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Are the deprescribing guidelines for proton pump inhibitors in palliative care applicable? A monocentric observational study
  1. Adrien Evin1,2,
  2. Claire Denis1,
  3. Pierre Nizet2,3,
  4. Roxane Denis4,
  5. Morgane Lannes4,
  6. Caroline Victorri-Vigneau2,5 and
  7. Jean Francois Huon2,3
  1. 1 CHU de Nantes, Service de soins palliatifs et de support, Nantes Université, Nantes, France
  2. 2 INSERM UMR 1246 SPHERE, Nantes Université, Nantes, France
  3. 3 CHU de Nantes, Pharmacie, Nantes Université, Nantes, France
  4. 4 CHU de Nantes, Service de santé publique, Nantes Université, Nantes, France
  5. 5 CHU de Nantes, Centre d’évaluation et d’information sur la pharmacodépendance-addictovigilance, Nantes Université, Nantes, France
  1. Correspondence to Dr Adrien Evin, CHU de Nantes, Hôpital Guillaume et René LAENNEC,Service de soins palliatifs et de support, Boulevard Jacques Monod, Nantes Universite, 44093 Nantes cedex 1, France; adrien.evin{at}


Objectives Proton pump inhibitors (PPIs) are among the most commonly prescribed medications. The aim of this study was to assess the appropriateness of prescribing PPIs in the palliative care unit on admission and during hospitalisation to determine the applicability of deprescribing recommendations.

Methods A monocentric observational study was conducted over a 6-month period in 2020 in a university palliative care unit. Data on indication, starting date, dose and posology were collected at discharge from the medical record and by contacting the prescriber. A physician and a pharmacist evaluated PPI prescription appropriateness according to guidelines.

Results 131 patients (mean age: 69.5 years; 82% with cancer) were included. Prior to admission, 41% (54/131) of patients were already prescribed PPIs. During hospitalisation, 50% of prescriptions were discontinued, while 12% were initiated. The indication was known for 50% of patients on admission and 59% during their stay. Among patients with PPI prescriptions, 56% had a relevant indication on admission, and 63% during their stay. The prevalence of potential drug interactions was low (<1/10).

Conclusions While PPIs remain essential for specific indications, this study highlights their excessive prescription even during palliative care. Implementing deprescribing recommendations in this population is crucial to optimise treatment plans.

  • Clinical assessment
  • Clinical decisions
  • Drug administration
  • End of life care
  • Hospital care

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  • Contributors AE, CD and JFH are responsible for study design, data analysis and manuscript preparation. ML and RD assisted in data analysis.

    PN, CV-V assisted in research design, manuscript preparation . AE acts as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.