disease guidance including information regarding the use of PPIs in this population can be accessed here: Paediatric reflux disease guidance
The use of proton pump inhibitors (PPI) and histamine H2 receptor antagonists (H2RAs) has been suggested to be a risk factor for the development of C. difficile-associated disease. PPIs can also increase the risk of fractures (particularly when used at high doses for over a year in the elderly), and may mask the symptoms of gastric cancer. Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, and if necessary, receive other preventative therapy.
MHRA advice (September 2015): Very infrequent cases of subacute cutaneous lupus erythematosus (SCLE) have been reported in patients taking PPIs. Drug-induced SCLE can occur weeks, months or even years after exposure to the drug. Refer to MHRA advice for management advice.
Measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a PPI, especially when used with other drugs that cause hypomagnesaemia or with digoxin. All acid-blocking medicines may reduce the absorption of vitamin B12 due to hypo- or achlorhydria. Monitoring may be considered in patients with reduced body stores or risk factors for reduced dietary vitamin B12 absorption on long-term therapy.
PPIs should only be used where there is a clear indication. PPIs should be prescribed at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically. All PPIs are absorbed in the small bowel (including dispersible tabs); where there is gastric outlet obstruction, IV omeprazole should be used.
For patients who have difficulty in swallowing, some PPI capsules may be opened and their contents dispersed in a suitable liquid. See individual product literature for further advice regarding suitable liquids. Where included in the formulary dispersible tablets may also be prescribed for patients with dysphagia or receiving tube feeding. Dispersible preparations should not be prescribed in any other circumstances. In tube fed patients, lansoprazole dispersible tablets are preferable as omeprazole dispersible tablets are more likely to block fine-bore tubes.
Indications and Dose
Indications and Dose