Main Article Content
Abstract
Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide and are widely used for the management of acid-related disorders, particularly among adults in their early ageing period, where concerns about inappropriate prescribing remain prevalent. This study aimed to evaluate the rational use of PPIs among adults aged ≥46 years at a primary healthcare centre in Banda Aceh, Indonesia. This study focuses on the appropriateness of indications, dosages, and durations, as well as potential drug–drug interactions. Dose appropriateness was assessed using Lexicomp standard adult dosing. Duration and appropriateness of indications were assessed according to the Indonesian Gastroenterology Consensus. A retrospective cross-sectional study was conducted, comprising 1,997 records. A sample of 107 patients who met the predefined inclusion and exclusion criteria was analysed. Most patients were aged 56–65 years and predominantly female, with dyspepsia as the main indication. Omeprazole was prescribed in all cases, commonly at 20 mg twice daily. Nearly half of prescriptions were inappropriate, and appropriate dosing was limited. While treatment duration was generally adequate, some cases were shorter than recommended. Potential drug–drug interactions were identified but were mostly of low clinical significance. Overall, the rational use of PPIs among the patients in this primary healthcare setting remains suboptimal, particularly in terms of indication and dosing. These findings highlight the need to strengthen adherence to clinical guidelines and to implement regular medication reviews to promote safer, more rational PPI use in this population.
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Copyright (c) 2026 Suryawati Suryawati, Lulu Animalika, Maghyan Narisa, Hijra Novia Suardi, Zahratul Aini, Vera Dewi Mulia, Desi Maghfirah

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
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- Shanika LGT, Reynolds A, Pattison S, Braund R. Proton Pump Inhibitor Use: Systematic Review of Global Trends and Practices. European Journal of Clinical Pharmacology 2023;79:1159–72. https://doi.org/10.1007/s00228-023-03534-z.
- Anwar MF, Daud NAA, Hussain R. From Prescribing Indicators to Rational Drug Use: A Medication Safety Perspective. Journal of Pharmaceutical Policy and Practice 2025;18. https://doi.org/10.1080/20523211.2025.2544656.
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- Koggel LM, Lantinga MA, Büchner FL, Drenth JPH, Frankema JS, Heeregrave EJ, et al. Predictors for Inappropriate Proton Pump Inhibitor Use: Observational Study in Primary Care. British Journal of General Practice 2022;72:e899–906. https://doi.org/10.3399/BJGP.2022.0178.
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- Syafhan NF, Augustine M, Ramadhani U, Hersunaryati Y. Proton-Pump Inhibitor Use and Potential Drug Interactions in Outpatients. International Journal of Applied Pharmaceutics 2018;10:358–63.
- Ben Ghezala I, Luu M, Bardou M. An Update on Drug–Drug Interactions Associated with Proton Pump Inhibitors. Expert Opinion on Drug Metabolism & Toxicology 2022;18:337–46. https://doi.org/10.1080/17425255.2022.2098107.
- Andrawes M, Andrawes W, Das A, Siau K. Proton Pump Inhibitors (PPIs)—An Evidence-Based Review of Indications, Efficacy, Harms, and Deprescribing. Medicina 2025;61:1569. https://doi.org/10.3390/medicina61091569.
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- Aubert CE, Blum MR, Gastens V, Dalleur O, Vaillant F, Jennings E, et al. Prescribing, Deprescribing and Potential Adverse Effects of Proton Pump Inhibitors in Older Patients with Multimorbidity: An Observational Study. CMAJ Open 2023;11:E170–8. https://doi.org/10.9778/cmajo.20210240.
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- Lexicomp. Adult Drug Information Handbook. Wolters Kluwer Clinical Drug Information; 2022.
- Danarastri S, Perry KE, Hastomo YE, Kurniawati, Priyonugroho K. Gender Differences in Health-Seeking Behaviour, Diagnosis and Treatment for TB. The International Journal of Tuberculosis and Lung Disease 2022;26:568–70. https://doi.org/10.5588/ijtld.21.0735.
- Kawi J, Fudolig M, Serafica R, Reyes AT, Sy F, Leyva EWA, et al. Health Information Sources and Health‐seeking Behaviours of Filipinos Living in Medically Underserved Communities: Empirical Quantitative Research. Nursing Open 2024;11:e2140. https://doi.org/10.1002/nop2.2140.
