Hospital Pharmacy - February 2018 - 64
64
Hospital Pharmacy 53(1)
Table 4. Comparison of Risk Factors Between Patients Who Tolerated Inpatient PPI Discontinuation and Those Who Did Not (n = 220).
Median age (years)
Median BMI (kg/m2)
Median daily outpatient PPI dose (mg)
Median duration of PPI use (years)
Median LOS (days)
Tolerated PPI
discontinuation (n = 211)
Intolerant of PPI
discontinuation (n = 9)
P value
70.5
30.3
20.0
7.0
4.0
69.0
33.7
40.0
11.0
7.0
.64
.046
.11
.37
.03
Note. PPI = proton pump inhibitor; BMI = body mass index; LOS = length of stay.
Table 5. Comparison of Risk Factors Between Patients Who Tolerated Outpatient PPI Discontinuation and Those Who Did Not (n = 42).
Risk factor
Tolerated PPI
discontinuation (n = 24)
Intolerant of PPI
discontinuation (n = 18)
P value
73.0
25.7
20.0
5.5
7.0 (29.2)
73.0
28.7
20.0
9.0
8.0 (44.4)
0.67
0.46
0.85
0.03
0.32
Median age (years)
Median BMI (kg/m2)
Median daily outpatient PPI dose (mg)
Median duration of PPI use (years)
Patients who filled AST on hospital
discharge, n (%)
Note. PPI = proton pump inhibitor; BMI = body mass index; AST = acid suppressive therapy.
Table 6. Comparison of Risk Factors Between Patients Who Tolerated Outpatient PPI Dose De-Escalation Those Who Did Not (n = 22).
Risk factor
Tolerated PPI dose
reduction (n = 18)
Intolerant of PPI dose
reduction (n = 4)
P value
76.5
30.2
30.0
9.0
5 (27.8)
72.5
27.7
20.0
11.5
0 (0)
.44
.17
.09
.61
.27
Median age (years)
Median BMI (kg/m2)
Median daily outpatient PPI dose (mg)
Median duration of PPI use (years)
Patients who filled AST on hospital discharge, n (%)
Note. PPI = proton pump inhibitor; BMI = body mass index; AST = acid suppressive therapy
patients maintained on PPIs do not truly require them during their hospitalizations, suggesting practitioners should
reconsider the practice of continuing all home PPIs upon
admission to the hospital, particularly for those patients
without a clear indication.
One explanation for the relatively high success rate in
the inpatient cohort of our study may relate to the average
LOS at our facility (approximately 4.25 days) in combination with the relatively long duration of action of PPIs.
Activity of parietal cells gradually returns over 2 to 3 days
after PPI discontinuation, thus the effects of prehospitalization PPI dosing may persist through the duration of
most hospital stays, rendering further PPI dosing unnecessary.32 This explanation is supported by the fact that
patients who did not tolerate inpatient discontinuation had
a significantly longer median LOS (7.0 vs 4.0 days). This
finding is consistent with the study by Niklasson et al,
whereby up to 44% of patients experienced rebound
hyperacidity during the first week after PPI discontinuation, particularly on days 5 and 6, after discontinuing a
month-long PPI treatment. The number of subjects experiencing hyperacidity symptoms fell to 24% and 16%, 2 and
3 weeks after discontinuation, respectively.22 Based on
this, patients with longer LOS may need to be re-evaluated periodically and practitioners consider scheduling
AST in this population, instead of the "as needed" therapy
utilized in this study. However, it is also possible that
patients with longer LOS had more comorbidities, or other
confounders, which necessitated the resumption of PPI
therapy, so further studies will be necessary to confirm
this association, particularly due to the small sample size
of the group requiring PPI resumption.
