How Long Should We Do GI Prophylaxis?
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I’m more on the ambulatory side of pharmacy, but often see big mistakes when it comes to determining how long we should do GI prophylaxis.
GI prophylaxis is adding a medication to protect the stomach (and GI tract) from other medications or conditions that may cause GI distress of injury. Classic medications used for GI prophylaxis include adding an H2 blocker (i.e. famotidine) or a PPI (i.e. omeprazole).
The two most common examples of medications that might necessitate GI prophylaxis are oral corticosteroids (usually prednisone) and NSAIDs. The issue that I have with GI prophylaxis is that it rarely gets reassessed.
A 72 year old female has a history of CHF, CKD, and osteoarthritis. She has been experiencing an increase in symptoms of her osteoarthritis and is put on ibuprofen 400 mg three times daily. Since initiating the ibuprofen, she has begun to experience GI distress. The ibuprofen has been beneficial for her pain, so instead of switching the ibuprofen to acetaminophen, her provider places her omeprazole 20 mg daily.
Over time, her CKD and CHF continue progressing. She has a nephrology consult and the nephrologist recommends avoiding the ibuprofen. Ibuprofen gets changed to acetaminophen (which maybe it should’ve been trialed in the first place). What gets left is the indefinite omeprazole for GI prophylaxis which often turns into a magical diagnosis of GERD at some point in the patient’s life.
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