- Jalo RI, Bamgboye EA, Salawu MM, Akinyemi JO, Uja U, Ogah OS, et al. Gender Disparities in Hypertension Prevalence, Awareness and Healthcare Seeking Behaviour among Young Adults in Nigeria. BMC Cardiovascular Disorders 2025;25:151. https://doi.org/10.1186/s12872-025-04603-0.
- Rata Mohan DS, Jawahir S, Manual A, Abdul Mutalib NE, Mohd Noh SN, Ab Rahim I, et al. Gender Differences in Health-Seeking Behaviour: Insights from the National Health and Morbidity Survey 2019. BMC Health Services Research 2025;25:900. https://doi.org/10.1186/s12913-025-13020-0.
- Vakil N, Niklasson A, Denison H, Rydén A. Gender Differences in Symptoms in Partial Responders to Proton Pump Inhibitors for Gastro‐oesophageal Reflux Disease. United European Gastroenterology Journal 2015;3:443–52. https://doi.org/10.1177/2050640614558343.
- Ye B, Wang Y, Lin L, Jiang L, Wang M. Sex-Based Differences in PH Parameters and Esophageal Impedance of Patients With Gastroesophageal Reflux Disease. Frontiers in Medicine 2021;8:629302. https://doi.org/10.3389/fmed.2021.629302.
- Guo H, Zhong S, Wang X, Chen J. Prevalence and Association of Functional Dyspepsia in the Elderly Patients: A Systematic Review and Meta-Analysis. The Aging Male 2025;28. https://doi.org/10.1080/13685538.2025.2511801.
- Plehhova K, Wray J, Aluko P, Sutton S, McArdle J, Dawson A, et al. Prescribing Practices for Proton Pump Inhibitors among Primary Care Physicians in England: An Evaluation. BJGP Open 2025;9:BJGPO.2024.0059. https://doi.org/10.3399/BJGPO.2024.0059.
- Stojaković N, Golić Jelić A, Stoisavljević Šatara S, Bednarčuk N, Stojiljković MP, Škrbić R. Characteristics and Patterns of Proton Pump Inhibitors Prescribing at the Primary Health Care. Medicina 2022;58:1622. https://doi.org/10.3390/medicina58111622.
- Wong SL, Sulaiman N, Ng KM, Lee ZY. Pharmacist-Structured Review of Proton Pump Inhibitor Utilisation in Primary Care: A Non-Randomised Control Study. Malaysian Family Physician 2021;16:87–96. https://doi.org/10.51866/oa1153.
- Plehhova K, Haering M, Wray J, Coyle C, Ibáñez E, Kostev K. Prescribing Patterns of Proton Pump Inhibitors in Germany: A Retrospective Study Including 472 146 Patients. Journal of Primary Care & Community Health 2023;14:21501319231221000. https://doi.org/10.1177/21501319231221002.
- Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology 2022;117:27–56. https://doi.org/10.14309/ajg.0000000000001538.
- Liang C, Lu N, Yao B, Zhang Y, Huang J, Yang Y, et al. CYP3A Mediates Drug-Drug Interactions between Atorvastatin and Omeprazole: Evidence from in Vitro and in Vivo Studies. Biochemical Pharmacology 2025;242:117241. https://doi.org/10.1016/j.bcp.2025.117241.
- Mohamed MR, Itani M, Abohelwa M, Ahmed MA, Abdouni L, Doumat G, et al. The Silent Epidemic: Inappropriate Use of Proton Pump Inhibitors among Hospitalized Patients. Arab Journal of Gastroenterology 2024;25:414–20. https://doi.org/10.1016/j.ajg.2024.07.001.
References
Ladjouzi N, Romdhani A, Zouloumis G, Schlatter J. Inappropriate Proton Pump Inhibitor Lansoprazole Prescription in Older Adults Hospitalized in Long-Term Care Unit. Irish Journal of Medical Science (1971 -) 2023;192:1661–4. https://doi.org/10.1007/s11845-022-03207-3.