Higher BMI was also identified as a risk factor for PPI
resumption in the inpatient cohort. A high-calorie or high-fat
diet, which may be more prevalent in those with higher
BMIs, tends to result in increased esophageal acid exposure
Table of Contents for the Digital Edition of Hospital Pharmacy - February 2018
Ed Board
TOC
Editorial
The Evolving Frontier of Digital Health: Opportunities for Pharmacists on the Horizon
Letter to the Editor
Immediate Attention Required: Another Shortage
ISMP Adverse Drug Reactions
ISMP Adverse Drug Reactions
Current FDA-Related Drug Information
Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights July-September 2017
ISMP Medication Error Report Analysis
Common Missteps With Medication Safety: Rolling a Single Dice, Ineffective Strategies, and Unexecuted Action Plans
Formulary Drug Reviews
Betrixaban
Pharmaceutical Pipeline Update
Antibiotics in Development for the Treatment of Resistant Bacterial Disease
Articles
Evaluation of the Incidence of Ibuprofen Administration in Alcohol and Opioid Detoxification Patients With Concomitant Thrombocytopenia
Antimicrobial Utilization Pattern in Pediatric Patients in Tertiary Care Hospital, Eastern Ethiopia: The Need for Antimicrobial Stewardship
Acute Hepatocellular Jaundice After Dofetilide Initiation: A Case Report
Outcomes From a Pharmacist: Led Proton Pump Inhibitor Stewardship Program at a Single Institution
Corrigendum
Hospital Pharmacy - February 2018 - Cover1
Hospital Pharmacy - February 2018 - Cover2
Hospital Pharmacy - February 2018 - 1
Hospital Pharmacy - February 2018 - 2
Hospital Pharmacy - February 2018 - 3
Hospital Pharmacy - February 2018 - Ed Board
Hospital Pharmacy - February 2018 - TOC
Hospital Pharmacy - February 2018 - Editorial
Hospital Pharmacy - February 2018 - The Evolving Frontier of Digital Health: Opportunities for Pharmacists on the Horizon
Hospital Pharmacy - February 2018 - 8
Hospital Pharmacy - February 2018 - 9
Hospital Pharmacy - February 2018 - 10
Hospital Pharmacy - February 2018 - Letter to the Editor
Hospital Pharmacy - February 2018 - Immediate Attention Required: Another Shortage
Hospital Pharmacy - February 2018 - 13
Hospital Pharmacy - February 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - February 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - February 2018 - 16
Hospital Pharmacy - February 2018 - Current FDA-Related Drug Information
Hospital Pharmacy - February 2018 - Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights July-September 2017
Hospital Pharmacy - February 2018 - 19
Hospital Pharmacy - February 2018 - 20
Hospital Pharmacy - February 2018 - 21
Hospital Pharmacy - February 2018 - 22
Hospital Pharmacy - February 2018 - 23
Hospital Pharmacy - February 2018 - ISMP Medication Error Report Analysis
Hospital Pharmacy - February 2018 - Common Missteps With Medication Safety: Rolling a Single Dice, Ineffective Strategies, and Unexecuted Action Plans
Hospital Pharmacy - February 2018 - 26
Hospital Pharmacy - February 2018 - 27
Hospital Pharmacy - February 2018 - Formulary Drug Reviews
Hospital Pharmacy - February 2018 - Betrixaban
Hospital Pharmacy - February 2018 - 30
Hospital Pharmacy - February 2018 - 31
Hospital Pharmacy - February 2018 - 32
Hospital Pharmacy - February 2018 - 33
Hospital Pharmacy - February 2018 - 34
Hospital Pharmacy - February 2018 - 35
Hospital Pharmacy - February 2018 - 36
Hospital Pharmacy - February 2018 - Pharmaceutical Pipeline Update
Hospital Pharmacy - February 2018 - Antibiotics in Development for the Treatment of Resistant Bacterial Disease
Hospital Pharmacy - February 2018 - 39
Hospital Pharmacy - February 2018 - Articles
Hospital Pharmacy - February 2018 - Evaluation of the Incidence of Ibuprofen Administration in Alcohol and Opioid Detoxification Patients With Concomitant Thrombocytopenia
Hospital Pharmacy - February 2018 - 42
Hospital Pharmacy - February 2018 - 43
Hospital Pharmacy - February 2018 - Antimicrobial Utilization Pattern in Pediatric Patients in Tertiary Care Hospital, Eastern Ethiopia: The Need for Antimicrobial Stewardship
Hospital Pharmacy - February 2018 - 45
Hospital Pharmacy - February 2018 - 46
Hospital Pharmacy - February 2018 - 47
Hospital Pharmacy - February 2018 - 48
Hospital Pharmacy - February 2018 - 49
Hospital Pharmacy - February 2018 - 50
Hospital Pharmacy - February 2018 - 51
Hospital Pharmacy - February 2018 - 52
Hospital Pharmacy - February 2018 - 53
Hospital Pharmacy - February 2018 - 54
Hospital Pharmacy - February 2018 - Acute Hepatocellular Jaundice After Dofetilide Initiation: A Case Report
Hospital Pharmacy - February 2018 - 56
Hospital Pharmacy - February 2018 - 57
Hospital Pharmacy - February 2018 - 58
Hospital Pharmacy - February 2018 - Outcomes From a Pharmacist: Led Proton Pump Inhibitor Stewardship Program at a Single Institution
Hospital Pharmacy - February 2018 - 60
Hospital Pharmacy - February 2018 - 61
Hospital Pharmacy - February 2018 - 62
Hospital Pharmacy - February 2018 - 63
Hospital Pharmacy - February 2018 - 64
Hospital Pharmacy - February 2018 - 65
Hospital Pharmacy - February 2018 - 66
Hospital Pharmacy - February 2018 - 67
Hospital Pharmacy - February 2018 - Corrigendum
Hospital Pharmacy - February 2018 - Cover3
Hospital Pharmacy - February 2018 - Cover4
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