Optimizing Proton-pump Inhibitor Therapy in Patients with Comorbidities Receiving Polypharmacy Treatment: Insights from Clinical Practice in India.

BACKGROUND

The safety and efficacy of proton-pump inhibitors (PPIs) in gastroesophageal reflux disease (GERD) patients on polypharmacy is challenging to manage. Rabeprazole's unique metabolism reduces drug-drug interactions (DDI), making it beneficial for patients with polypharmacy. This study aimed to explore the safety and effectiveness of rabeprazole in Indian comorbid GERD patients on polypharmacy.

METHODS

A cross-sectional survey was conducted (November, 2024 and January, 2025), which included healthcare professionals (HCPs) with experience in prescribing PPIs. The survey included 10 questions addressing issues faced in polypharmacy settings.

RESULTS

Around 91.9% preferred prescribing rabeprazole over other PPIs in polypharmacy patients. CYP450 enzyme interactions are considered by 73.3% HCPs when prescribing PPIs, with a strong emphasis on minimizing DDI in polypharmacy contexts. Rabeprazole was chosen by a major share of HCPs for its unique nonenzymatic metabolism and minimal interaction with the cytochrome P450 system, suggesting suitability in polypharmacy patients. Furthermore, 70% HCPs suggested rabeprazole could improve cardiovascular (CV) outcomes by optimizing antiplatelet therapy, and 74.4% supported its safety in patients on antiplatelet therapy.

CONCLUSION

Rabeprazole appears to be the preferred PPI in managing GERD among patients on polypharmacy, primarily due to its favorable safety profile and minimal DDI, and may be advantageous in clinical practice.