What is the PRN (as needed) medication for Gastroesophageal Reflux Disease (GERD) in a 60-year-old female (YOF) patient hospitalized for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

For a 60-year-old female hospitalized with COPD exacerbation who needs PRN medication for GERD, I recommend a proton pump inhibitor like omeprazole 20 mg once daily as the first-line option, as it is a reasonable initial single-dose PPI trial, titrating up to twice daily in those with typical GERD symptoms, according to the most recent guidelines 1. This recommendation is based on the latest evidence from the American Gastroenterological Association (AGA) clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease, which suggests that consideration should be given toward diagnostic testing for reflux before initiation of proton pump inhibitor (PPI) therapy in patients with potential extraesophageal manifestations of GERD, but without typical GERD symptoms 1. Some key points to consider when administering these medications include:

• Monitoring for improvement in symptoms and potential side effects
• Implementing non-pharmacological measures, including elevating the head of the bed, avoiding meals within 2-3 hours of bedtime, and limiting trigger foods
• Being aware that GERD symptoms may worsen during COPD exacerbations, and some COPD medications like theophylline or systemic corticosteroids can exacerbate GERD symptoms
• Developing a care plan for investigation of symptoms suggestive of GERD, selection of therapy, and long-term management, including possible de-escalation, in a shared-decision making model with the patient, as suggested by the AGA clinical practice update on the personalized approach to the evaluation and management of GERD 1.

From the FDA Drug Label

14.3 Symptomatic Gastroesophageal Reflux Disease (GERD) Orally-administered Famotidine was compared to placebo in a U.S. trial that enrolled patients with symptoms of GERD and without endoscopic evidence of esophageal erosion or ulceration. As shown in Table 6, patients treated with Famotidine 20 mg twice daily had greater improvement in symptomatic GERD than patients treated with 40 mg at bedtime or placebo

The Famotidine 20 mg twice daily can be used as a PRN medication for GERD in a 60-year-old female while in the hospital for COPD 2.

From the Research

PRN Medication for GERD in 60 YOF while in Hospital for COPD

• The management of gastroesophageal reflux disease (GERD) in elderly patients, such as a 60-year-old female, is crucial, especially when they are hospitalized for other conditions like COPD 3, 4.
• Proton pump inhibitors (PPIs) are the medical treatment of choice for GERD, and they can be used as PRN medication to control symptoms 5, 6.
• However, the use of PPIs in elderly patients requires careful consideration due to potential side effects and interactions with other medications 6, 4.
• The presentation of GERD in elderly patients can be different from that in younger patients, with a greater proportion experiencing atypical symptoms rather than heartburn or regurgitation 4.
• Combination therapy with PPIs and histamine(2) receptor antagonists may not provide additional benefits in controlling GERD symptoms, and further investigation is needed to determine optimal therapy in patients refractory to standard doses of PPIs 7.
• In the hospital setting, PRN medication for GERD in a 60-year-old female with COPD should be guided by evidence-based recommendations and individual patient needs, taking into account potential interactions with other medications and underlying health conditions 5, 4.