Proton Pump Inhibitors (PPIs) Are Among the Most Common Medications We See—But Stopping Them Isn’t Always the Right Choice
At Centrum Pharmacy, we provide clinical care with a conscience. Every week, patients come to us for MedsChecks—a vital opportunity to review their medication regimens. One medication class that often comes up is proton pump inhibitors (PPIs), such as pantoprazole, omeprazole, or rabeprazole, typically prescribed to treat:
- Gastroesophageal reflux disease (GERD)
- Stomach or duodenal ulcers
- NSAID-induced GI irritation
- H. pylori eradication protocols
- Eosinophilic esophagitis
- Barrett’s esophagus and more
At Centrum Pharmacy, cutting corners—especially not when it comes to medications that keep you pain-free, functional, and protected. Many corporate pharmacies and even some deprescribing guidelines treat PPIs as “low-hanging fruit”—an easy target for discontinuation. But in real-world practice, especially with older adults or those managing chronic reflux symptoms, deprescribing PPIs is far from simple—and may not be advisable.
The Corporate Deprescribing Trap
In many chain pharmacies, pharmacists are encouraged—or required—to complete a certain quota of MedsChecks per day. These time-constrained reviews often rely on checklists and algorithms that flag PPIs for automatic discontinuation.
What gets lost in this checkbox approach?
- Your actual symptom experience
- The reason you were prescribed a PPI in the first place
- Your risk of rebound symptoms
- Whether non-pharmacologic measures have been tried
- Your preferences and health priorities
At Centrum Pharmacy, we believe deprescribing should be clinical, personalized, and careful—not automated or quota-driven.
What the Research Says About PPI Use
- PPIs are extremely effective for treating GERD—up to 95% effective for symptom control, compared to 37% for H2-blockers (like ranitidine or famotidine).
- Studies show low rates of side effects for most patients. The most notable risk is a slight increase in enteric infections like C. difficile, but no consistent link with fractures, kidney disease, or mortality has been found in well-designed trials.
- In Canada, PPIs are widely used and publicly funded for seniors. Nearly 25% of older adults use them chronically, and most do not want to stop unless there’s a compelling reason.
What the Research Tells Us
Recent studies show that PPIs are:
- Among the most effective medications for GERD, with up to 95% symptom relief (compared to 37% for H2 blockers).
- Well tolerated by most patients, with very few side effects.
- Safe for long-term use, especially when clinically indicated.
While older observational studies raised alarms about risks (fractures, kidney disease, infections), the largest randomized trials to date confirm that PPIs have an excellent safety profile. The most consistent risk is an increase in enteric infections like C. difficile, but there is no increased risk of death, fractures, or kidney disease when used responsibly.
So why the push to deprescribe?
Because quotas and productivity targets—not patient care—are driving the decisions at some retail chains.
The Risk of Rebound Acid Symptoms
One of the biggest concerns with sudden PPI discontinuation is rebound acid hypersecretion. While on a PPI, your stomach produces less acid. Over time, the body compensates by increasing the number of acid-producing cells. So when the medication is stopped suddenly:
- Your body overproduces acid.
- Symptoms often return worse than before.
- Rebound can last 2–6 months after stopping the drug.
- Over 40% of patients who try to quit PPIs cold turkey end up restarting them, sometimes at higher doses.
Deprescribing done wrong causes suffering, confusion, and mistrust.
Understanding Why You Were Prescribed a PPI Matters
When evaluating PPI use, we always ask:
- Was the PPI prescribed for chronic GERD or a temporary ulcer?
- Has the patient tried lifestyle changes (e.g. weight loss, elevating the bed, dietary triggers)?
- Are they at high risk for ulcers or bleeding (e.g. NSAID users, seniors)?
- Do they experience nighttime symptoms or regurgitation?
- Have they had a history of esophagitis, Barrett’s esophagus, or GI bleeds?
At Centrum Pharmacy, we take the time to understand why you’re on your medication before making any recommendation to stop it.
Why Arbitrary Deprescribing Is Harmful
It’s tempting to reduce medication burden by cutting back on “non-essential” drugs—but for many patients, PPIs are essential. Abruptly discontinuing them can:
- Cause distressing symptoms
- Disrupt quality of life
- Lead to increased medication use later
- Undermine trust in the healthcare system
At Centrum Pharmacy, your pharmacist has the time, training, and independence to make informed, thoughtful recommendations—not ones dictated by profit margins or productivity quotas.
When Deprescribing Is Appropriate, We Do It Right
If there’s a good clinical reason to taper or discontinue your PPI, we do so gradually, using evidence-based protocols:
- Lower the dose slowly (e.g. from 40 mg to 20 mg daily)
- Switch to every-other-day dosing
- Use H2 blockers like famotidine as a bridge
- Add short-term antacids to relieve rebound
- Implement non-drug measures: dietary changes, sleep position, weight management
We work with you—not around you. And we never deprescribe just to tick a box.
Personalized Medication Reviews – Not Corporate Medicine
When you come to Centrum Pharmacy, you’re choosing a place where:
- We do comprehensive, clinical MedsChecks
- We have time for real conversations about your symptoms
- Our pharmacists are not rushed or overworked
- We don’t answer to corporate executives who’ve never filled a prescription in their lives
We answer to you.
Because we’re not here to sell perfume, groceries, or cosmetics. We’re here to provide you with exceptional pharmacy care—pure and simple.
Final Thought: Your Health Is Important. Isn’t It?
In today’s healthcare landscape, where you choose to get your prescriptions matters more than ever.
At many big box or corporate chain pharmacies, the focus isn’t on you—it’s on selling perfume, pushing groceries, and hitting daily quotas. Pharmacists in these environments are often overworked, rushed, and burdened by top-down directives from corporate executives who have never stood behind a pharmacy counter.
At Centrum Pharmacy, we do things differently.
Here, our primary business is your health—not cosmetics, not candy bars, and certainly not corporate spreadsheets. Our pharmacists have the time, clinical training, and independence to offer truly personalized care. We’re not pressured by sales targets or shareholder expectations. Our only priority is you.
But at Centrum Pharmacy, your health is our only priority.
We’re a clinical pharmacy—not a convenience store. We’re not here to upsell you multivitamins or gift baskets. We’re here to safeguard your well-being with unbiased, evidence-based care—and the time and attention you deserve.
So, ask yourself: Because your health is important… isn’t it?
If your health really matters to you… why trust it to a discount pharmacy or corporate chain?
Why trust your health to a pharmacy that treats you like a number?
Why settle for 3-minute care when you could get thoughtful, clinical guidance from someone who knows your name?
Come to Centrum Pharmacy and experience what real pharmacy care feels like.
- Choose a pharmacy that puts your health first—always.
- Compassion. Expertise. No quotas.
- Experience The Centrum Difference.
MedsCheck: Your Personal Medication Review at Centrum Pharmacy
Managing multiple medications can feel overwhelming. At Centrum Pharmacy, we are here to help you stay safe, informed, and confident in your treatment plan. Through Ontario’s publicly funded MedsCheck program, our pharmacists can sit down with you for a free, one-on-one review of all your medications.
Come for the Convenience, Stay for the Service.
Caring for Your Family Since 1999
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Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your healthcare provider first. Full Disclaimer.