Shanika LGT, Reynolds A, Pattison S, Braund R. Proton Pump Inhibitor Use: Systematic Review of Global Trends and Practices. European Journal of Clinical Pharmacology 2023;79:1159–72. https://doi.org/10.1007/s00228-023-03534-z.
Anwar MF, Daud NAA, Hussain R. From Prescribing Indicators to Rational Drug Use: A Medication Safety Perspective. Journal of Pharmaceutical Policy and Practice 2025;18. https://doi.org/10.1080/20523211.2025.2544656.
Lata T, Trautman J, Townend P, Wilson RB. Current Management of Gastro-Oesophageal Reflux Disease—Treatment Costs, Safety Profile, and Effectiveness: A Narrative Review. Gastroenterology Report 2022;11:goad008. https://doi.org/10.1093/gastro/goad008.
Koggel LM, Lantinga MA, Büchner FL, Drenth JPH, Frankema JS, Heeregrave EJ, et al. Predictors for Inappropriate Proton Pump Inhibitor Use: Observational Study in Primary Care. British Journal of General Practice 2022;72:e899–906. https://doi.org/10.3399/BJGP.2022.0178.
Yuliana E, Linggardini K. Efectiveness of Health Education Using Flipchart Media on Health Cadres Knowledge About Climacterium in Susukan Village, Banjarnegara. Proceedings Series on Health & Medical Sciences 2024;5:41–6. https://doi.org/10.30595/pshms.v5i.959.
Rahman FF. Indonesian Journal of Global Health Research. Indonesian Journal of Global Health Research 2024;6.
Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, et al. Prevalence of Multimorbidity and Polypharmacy among Adults and Older Adults: A Systematic Review. The Lancet Healthy Longevity 2024;5:e287–96. https://doi.org/10.1016/S2666-7568(24)00007-2.
Condur LM, Chirila SI, Alexandrescu L, Iancu MA, Neculau AE, Berariu FV, et al. Proton Pump Inhibitor Use in Older Adult Patients with Multiple Chronic Conditions: Clinical Risks and Best Practices. Journal of Clinical Medicine 2025;14:5318. https://doi.org/10.3390/jcm14155318.
Anindita M, Syafhan NF, Hersunaryati Y, Andrajati R. Appropriate Use of Proton Pump Inhibitor in Inpatients of Central Army Gatot Soebroto Hospital. Journal of Young Pharmacists 2017;9:S9.
Syafhan NF, Augustine M, Ramadhani U, Hersunaryati Y. Proton-Pump Inhibitor Use and Potential Drug Interactions in Outpatients. International Journal of Applied Pharmaceutics 2018;10:358–63.
Ben Ghezala I, Luu M, Bardou M. An Update on Drug–Drug Interactions Associated with Proton Pump Inhibitors. Expert Opinion on Drug Metabolism & Toxicology 2022;18:337–46. https://doi.org/10.1080/17425255.2022.2098107.
Andrawes M, Andrawes W, Das A, Siau K. Proton Pump Inhibitors (PPIs)—An Evidence-Based Review of Indications, Efficacy, Harms, and Deprescribing. Medicina 2025;61:1569. https://doi.org/10.3390/medicina61091569.
Ben-Eltriki M, Chhabra M, Cassels A, Wright JM. Inappropriate Use of Proton Pump Inhibitor Among Elderly Patients in British Columbia: What Are the Long-Term Adverse Events? Current Drug Safety 2024;19:244–7. https://doi.org/10.2174/1574886318666230726124540.
Aubert CE, Blum MR, Gastens V, Dalleur O, Vaillant F, Jennings E, et al. Prescribing, Deprescribing and Potential Adverse Effects of Proton Pump Inhibitors in Older Patients with Multimorbidity: An Observational Study. CMAJ Open 2023;11:E170–8. https://doi.org/10.9778/cmajo.20210240.
Indonesia PG. Konsensus Nasional Penatalaksanaan Penyakit Refluks Gastroesofageal (GERD) di Indonesia (Revisi 2022). Jakarta: PGI; 2022.
Lexicomp. Adult Drug Information Handbook. Wolters Kluwer Clinical Drug Information; 2022.
