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Long-term PPI risks — GPhC CRA MCQ

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ModerateAdverse Drug ReactionsLong-term PPI risksGPhC CRA

A 60-year-old woman is collecting her repeat prescription for lansoprazole 30 mg once daily. She has been taking it for over a year for gastro-oesophageal reflux disease. She mentions she recently had a DEXA scan showing osteopenia. What is the most appropriate action?

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Correct answer: A — Discuss with her GP whether the PPI can be stepped down or stopped, as long-term PPI use is associated with increased fracture risk

Long-term PPI use has been associated with an increased risk of osteoporotic fractures, particularly of the hip, wrist, and spine. The MHRA advises that PPIs should be prescribed at the lowest effective dose for the shortest duration necessary. Given the DEXA scan showing osteopenia, it is appropriate to discuss with the GP whether the PPI can be stepped down to a lower dose, switched to as-needed use, or discontinued with trial of lifestyle modifications.

Reference: BNF; MHRA Drug Safety Update; NICE CKS GORD