Drug Utilization and Potential Drug-Drug Interactions of Proton Pump Inhibitors Among In-patients of Medicine Ward of a Tertiary Care Hospital, Pokhara, Nepal

Introduction: Proton pump inhibitors (PPIs) are commonly prescribed anti-secretory drugs which raise pH of the stomach by suppressing the production of gastric acid via blockage of the H⁺/K ATPase pump in the stomach parietal cells. A drug utilization review (DUR) study of PPIs could shed insight into a number of prescribing-related aspects, including frequency, dosage, length of therapy, quality of indications, determinants, and drug use outcomes. Methods: A cross-sectional study was conducted among 260 inpatients admitted to medicine ward of Manipal Teaching Hospital (MTH), Pokhara, Nepal. Prescribing indicators was evaluated based on WHO prescribing indicators and potential drug-drug interactions were evaluated through Medscape. The duration of data collection was from June 2 to June 30, 2024. Results: The total number of drugs prescribed were 1753 for 260 patients. Average number of drugs per prescription was 6.74, the percentage of drugs prescribed by generic name was 5.58%, the percentage of prescriptions with antimicrobial was 73.46%, the percentage of prescriptions with injection was 92.69%, and the percentage of drug prescribed from national essential drug list was 37.19%. Pantoprazole was prescribed for 197 (75.77%) patients, followed by Esomeprazole for 63 (24.23%) that were various strengths of 20, 40, and 80 mg. Generic prescription was observed in 7 cases (2.70%) which was much lower than that of brand prescription 253 (97.30%). Among them, 176 (67.70%) patients were prescribed PPIs once a day whereas 84 (32.30%) were prescribed twice a day. Potential drug-drug interactions were found to be 25 (9.61%) interactions in 25 patients. Conclusions: Pantoprazole was the most often prescribed PPI during the study period, and brand prescriptions were common. This study emphasizes risk for potential drug-drug interactions (pDDIs), particularly with PPIs on patients with multiple medical conditions and patients on polypharmacy.