PPI’s for NSAID Prophylaxis – Case Study

PPI’s for NSAID prophylaxis is a common practice I’ve seen by numerous clinicians.  In the geriatric population especially, there is significant GI ulcer risk from NSAIDs.  The problem of polypharmacy is a big one, make sure you are paying attention to the diagnosis the PPI is being used for!

The case: A 82 year old female with a past medical history of osteoarthritis, hypertension, hyperlipidemia, and coronary artery disease was having increasing osteoarthritic pain.  Increases in acetaminophen were not adequately relieving this patient’s pain.  Cold weather seemed to give this particular patient problems.

The primary provider desired to initiate naproxen 500 mg twice daily to help manage the pain.  With the naproxen, it was felt that this patient would need GI prophylaxis to try to prevent an NSAID induced ulcer.  She was placed on omeprazole 20 mg daily with the naproxen.

The patient started the naproxen without much relief, which led to further assessment by the primary provider with initiation of tramadol as needed.  At this point, the patient had stopped taking the naproxen.  The patient was now hospitalized for a non-pain related reason, never told to discontinue the PPI, and upon hospital discharge, a new diagnosis for the omeprazole was clarified:  she was now diagnosed with GERD even though she had never had a GI problem throughout the previous several years.

This is a classic case of the “healthcare team” not paying attention.  Don’t lose faith however, we can continually ask and assess these things at every visit and make sure we are not adding to the problem of polypharmacy!

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Eric Christianson, PharmD, BCPS, CGP

Written By Eric Christianson

October 25, 2015

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