PPIs

• PPIs MOD

  • Reduces the amount of acid produced by the stomach
  • decrease intragastric acidity therefore can affect absorption of certain medications
• OTC PPIs

  • For adults aged 18 and over
  • Omeprazole & pantoprazole metabolised by CYP450 - affect warfarin
  • Esomeprazole & clopidogrel - clinical relevance is uncertain, use of both together is discouraged
• Maximum duration of OTC PPI treatment is 2 weeks (refer to GP after this)
• PPIs referral?

  • >55 yrs with first time symptoms/ change in symptoms
  • >55 yrs old with unexplained dyspepsia that has not responded to treatment
  • >45yrs who suffer from long recurrent symptoms of indigestion/heartburn
  • dyspepsia with: bleeding, dysphagia, recurrent vomiting, weight loss (suspect gastric malignancy)
  • previous history of gastric ulcers
  • concurrent medication: nelfinavir, atazanavir
  • pregnant/breastfeeding
• Dosages for OTC PPIs?

  • Omeprazole= TWO (10mg) tablets ONCE daily (guardium, pyrocalm)
  • Pantoprazole= ONE (20mg) tablet ONCE per day (pantoloc)
  • Esomeprazole= ONE (20mg) once per day (nexium)
• side effects of PPIs?

  • headache, nausea, diarrhoea
• counselling points for PPIs?


  • swallow whole with plenty of water before a meal (ideally in the morning) tablets should NOT be crushed or chewed
  • eat smaller meals, leave 3-4 hours after evening meal before going to sleep
  • prop up the bed head, weight reduction, avoid coffee-smoking-spicy/heavy/fatty foods