Abstract

Long-term use of proton pump inhibitors (PPIs) is highly prevalent and often exceeds the duration recommended in clinical guidelines. Although PPIs are effective and generally safe when appropriately prescribed, prolonged or unjustified use has been associated with clinically relevant nutritional and electrolyte alterations in selected patients. This mini-review summarizes evidence on vitamin B12, iron, magnesium and calcium status, as well as fracture risk. The mechanisms proposed include increased gastric pH, impaired mineral solubility and absorption, changes in intestinal transport pathways and possible microbiota-related effects. However, the strength of evidence differs between outcomes, and some associations may be influenced by confounding factors such as age, comorbidity, frailty, concomitant medication and baseline nutritional status. Community pharmacy can contribute to the early identification of patients who may benefit from treatment review through active dispensing, structured screening, health education and referral for medical assessment when deprescribing may be appropriate. Optimizing long-term PPI use may help reduce preventable medicine-related risks while preserving treatment benefits in patients with a valid indication.

Keywords

proton pump inhibitors, nutritional deficiencies, deprescribing, community pharmacy