Background Gastroprotective agents are widely used in both hospital and community settings, and they are generally perceived as safe drugs.
Purpose To find out whether the prescription of anti-ulcer drugs in the Emergency Room (ER) accords with their approved indications, and the financial impact of their inappropriate use.
Materials and Methods Indications for use of proton pump inhibitors (PPIs) and H2 antagonists (via the Spanish Medicines Agency): gastro-duodenal ulcers (including NSAIDs and steroid-related ulcers), reflux oesophagitis, Zollinger-Ellison’s syndrome, and Helicobacter pylori eradication. Inclusion criteria: patients >65 years old on at least four home medicines and an anti-ulcer prescription in the ER. Pharmaceutical interventions were recorded and their degree of acceptance calculated. The cost resulting from drug misuse was calculated considering a mean stay in the unit of one day.
Results 111 patients, 70.2% male, median age 78.9 years-old [65–94]. 94.6% of patients (92.9% PPI, 1.7% H2 antagonists) received one of these agents upon presentation (95.5% of them were prescribed de novo), with intravenous pantoprazole the agent mainly involved (82% of cases). 29.7% of prescriptions did not meet the indications, while this percentage decreased to 12.5% upon ward admission. The pharmaceutical interventions were accepted in 16.2% of cases. Monthly, the estimated cost of the off-label use was €1850.
Conclusions Gastro-protection in the ER did not meet the criteria in nearly 1/3 of patients. This contrasted with the poor acceptance of the pharmaceutical recommendations of discontinuation. The rationale might be the so-perceived harmless profile of these drugs with the short-term use. The rate of off-label prescriptions dropped to half upon ward admission, likely due to thorough revision by the prescriber. Since only patients at a higher risk of suffering from a medicines-related problem were included, the cost resulting from the misuse of anti-ulcer drugs was probably underestimated. In conclusion, forthcoming pharmacy policies should focus on improving the adherence to the indications of both widely-used and expensive drugs, given their financial and health-care impact.
No conflict of interest.
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