Danarastri S, Perry KE, Hastomo YE, Kurniawati, Priyonugroho K. Gender Differences in Health-Seeking Behaviour, Diagnosis and Treatment for TB. The International Journal of Tuberculosis and Lung Disease 2022;26:568–70. https://doi.org/10.5588/ijtld.21.0735.
Kawi J, Fudolig M, Serafica R, Reyes AT, Sy F, Leyva EWA, et al. Health Information Sources and Health‐seeking Behaviours of Filipinos Living in Medically Underserved Communities: Empirical Quantitative Research. Nursing Open 2024;11:e2140. https://doi.org/10.1002/nop2.2140.
Jalo RI, Bamgboye EA, Salawu MM, Akinyemi JO, Uja U, Ogah OS, et al. Gender Disparities in Hypertension Prevalence, Awareness and Healthcare Seeking Behaviour among Young Adults in Nigeria. BMC Cardiovascular Disorders 2025;25:151. https://doi.org/10.1186/s12872-025-04603-0.
Rata Mohan DS, Jawahir S, Manual A, Abdul Mutalib NE, Mohd Noh SN, Ab Rahim I, et al. Gender Differences in Health-Seeking Behaviour: Insights from the National Health and Morbidity Survey 2019. BMC Health Services Research 2025;25:900. https://doi.org/10.1186/s12913-025-13020-0.
Vakil N, Niklasson A, Denison H, Rydén A. Gender Differences in Symptoms in Partial Responders to Proton Pump Inhibitors for Gastro‐oesophageal Reflux Disease. United European Gastroenterology Journal 2015;3:443–52. https://doi.org/10.1177/2050640614558343.
Ye B, Wang Y, Lin L, Jiang L, Wang M. Sex-Based Differences in PH Parameters and Esophageal Impedance of Patients With Gastroesophageal Reflux Disease. Frontiers in Medicine 2021;8:629302. https://doi.org/10.3389/fmed.2021.629302.
Guo H, Zhong S, Wang X, Chen J. Prevalence and Association of Functional Dyspepsia in the Elderly Patients: A Systematic Review and Meta-Analysis. The Aging Male 2025;28. https://doi.org/10.1080/13685538.2025.2511801.
Plehhova K, Wray J, Aluko P, Sutton S, McArdle J, Dawson A, et al. Prescribing Practices for Proton Pump Inhibitors among Primary Care Physicians in England: An Evaluation. BJGP Open 2025;9:BJGPO.2024.0059. https://doi.org/10.3399/BJGPO.2024.0059.
Stojaković N, Golić Jelić A, Stoisavljević Šatara S, Bednarčuk N, Stojiljković MP, Škrbić R. Characteristics and Patterns of Proton Pump Inhibitors Prescribing at the Primary Health Care. Medicina 2022;58:1622. https://doi.org/10.3390/medicina58111622.
Wong SL, Sulaiman N, Ng KM, Lee ZY. Pharmacist-Structured Review of Proton Pump Inhibitor Utilisation in Primary Care: A Non-Randomised Control Study. Malaysian Family Physician 2021;16:87–96. https://doi.org/10.51866/oa1153.
Plehhova K, Haering M, Wray J, Coyle C, Ibáñez E, Kostev K. Prescribing Patterns of Proton Pump Inhibitors in Germany: A Retrospective Study Including 472 146 Patients. Journal of Primary Care & Community Health 2023;14:21501319231221000. https://doi.org/10.1177/21501319231221002.
Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology 2022;117:27–56. https://doi.org/10.14309/ajg.0000000000001538.
Liang C, Lu N, Yao B, Zhang Y, Huang J, Yang Y, et al. CYP3A Mediates Drug-Drug Interactions between Atorvastatin and Omeprazole: Evidence from in Vitro and in Vivo Studies. Biochemical Pharmacology 2025;242:117241. https://doi.org/10.1016/j.bcp.2025.117241.
Mohamed MR, Itani M, Abohelwa M, Ahmed MA, Abdouni L, Doumat G, et al. The Silent Epidemic: Inappropriate Use of Proton Pump Inhibitors among Hospitalized Patients. Arab Journal of Gastroenterology 2024;25:414–20. https://doi.org/10.1016/j.ajg.2024.07.001.