1 / 22

Proton Pump Inhibitor and histamine 2 receptor antagonist use and vitamin b 12 deficiency

Proton Pump Inhibitor and histamine 2 receptor antagonist use and vitamin b 12 deficiency. Tamara Lallier, PharmD , MBA PGY-1 Resident Pharmacist Northeast Iowa Family Practice Center Waverly Health Center. Article information.

leoma
Download Presentation

Proton Pump Inhibitor and histamine 2 receptor antagonist use and vitamin b 12 deficiency

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Proton Pump Inhibitor and histamine 2 receptor antagonist use and vitamin b12 deficiency Tamara Lallier, PharmD, MBA PGY-1 Resident Pharmacist Northeast Iowa Family Practice Center Waverly Health Center

  2. Article information • Lam J, Schneider JL, Zhao W, Corley DA. (December 2013) Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA 310:22, 2435-2442. • Funding: • Kaiser Permanente Community Benefit Grant

  3. Background • Vitamin B12 deficiency • Dementia, neurologic damage, anemia • Risk factors • Chronic alcoholism • Atrophic gastritis • Pernicious anemia • H.pylori infection • Long-term use of biguanides • Vegetarian/Vegan diet .

  4. Acid inhibitors • Proton pump inhibitors • i.e. esomeprazole, omeprazole • Histamine 2 receptor antagonists • i.e. ranitidine, famotidine • Suppress gastric acid production

  5. Purpose • To study the association between use of PPIs and H2RAs and vitamin B12 deficiency in a community-based setting in the United States

  6. Measured Outcomes • Risk of vitamin B12 deficiency after >2 years of PPI or H2RA use • Other exposures evaluated: • Number of pills/day • Discontinuation of use • Duration of use • Age • Gender • Known conditions associated with vitamin B12 deficiency

  7. Inclusion Criteria • Case Patients • ≥ 18 years old • ≥ 1 year Kaiser membership at index date • Diagnosed with vitamin B12 deficiency between 1/97-6/11 • Diagnosis: Presence of 1 of the following: • Pernicious anemia • Other Vitamin B12 deficiency anemia • Vitamin B12 deficiency • Vitamin B12 deficiency (listed in the Problem List) • Abnormally low value of serum vitamin B12 • New AND ≥ 6 month supply of injectable vitamin B12 • Control Patients • Max 10 per 1 Case patient

  8. Medication exposure • Exposure: “Days supplied” variable • Exposure duration: time between first and last prescription (+ days supplied for last rx) • Adherence • Dose intensity • < 0.75 pills/day • 0.75-1.49 pills/day • ≥ 1.5 pills/day • “Exposed” patient • ≥ 2-year supply of medication prior to index date

  9. Confounding variables • Other conditions • Health care utilization • Other commonly used medications • Estrogen, thiazides, ACE-Is, CCB • GERD diagnosis • Metformin exposure

  10. Patient characteristics

  11. Results • Presence of other risk factors for vitamin B12 deficiency • None: OR 1.65 (95% CI 1.43-1.91) • ≥ 1 risk factor: OR 1.50 (95% CI 1.42-1.58) • Age • <30 years: OR 8.12 (95% CI 3.36-19.59) • > 80 years: OR 1.04 (95% CI 0.96-1.13) • Gender • Female: OR 1.84 (95% CI 1.74-1.95) • Male: OR 1.43 (95% CI 1.33-1.53) • Race/Ethnicity • No significant interaction (P=0.18)

  12. Hill’s criteria

  13. Conclusion • Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. • These findings should be considered when balancing the risks and benefits of using these medications.

  14. Strengths • Large size • 15 years of data • Retrieval of all recorded diagnoses • Data for dispensed medication • Generalizable control group • Ability to evaluate several confounders

  15. Limitations • Case-control study • Asymptomatic screening for patients • No information on short-term or intermittent use • Mean daily dose • OTC product use • Study location not generalizable

  16. Clinical Relevance • ≥ 2 years of PPIs or H2RAs was associated with vitamin B12 deficiency • Screen symptomatic patients • Continue use of these medications for patients who need them • Recommend against higher doses • Be aware of symptoms of B12 deficiency

  17. References • Lam J, Schneider JL, Zhao W, Corley DA. (December 2013) Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA 310:22, 2435-2442. • Evatt MLMP, Bobo JK, Kimmons J, Williams J. Why Vitamin B12 Deficiency Should be on Your Radar Screen. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncbddd/b12/index.html. Accessed February 18, 2014. • Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risks of vitamin B12 deficiency in older adults. J ClinEpidemiol. 2004;57(4):422-428.

  18. QUESTIONS?Proton Pump Inhibitor and histamine 2 receptor antagonist use and vitamin b12 deficiency Tamara Lallier, Pharm.D., MBA PGY-1 Resident Pharmacist Northeast Iowa Family Practice Center Waverly Health Center

More Related