Despite Risks, Patients Still Turn to Anti-Inflammatory Drugs

One in eight patients is at risk of developing a serious adverse drug event (ADE) from taking over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), according to a new study.

Researchers at Erasmus Medical Center (Rotterdam, The Netherlands) conducted a study among 385 adults registered with four Dutch general practitioners (GPs). Two samples of different patient populations were selected; a random sample of adults and a sample of adult patients with a high risk of developing a serious ADE from NSAID use (high-risk population). The patients' risk profiles were determined using their electronic medical records (EMRs). The results showed that in the high-risk population, 13% had used an OTC NSAID during the previous four weeks. In the general population sample, 29% had used an OTC NSAID.

Over 30% of OTC NSAID users had taken the treatment for more than seven days in the high-risk population, and over 20% in the general population, with dosages exceeding the recommended daily maximum dose taken by 3% and 9% in the high risk and the general populations respectively. Musculoskeletal complaints formed the most commonly cited reason for OTC NSAID use in the high-risk group, with 67% giving this as a reason for use. The study was presented at the Annual Congress of the European League Against Rheumatism (EULAR), held during June 2013 in Madrid (Spain).

“NSAIDs tend to be regarded by patients as harmless painkillers. However, in reality, even those available over the counter can cause a number of unpleasant side effects,” said lead author Aafke Koffeman, MD, of the department of general practice. “In most cases, it is likely to be ignorance of these potential ADEs rather than a deliberate disregard of the risks and contraindications.”

Patients were considered at high risk of a serious ADE if they had a history of a peptic ulcer or ulcer complication, myocardial infarction (MI), stroke, or heart failure, were aged over 70 years, had a glomerular filtration rate < 30 mL/min, or had a combination of two or more of the following: use of an anticoagulant, aspirin, corticosteroid or selective serotonin reuptake inhibitor; age 60–70 years; and a history of severe rheumatoid arthritis (RA) or diabetes mellitus.

The two main ADEs relate to the gastrointestinal (GI) and renal effects of NSAIDs, with upper GI ADEs representing 43% of drug-related emergency visits. These effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, dyspepsia, upper GI bleeding, and death, limiting the use of NSAID therapy. NSAIDs may also interact with other medications; for example, concurrent use of NSAIDs and quinolones may increase central nervous system (CNS) effects, including seizure.

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