It is estimated that the National Health Service (NHS) spends at least £100m per year on needless indigestion drugs, according to an editorial published in the British Medical Journal (BMJ). The UK is not alone in this kind of spending – apparently, almost £2bn are spent globally on such drugs each year.

Two gastroenterology doctors at King’s College Hospital, London, write that proton pump inhibitors are the most commonly prescribed classes of drug worldwide. They inhibit the backflow of stomach acid that causes dyspepsia (indigestion). The world spent £7bn on these drugs in 2006, the UK spent £425m.

Even though alternative drugs, which are cheaper and effective, are available for many patients, prescriptions for proton pump inhibitors have overtaken those for all other acid inhibiting agents – they now make up 90% of the NHS drug budget for dyspepsia treatment.

Because they are more expensive, prescribing guidelines for proton pump inhibitors that have been drawn up in the UK and several other countries – particularly in the long term – are relatively selective.

What indications are there that the guidelines are not followed?

63% of Australian, 33% of Irish, and 67% of British patients who were taking proton pump inhibitors did not meet their country’s criteria for taking the medication, according to a study of hospitalized patients. A separate US study of hospitalized patients found that the majority of them were taking these drugs needlessly at the time of discharge.

A Swedish primary care study of patients who had been taking proton pump inhibitors for four years showed that 27% of them were able to stop taking the drug completely.

An audit of patients admitted as a medical emergency to a Welsh hospital found that one in four of them were taking proton pump inhibitors, but only half of them were deemed to be suitable for such drugs. After distributing the NICE guidelines to local doctors, another audit was performed six months later. It found that the same percentage of patients was taking a proton pump inhibitor, while the same number of patients were deemed suitable for such medications (half of them).

Even though proton pump inhibitors have been a fantastic therapeutic breakthrough and have improved the lives of patients with previously persistent symptoms, they are being overused, the authors write.

The risk of becoming infected with Clostridium difficile may be significantly higher for a patient taking proton pump inhibitors.

Although side effects are quite rare, they should not be overlooked, the authors stress. Global over-prescribing is a real problem. It is important to find ways of motivating doctors to follow guidelines.

“Overprescribing proton pump inhibitors.”
Ian Forgacs, Aathavan Loganayagam
BMJ 2008;336:2-3 doi: 10.1136/bmj.39406.449456.BE

Written by – Christian Norqvist