Inappropriate Medication Use and Cost Comparison Analysis of Proton Pump Inhibitors: Evidence from an Indian Tertiary Care Facility

Author(s): Rajesh Venkataraman, Muhammed Rashid*, Heamant Shrestha

Journal Name: Current Drug Safety

Volume 15 , Issue 2 , 2020

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Graphical Abstract:


Rationale and Objective: Proton pump inhibitor (PPI) is one of the most widely prescribed medicines and commonly used in gastric related disorders and there is a huge need to analyze the irrational use of PPI in a country like India. The present study was designed to describe the rational drug use and cost comparison analysis of PPI in a rural tertiary care hospital.

Methodology: A prospective observational study was performed among 253 inpatients for a period of 9 months after getting ethical approval. Those who received the PPIs for any of its indications were included in the study without any gender or age restriction. US FDA guidelines were used to analyse the appropriateness of the drug use and cost comparison analysis of the branded versus generic PPIs was also performed.

Findings: Among the 253 inpatients, the majority (62%) were male and the mean age was 46±19 years. Mean hospital stay and the number of drugs in prescription were found to be 4.0 ± 1days 4.39 ±1.16 items, respectively. Pantoprazole (76%) was the most prescribed PPI even though the majority (57%) of the patients treated outside the FDA approved indication. Drug interaction has been reported in 14% and ADR in 9% of the population. The average cost of hospital stay estimated as 207.96+149.57 INR, and potential cost saving of INR 41582 was observed with generic replacement.

Conclusion: The study inferred irrational drug use of PPI still prevalent, that too without considering the economic impact of it on general populations. Healthcare practitioners should be aware and cautious while prescribing the PPI to identify the actual need and to choose the most cost-effective alternative 1.

Keywords: Proton pump inhibitors, clinical practice patterns, drug safety, cost analysis, rational drug use, pharmacoeconomics.

Chia CT, Lim WP, Vu CK. Inappropriate use of proton pump inhibitors in a local setting. Singapore Med J 2014; 55(7): 363-6.
[] [PMID: 25091884]
DeVault KR, Castell DO. American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100(1): 190-200.
[] [PMID: 15654800]
Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep 2008; 10(6): 528-34.
[] [PMID: 19006606]
Gill JM, Player MS, Metz DC. Balancing the risks and benefits of proton pump inhibitors. Ann Fam Med 2011; 9(3): 200-2.
[] [PMID: 21555747]
Satoh H. Discovery and development of proton pump inhibitors. In:Chiba T, Malfertheiner P, Eds Proton Pump Inhibitors: A balanced view. Basel: Karger 2013; pp. 1-17.
Wallace JL. Nonsteroidal anti-inflammatory drugs and gastroenteropathy: The second hundred years. Gastroenterology 1997; 112(3): 1000-16.
[] [PMID: 9041264]
Sachs G, Shin JM, Howden CW. Review article: The clinical pharmacology of proton pump inhibitors. Aliment Pharmacol Ther 2006; 23(Suppl. 2): 2-8.
[] [PMID: 16700898]
Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Use of proton pump inhibitors and risk of osteoporosis-related frac-tures. CMAJ 2008; 179(4): 319-26.
[] [PMID: 18695179]
Ganachari MS, Mahendra BJ, Shashikala C, Fibin M. Assessment of drug therapy intervention by clinical pharmacist in tertiary care hospital. Int J Pharm Pract 2010; 3(3): 22-8.
Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician 2017; 63(5): 354-64.
[PMID: 28500192]
Cahir C, Fahey T, Tilson L, Teljeur C, Bennett K. Proton pump inhibitors: Potential cost reductions by applying prescribing guidelines. BMC Health Serv Res 2012; 12: 408.
[] [PMID: 23163956]
Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver 2018; 12(1): 7-16.
[] [PMID: 28427116]
Lai PS, Wong YY, Low YC, Lau HL, Chin KF, Mahadeva S. Unexplained abdominal pain as a driver for inappropriate therapeutics: An audit on the use of intravenous proton pump inhibitors. PeerJ 2014; 2e451
[] [PMID: 25024919]
Wedemeyer RS, Blume H. Pharmacokinetic drug interaction profiles of proton pump inhibitors: An update. Drug Saf 2014; 37(4): 201-11.
[] [PMID: 24550106]
Venkataraman R, Rashid M, Shashikantha B, et al. Prescribing pattern of antihypertensive medication and adherence to Joint National Commission-8 guidelines in a rural tertiary care Indian teaching hospital. J Basic Clin Physiol Pharmacol 2019; 31(1): pii:/j/jbcpp.2020.31.
[] [PMID: 31503542]
US Food and Drug Administration. Proton pump inhibitors: US Food and Drug Administration-approved indications and dosages for use in adults. Silver Spring: US Food and Drug Administration 2014. Available from:.
Bureau of Pharma PSUs of India (BPPI). PMBJP Products-price list Available from:
Chandra A, Kumar M, Kumar L, Dikshit H. Cost variation analysis of proton pump inhibitors available in Indian market. Int J Basic Clin Pharmacol 2018; 7(8): 1626-9.
Kashyap A, Balaji MN, Chhabra M, Rashid M, Muragundi PM. Cost analysis of various branded versus generic chemotherapeutic agents used for the treatment of early breast cancer- a deep insight from India. Expert Rev Pharmacoecon Outcomes Res 2019; 1-7.
[] [PMID: 31248303]
SPSS Inc. Released 2007.In: SPSS for Windows, Version 160. Chicago: SPSS Inc 2007.
Klotz U, Schwab M, Treiber G. CYP2C19 polymorphism and proton pump inhibitors. Basic Clin Pharmacol Toxicol 2004; 95(1): 2-8.
[] [PMID: 15245569]
Gaddam S, Sharma P. Shedding light on the epidemiology of gastroesophageal reflux disease in India--a big step forward. Indian J Gastroenterol 2011; 30(3): 105-7.
[] [PMID: 21785993]
SS M. MK S, Vishnu VG, Jose F, Siraj ST, Anand VP. The prevalence of polypharmacy in South Indian Patients: A pharmacoepidemiological approach. Indian J Pharm Practice 2012; 5(3): 40.
Van Soest EM, Siersema PD, Dieleman JP, Sturkenboom MC, Kuipers EJ. Persistence and adherence to proton pump inhibitors in daily clinical practice. Aliment Pharmacol Ther 2006; 24(2): 377-85.
[] [PMID: 16842465]
Kulkarni V, Bora SS, Sirisha S, Saji M, Sundaran S. A study on drug-drug interactions through prescription analysis in a South Indian teaching hospital. Ther Adv Drug Saf 2013; 4(4): 141-6.
[] [PMID: 25114777]
Juhi S, Singh TS, Singh JM, Muhammed R, Manik C, Kumar TR. Ataxia, manifestation of phenytoin toxicity: A case report. J Young Pharm 2019; 11(1): 112.
Rashid M, Kashyap A, Undela K. Valproic acid and Stevens-Johnson syndrome: A systematic review of descriptive studies. Int J Dermatol 2019; 58(9): 1014-22.
[] [PMID: 30809807]
Bargade MB, Mahatme MS, Hiware S, Admane PD. Cost-minimization analysis of proton pump inhibitors in India. Int J Basic Clin Pharmacol 2016; 5: 1043-7.

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Article Details

Year: 2020
Page: [147 - 155]
Pages: 9
DOI: 10.2174/1574886315666200311120151
Price: $65

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