Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence

Ther Adv Drug Saf. 2017 Sep;8(9):273-297. doi: 10.1177/2042098617715381. Epub 2017 Jun 29.


Proton-pump inhibitors (PPIs) are a widely prescribed class of medications used to treat acid-related disorders and use has significantly increased over the last few decades. PPIs are often inappropriately prescribed and since they have been on the market, a number of post-marketing studies have been published demonstrating associations between longer duration of PPI therapy and a number of adverse effects that are a concern in older adults. The objective of this review is to discuss the existing literature of potential adverse effects with long-term PPI use in older adults and to summarize the implications in clinical practice. A PubMed search was conducted to identify studies evaluating the potential long-term adverse effects of PPI therapy in older adults, and publications were selected based on relevant criteria. PPIs have been associated with an increased risk of a number of adverse effects including osteoporotic-related fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin B12 deficiency, kidney disease, and dementia, demonstrated by a number of case-control, cohort studies, and meta-analyses. Older adults should be periodically evaluated for the need for continued use of PPI therapy given the number of potential adverse effects associated with long-term use.

Keywords: Clostridium difficile; aged; bone fractures; dementia; kidney diseases; long-term adverse effects; osteoporosis; pneumonia; proton-pump inhibitors; vitamin B 12 deficiency.

Publication types

  • Review