Too Many Heartburn Meds Among Vets

Acid reflux medications given in high dosages to US veterans without reducing therapy

(RxWiki News) Certain heartburn medicines have been prescribed too often or at too high a dosage across the US. Until now, little was known about the heartburn treatment that American veterans received for their chest pains.

Many US veterans received high initial doses of a certain heartburn medicine that slows stomach acid production and few have reduced or stopped therapy, according to a recently published study.

Knowing the trends in heartburn prescriptions and how veterans use a group of heartburn medicines called proton pump inhibitors (PPI) can help medical personnel optimize its usage and prevent overuse among future veterans, researchers said.

"Coughing may mean heartburn; get it checked out."

Proton pump inhibitors help prevent excessive production of stomach acid. Previous studies documented how the drugs have been overused at times, and researchers said that it can lead to unnecessary costs, side effects and risks. 

The study looked at PPI prescriptions written for veterans between 18 and 90 years of age who had been diagnosed with acid reflux disease. Up until now, little research had been done on prescriptions among soldiers in the Veteran's Administration (VA).

Researchers under the direction of Andrew Gawron, MD, PhD, fellow in the Division of Gastroenterology & Hepatology at Northwestern University in Chicago, also focused on how PPI prescriptions were used two years after the meds had initially been prescribed.

More than 1,600 veterans who were diagnosed with gastroesophageal reflux disease were included in the study at Hines VA Hospital between 2003 and 2007. These veterans were prescribed a PPI within 30 days of being diagnosed with the disease.

The prescriptions were categorized into one of two groups based on strength: standard total daily dose or high total daily dose. Researchers reviewed patients' medical histories to ensure the prescriptions were designated in the correct category.

More than 23 percent of the veterans had high total daily dose prescriptions for PPIs, researchers found. The rest initially received standard total daily doses.

The initial prescriptions for about two-thirds of the patients lasted for 90 days or longer.

Two years after receiving the initial prescription, 13 percent of the patients with the standard dosage stepped up their therapy.

At the same time, slightly more than 7 percent of patients given the high dosage had their dosage decreased.

And almost 84 percent of patients had at least one refill over the two year period.

The findings showed how veterans were initially prescribed acid reflux medications and how those prescriptions continue over time.

"These findings could be used to guide attempts to decrease unnecessary PPI use and modify prescribing practices within the Veterans' Administration," researchers wrote in their report.

"When PPIs are started empirically, providers should be vigilant in ensuring appropriate dosing, and timely assessment of response and opportunities to decrease or stop therapy."

Researchers noted that their data came from a single clinic, which cannot be generalized to other heartburn treatment centers across the US. In addition, PPI medications could have been prescribed for reasons other than heartburn, which may skew results.

The Office of Research and Development, Health Services Research and Development of the Department of Veterans Affairs supported the study, which was published February 12 in the Journal of General Internal Medicine.

One of the authors was a consultant for Given, Sandhill, and Shire, and on the advisory board for Crospon.

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Review Date: 
February 24, 2013