June 25, 2014
Purchasers of Nonprescription PPIs Need Pharmacist Advice

Cleveland—Pharmacist counseling could make a significant difference for gastroesophageal reflux disease (GERD) sufferers who purchase medication over the counter.

A new study found that patients prescribed proton pump inhibitors (PPIs) by gastroenterologists are the most likely to use the drugs appropriately and get the best results, while a higher percentage of consumers purchasing OTC formulations use the drugs suboptimally with worse symptom control.

Researchers from Case Western Reserve University and MetroHealth System, both in Cleveland, said that patients prescribed the GERD drugs by primary care physicians fell somewhere in between on appropriate usage and symptom control. Their study was published recently in the American Journal of Gastroenterology.

Overall, the study found that just more than one-third, 39%, of those buying the medications OTC used them appropriately compared to slightly less than half, 47%, of those who were prescribed the drugs by their primary care doctor. Yet, 71% of those who were given a prescription by a gastroenterologist used the drugs as the labels directed, according to the study.

“In order to activate the medicine, you must eat. For that reason, you take it before breakfast. If you don’t take the drug correctly, you don’t do as well,” said the study’s senior author, M. Michael Wolfe, MD, a gastroenterologist and chair of the department of medicine at MetroHealth System.

Wolfe noted that users who fail to heed labels advising that the drugs should be taken before breakfast, “are wasting money. They're not feeling well and they aren't getting symptom relief.”

Study authors said they conducted the research to determine treatment patterns and symptom control in OTC consumers compared to those receiving prescriptions.

For the study, patients at five clinics were surveyed regarding diagnosis of GERD, use of OTC or prescription PPIs, information on time of day dosing, demographics, and symptom relief based on the Gastroesophageal Reflux Disease Symptom Assessment Scale.  

Of the 1,959 patients surveyed, 610 (31%) used PPIs for GERD. Of those, 190 (31%) received prescriptions from gastroenterologists (GIs); 223 (37%) received prescriptions from primary care physicians (PCPs); and 197 (32%) purchased OTC PPIs.

GERD symptoms, frequency, and severity scores all were significantly better in patients prescribed PPIs by GIs than in other patients, results indicate. Not surprisingly, those scores also were notably better in patients using PPIs optimally compared with those taking PPIs suboptimally or excessively.

“Patients receiving prescription PPI from a GI are more likely to be optimal users with better symptom control,” the authors conclude. “Conversely, consumers are more likely to be suboptimal users with inadequate symptom control.”

The bottom line is “it boils down to education,” Wolfe said, advising that patients take the medication in the morning and then eat something that creates stomach acid, such as protein.

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