Lowest effective doses of PPIs every other day

What is your opinion on administering the lowest effective dose of a proton pump inhibitor (PPI) every second day instead of every day?

Paul Moayyedi, MB ChB, PhD: As needed, but I would not mandate it must be every second day. I always tell the patient, “Just take the drug if you feel you need it.” They often use it as a lifestyle thing. They may not take it for a few days but they know that it is Friday night, they have had half a bottle of wine, and this is when they get reflux, so they take a PPI before. We often frown upon the use of “lifestyle” drugs in this way, but I think when used responsibly it is a better way of taking these drugs than either every day or not at all, where if patients are getting acid reflux it could damage their esophagus and they can have complications in the future.

When patients feel they need it, they should take it. If they feel they do not need it, please stop. These are not antibiotics—you do not have to take them as prescribed for a specific period. [You should take them] for symptoms as you need them.