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ISSUE 6 DECEMBER
Letters to the Editor

Deprescribing in older people: helpful tools and proton pump inhibitors

  • Ajay K Shukla, Michelle Liacos, Amy Theresa Page, Christopher Etherton-Beer

Letter to the Editor

I read the informative article about deprescribing in older people by Michelle Liacos, Amy Page and Christopher Etherton-Beer.1 While appreciating their efforts, I wish to make the following observations.

Table 3 of the article lists tools to support deprescribing decisions. Explicit tools like the Beers2 and STOPP criteria3 can also be applied to detect inappropriate medications in the elderly and would be a useful addition to the article.

Regarding the section on adverse effects, there are some serious concerns about proton pump inhibitors which are worth mentioning. Elderly patients are especially prone to developing osteoporosis-related fractures.3 Long-term use of proton pump inhibitors (for more than one year) independently increases this risk. Long-term use also increases the risk of vitamin B12 deficiency, hypomagnesemia and fundic gland polyps.4

Ajay K Shukla Assistant professor
Department of Pharmacology
All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India

 

Authors' response

We thank Ajay Shukla for his thoughtful input and elaboration on our article. We agree that there are risks associated with the long-term use of proton pump inhibitors. Along with other drugs, they generally pose the greatest potential for absolute benefit but also carry a risk of adverse effects in older adults.

Tools such as the Beers criteria and STOPP will be familiar to many readers, and we have summarised these previously.5 In our Australian Prescriber article we sought to highlight general tools, and specific deprescribing resources, that readers may access to support practice.

 

References

  1. Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr 2020;43:114-20.
  2. Duke Clinical Research Institute. Beers criteria medication list. [cited 2020 Nov 1]
  3. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age ageing 2015;44:213-8.
  4. Kinoshita Y, Ishimura N, Ishihara S. Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil 2018;24:182-96.
  5. Page AT, Potter K, Clifford R, Etherton-Beer C. Deprescribing in older people. Maturitas 2016;91:115-34.
 

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by any responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

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Article
Deprescribing in older people Aust Prescr 2020;43:114-20
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Article
Deprescribing in older people Aust Prescr 2020;43:114-20

Ajay K Shukla

Assistant professor, Department of Pharmacology, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India

Michelle Liacos

Pharmacist, Pharmacy Department, Alfred Health, Melbourne

Amy Theresa Page

Pharmacist, Pharmacy Department, Alfred Health, Melbourne

Pharmacist, WA Centre for Health and Ageing, University of Western Australia, Crawley, WA

Pharmacist, Centre for Medicine Use and Safety, Monash University, Melbourne

Christopher Etherton-Beer

Associate professor, WA Centre for Health and Ageing, University of Western Australia, Crawley, WA

Geriatrician and Clinical pharmacologist, Royal Perth Hospital, Perth