PPIs should be used only when there is a specific clinical indication, and at the lowest effective dose for the shortest period of time. When appropriate, PPI treatment may be stepped down to a lower dose, used as needed only or stopped completely. PPIs are indicated for the prevention and treatment of the following conditions related to gastric acid secretion: 1.
For further information on PPIs, see: www. There are currently three fully subsidised PPIs available in New Zealand: omeprazole, pantoprazole and lansoprazole.
Rabeprazole is also available with a prescription but is not subsidised. In , omeprazole was the third most commonly dispensed medicine in New Zealand, after paracetamol and atorvastatin. The prevalence of GORD increases with age, which may be explained by age-related functional changes to the lower oesophageal sphincter, decreased salivary bicarbonate secretion or the use of medicines that affect sphincter tone, e.
Typically, a short-course of treatment with a PPI, i. The expected duration of treatment should be discussed with patients when initiating a PPI so they are aware that it is intended for short-term use. Ongoing treatment may be indicated if symptom resolution has not been achieved or for patients with complications associated with GORD. NSAIDs increase the risk of gastric or duodenal ulceration and bleeding when used long-term as they reduce the production of gastric mucus which provides protection against erosion by gastric acid.
For further information on the COX-2 inhibitor, celecoxib, see: www. Treatment of gastric and duodenal ulcers and bleeding. If left untreated, the complications associated with ulceration, i. Treatment of Helicobacter pylori infection. For patients who have confirmed H.
For further information on testing for H. People who present with dyspepsia, including epigastric pain or discomfort, heartburn or regurgitation, with or without bloating, nausea or vomiting, and have red flags see below should be referred for endoscopy. PPIs are generally well tolerated when used short-term. The most common adverse effects are headaches or GI disturbances, e. PPIs may interact with other medicines by altering their absorption or hepatic metabolism, however, in general, this has little clinical significance.
Dose adjustments or switching to another type of PPI may be appropriate for some patients. Long-term PPI use has been associated with an increased risk of several adverse outcomes in observational studies, including bone fractures, vitamin B12, magnesium or iron deficiency, Clostridium difficile infection and community-acquired pneumonia. Fracture risk.
Some older people taking PPIs may be more vulnerable to fractures than others, e. Ensure that patients with risk factors for osteoporosis maintain adequate vitamin D and calcium intake, and that strategies to reduce the risk of falls are in place, e. For further information on frailty and falls, see: www. For further information on osteoporosis, see: www.
Nutrient deficiencies. A balanced diet including foods that contain vitamin B12, magnesium and iron should be sufficient to avoid nutrient deficiencies for most people taking a PPI long-term, and routine monitoring of magnesium or vitamin B12 levels is not recommended. For further information on hypomagnesaemia associated with PPI use, see: www.
Infection risk. While the increased absolute risk of C. Bone fractures. Malabsorption of nutrients. Gastric acidity is important for the absorption of dietary protein-bound vitamin B12 and minerals ingested as salts, e. Clostridium difficile infection. The acid-lowering effect of PPIs can promote C. Community-acquired pneumonia. The acid-lowering effects of PPIs is thought to allow proliferation of bacteria in the stomach, which may then move up into the oesophagus to be aspirated and cause lower respiratory tract infection, e.
Chronic kidney disease. PPI use has been associated with chronic kidney disease and end-stage renal disease. For further information on PPIs and acute interstitial nephritis and acute kidney injury, see: www. The association between PPI use and dementia is unclear. Some studies have reported an increased risk, however, the failure to control for potentially significant factors, e. PPI use should be periodically reviewed to determine whether long-term use is still indicated.
For people who are taking multiple medicines, stopping unnecessary treatment with a PPI has the added benefit of reducing the number of medicines they are taking, i. An audit of PPI prescribing for general practitioners can be found here: www. For some patients, long-term treatment with a PPI is indicated and withdrawal of the medicine is not appropriate, e. Stepping down involves gradually reducing the dose over time, e. Stopping PPI treatment can cause rebound acid hypersecretion, leading to the transient appearance of symptoms such as indigestion, heartburn or regurgitation.
Skip to main content Skip to need help. Search FAQs. About us About us. Outlook November Check your money's safe Use our bank and savings protection checker to check your money is protected. Check you're protected. What we cover. Home What we cover Payment protection insurance Payment protection insurance. If the firm failed after 1 Jan Down Arrow. If it failed before 1 Jan Down Arrow. What is PPI? Down Arrow. If you have received an offer from us that you wish to accept, or you have already accepted an offer from us and have been asked to provide bank details, you can do so by completing our quick and easy online form.
This form requires some personal details to help us to verify your identity, ensure payment is made to your preferred account and so that we can let you know when it has been made.
The form should take no longer than 5 minutes to complete and will ask you for the following:. Alternatively you can complete the paper form that is enclosed with the letter containing your offer and send it back in the pre-paid envelope to us at:. If you are making a complaint, we want to ensure we make this process as easy as possible for you and so if you have specific needs such as large print, braille or translation services, then please let us know.
Improving accessibility for our customers. Please be assured that neither your relationship with the bank or your credit score will be affected by complaining about PPI.
We offer comprehensive translation services in conjunction with our language partner, thebigword. We can provide translation into over languages, ensuring your PPI claim is processed accurately and without delay. Should you require immediate support, we work with thebigword to provide telephone interpreting, which is available around the clock, every day of the year.
If you have any questions about these services, please contact , and we will be happy to help. If the text on our website is too large or too small, we have a step-by-step guide on how to adjust this according to your needs. How to adjust the text size on our site.
We are committed to investigating your complaint fully and fairly and each complaint is dealt with in the same way.
The following steps are taken to ensure that all complaints are dealt with fully and fairly. Once your complaint has been registered on our systems we will issue you an acknowledgement letter which will provide you with your unique PPI complaint reference. We collect all relevant information relating to your complaint before conducting a thorough investigation. During this time we may contact you to gather any further information to assist us with investigating your complaint fully.
Final decision Once a final decision has been made regarding your complaint, we will notify you in writing. Yes, all you will need to do is provide a letter authorising you to act for them.
Alternatively, if you hold Power of Attorney for them or act as an executor you can provide the relevant certified documents. However, you may be able to complain after the deadline if:. This is because the bank has limitation on the data it holds in relation to historic credit cards. We may request information about you from third parties to help verify your identity to comply with laws that apply to us.
This request will not affect your ability to obtain credit in the future. You have certain legal rights to control what we do with your information and we may need to use third parties to verify your details. To find out more about how we use your information, please see our full privacy policy. We're aware some of our customers are contacted by fraudsters who make promises around PPI payments, but also look to gather personal and payment details, which are then mis-used.
Always make sure you are aware of who it is you are talking to and be careful with what information you provide.
Read more about PPI refund scams. We deal with all complaints in the same way, regardless of your financial situation. Any compensation we have offered in relation to your complaint may be affected. Please let us and your insolvency practitioner know when making a complaint.
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