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All about Proton Pump Inhibitors (PPIs)

It is clear that patients who take PPIs unnecessarily or for unclear indications should be advised to stop. However some patients may experience “rebound hyperacidity” when PPIs are ceased after two months use or more.1,2 This can be managed using antacids as rebound hyperacidity may also occur after stopping histamine (H2)-blocker therapy.

Reassure your female patients - a recent meta-analysis of seven studies involving over 1500 women concluded that PPIs can be used safely during pregnancy. PPI use was not associated with elevated risk for major congenital malformations, spontaneous abortions, or preterm delivery. Omeprazole accounted for 87% of the PPI exposures in this study.3

Several recent studies have suggested that there is a potential interaction between some PPIs and clopidogrel. It has been reported that omeprazole, lansoprazole and rabeprazole (not available in New Zealand) adversely affect the anti-platelet activity of clopidogrel but pantoprazole does not show this effect.4 H2-receptor blockers (e.g. ranitidine) and antacids are not associated with this interaction. Medsafe in New Zealand is currently reviewing this possible medicine interaction. In the meantime Medsafe has advised that clopidogrel datasheets will be updated to include this precaution. Prescribers should review patients using clopidogrel and ensure that PPIs are not used concomitantly unless absolutely necessary.

As of 1st September, patients can purchase Losec (omeprazole) 10 mg tablets over-the-counter at pharmacies.


  1. Reimer C et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009 Jul; 137:80.
  2. McColl KEL, Gillen D. Evidence that proton pump inhibitor therapy induces the symptoms it is used to treat. Gastroenterology 2009;137:20.
  3. Gill SK et al. The safety of proton pump inhibitors (PPIs) in pregnancy: A meta-analysis. Am J Gastroenterol 2009;104:1541.
  4. Juurlink D, Gomes T, Ko D, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009;180(7): 713-18.

Fire hazard with paraffin based skin products

Bandages, dressings and clothing in contact with paraffin based skin products e.g. liquid paraffin, white soft paraffin, emulsifying ointment are easily ignited with a naked flame or cigarette. Ensure that patients and caregivers are aware of this potential fire risk when prescribing these products.

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