Journal of Preventive Medicine and Public Health

Original Articles

Utilization of Acid Suppressants After Withdrawal of Ranitidine in Korea: An Interrupted Time Series Analysis: Jeong Pil Choi, Sangwan Kim, Jung Su Park, Mi-Sook Kim, Nam-Kyong Choi, Cheol Min Shin, Joongyub Lee; J Prev Med Public Health. 2025;58(1):21-30. Published online December 30, 2024; DOI: https://doi.org/10.3961/jpmph.24.357

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Abstract Summary PDF Supplementary Material

Objectives
This study was performed to evaluate the utilization patterns of acid suppressants following the withdrawal of ranitidine in Korea.
Methods
Health Insurance Review & Assessment Service (HIRA) data from January 2016 to May 2023 were utilized to assess the usage of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) for acid-related diseases. Drug utilization was calculated for each agent based on the defined daily dose (DDD). To evaluate changes in utilization following the ranitidine recall, an interrupted time series analysis was conducted using segmented linear regression and an autoregressive integrated moving average model.
Results
Before the withdrawal of ranitidine, the DDD per 100 000 inhabitants per day was increasing by 6.9 (95% confidence interval [CI], 4.7 to 9.0) for H2RAs and by 19.3 (95% CI, 16.9 to 21.8) for PPIs each month. After the recall, H2RA utilization immediately declined by -1041.7 (95% CI, -1115.8 to -967.7), followed by a monthly increase of 6.6 (95% CI, 3.7 to 9.6) above the previous trend. PPI utilization temporarily surged by 235.2 (95% CI, 149.1 to 321.3), then displayed a monthly increase of 4.1 (95% CI, 0.7 to 7.6) on top of the pre-recall trend. Among PPIs, esomeprazole and rabeprazole demonstrated notable increases, representing the most commonly used acid suppressants in 2023.
Conclusions
PPI usage rose prominently following the withdrawal of ranitidine from the market. Considering the potential adverse effects of PPIs, further research is necessary to evaluate the public health implications of shifts in the utilization of acid suppressants.

Summary

Korean summary
- 위산분비억제제의 국내 사용량은 양성자 펌프 억제제를 중심으로 지속적으로 증가하고 있으며, 라니티딘이 시장에서 퇴출된 이후 더욱 급격히 증가하는 양상이 관찰되었다. - 양성자 펌프 억제제 사용 증가와 관련해 장기 복용의 안전성, 처방의 적절성, 잠재적 오남용의 가능성, 비용효과성의 측면에서의 보건학적 의의에 대한 평가가 필요하다.

Key Message
- The use of gastric acid suppressive drugs in Korea has demonstrated a consistent upward trend, with proton pump inhibitors (PPIs) predominating, especially following the withdrawal of ranitidine from the market. - The escalating utilization of PPIs necessitates a comprehensive evaluation of their public health implications, encompassing the long-term safety, appropriateness of prescribing, potential overuse, and cost-effectiveness.

Citations

Citations to this article as recorded by

Prenatal Exposure to Acid-Suppressive Medications and Risk of Neuropsychiatric Disorders in Children
Seohyun Hong, Sooji Lee, Hyunjee Kim, Hyesu Jo, Kyeongmin Lee, Yeona Jo, Tae Hyeon Kim, Jaeyu Park, Jinseok Lee, Ho Geol Woo, Hayeon Lee, Dong Keon Yon
JAMA.2026; 335(7): 609. CrossRef
Proton Pump Inhibitors (PPIs)—An Evidence-Based Review of Indications, Efficacy, Harms, and Deprescribing
Monica Andrawes, Wessam Andrawes, Abhishek Das, Keith Siau
Medicina.2025; 61(9): 1569. CrossRef

Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients.: Wonsik Lee, Seung Mi Lee, Hye Won Koo, Byung Joo Park; Korean J Prev Med. 2002;35(1):41-48.

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Abstract PDF: OBJECTIVES
To review the drug prescription pattern of antiulcerative agents for elderly inpatients. METHODS: The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1994. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription. Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. RESULTS: The number of patients prescribed antiulcerative agents was 1,059 (64.9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by H2 antagonist (16.0%). Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the total omeprazole prescriptions. CONCLUSIONS: Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulcerative agents.; Summary

Nonsteroidal Anti-inflammatory Drugs Utilization Patterns among the Elderly with Osteoarthritis at Primary Ambulatory Care Units in Busan Metropolitan City, Korea.: Nam Kyong Choi, Yooni Kim, Seung Mi Lee, Byung Joo Park; J Prev Med Public Health. 2004;37(2):150-156.

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Abstract PDF: OBJECTIONS: To investigate the utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) among the elderly with osteoarthritis (OA) undergoing primary ambulatory care in Busan metropolitan city, Korea. METHODS: OA patients, aged 65 years and over, were identified from the Korean National Health Insurance Review Agency drug prescription database. The subjects had at least one episode of claim for OA (ICD-10-CM: M15-M19) between August 1, 2000 and February 28, 2002. Trends in the determinations of NSAIDs utilization were identified using chi-squared tests for trend. RESULTS: There were 47, 711 osteoarthritic patients. The total number of visits by these patients was 177, 443, with a total frequency for NSAID prescriptions of 214, 952. Seventy-nine percent of the OA patients were female. NSAIDs were prescribed on 133, 284 visits (75.1%) and the proportion of prescriptions was significantly increased with age. Only the proportion of visit when NSAIDs were prescribed decreased, from 65.1 to 43.5%, during the study period (p< 0.001). However, the proportion of combined treatments with anti-ulcer drugs was increased. The use of NSAIDs injections was decreased. Of the individual NSAIDs, diclofenac (28.7% of total frequency of NSAID prescriptions), piroxicam (15.0%) and talniflumate (8.7%), were the most frequently prescribed. Among the NSAIDs prescribed OA visits, 45.7% used two or more NSAIDs. CONCLUSION: The total proportion of NSAIDs prescribed to the osteoarthritic patients was higher than in other studies. The decline in the use of NSAIDs during the study period, and the frequent selection of safer medications, such as combination therapy with anti-ulcer drug, may reflect the risk awareness of the use of NSAIDs.; Summary

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