Risks identified in common drug therapy

Risks associated with one of the most commonly prescribed drugs in Australia, accounting for about one million prescriptions a year, are examined in two articles in the latest Medical Journal of Australia.

Proton Pump Inhibitors (PPIs) are the most commonly used acid suppressants. Acid suppressant therapy resulted in world-wide sales of almost $27 billion in 2005.

A study by Elizabeth Roughead (University of South Australia) and colleagues, which examined Australian war veterans’ health records over five years, showed patients using PPI have a small but significantly increased risk of hospitalisation for pneumonia.

The increased risk may be caused by an increase in colonisation of ingested pathogens due to the suppression of gastric acid.

Further risks to PPI users are identified in an editorial by the Mayo Clinic’s Professor Nicholas Talley, which maintains that no drug is completely safe and “while the risks seem small, some side effects can be serious”.

Professor Talley quotes a number of international studies showing enteric infections, osteoporosis, vitamin B12 deficiency and interstitial nephritis have all been associated with PPI use.

The editorial says while risks are small, doctors should prescribe the lowest possible dose for as short a time as possible and consider alternative management options where available. The editorial also says patients should be warned about the potential serious (albeit rare) side effects.