Child development

September 2011


Proton pump inhibitors

Uncommon adverse effects

Volume 40, No.9, September 2011 Pages 705-708

Stephen Oh


Proton pump inhibitors (PPIs) are one of the most popularly prescribed drugs in Australia for conditions such as gastro-oesophageal reflux disease, peptic ulcer disease and functional dyspepsia. Despite their good safety profile, PPIs have potential adverse effects, yet they are often overprescribed and without a clear indication.


This article reviews the uncommon adverse effects of PPIs and provides recommendations for managing patients receiving this therapy.


Uncommon adverse effects include rebound acid hypersecretion syndrome, fragility fractures, interstitial nephritis, electrolyte derangements, pneumonia, enteric infection and vitamin B12 deficiency. General practitioners should be aware of these potential adverse effects and ensure that PPIs are used appropriately and where benefit clearly outweighs any harmful effects.

Proton pump inhibitors (PPIs) are one of the most widely used classes of drug in Australia, with more than 130 million Pharmaceutical Benefits Scheme (PBS) prescriptions dispensed since 1992.1 Both esomeprazole and pantoprazole are placed in the list of top 10 drugs by prescription counts (Table 1).2 Overprescription inevitably adds burden to the healthcare system, with esomeprazole costing more than $200 million in 2008–2009.2

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