European Journal of Clinical Pharmacology

, Volume 60, Issue 10, pp 731–738 | Cite as

Pattern of NSAID use in the Italian general population: a questionnaire-based survey

  • Domenico Motola
  • Alberto Vaccheri
  • Maria Chiara Silvani
  • Elisabetta Poluzzi
  • Ambrogio Bottoni
  • Fabrizio De Ponti
  • Nicola MontanaroEmail author
Pharmacoepidemiology and Prescription



Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medicines in the developed countries. The most important adverse reactions involve the upper gastrointestinal tract and can be life threatening. A detailed knowledge of the pattern of use of NSAIDs may help doctors in advising their patients about appropriateness and safety of use.


The aim of the present survey was to evaluate the prevalence and pattern of NSAID use in the general population, as well as the main characteristics of NSAID users.


Between March and September 2002, a self-administered questionnaire was submitted to a random sample, stratified by gender and age, representative of the Italian adult population (n=3,250). The questionnaire was divided into three parts regarding: (1) sociodemographic information, (2) symptoms/illnesses and (3) any drug taken during the previous week and the corresponding purpose. A statistical analysis (logistic regression) was performed.


Of the 2,738 subjects who filled in the questionnaire, 65% took at least one drug in the previous week and, among them, 35% used NSAIDs (top drug class; n=633). Of the NSAID users, 20% were ≥65 years of age and 18% were chronic users (daily or frequent use for more than 6 months). NSAID use was significantly higher in women, both for overall and chronic use. The older age groups showed an increasing risk of chronic NSAID use. Among NSAIDs, nimesulide was the most used compound (35%) followed by acetylsalicylic acid (14%) and ibuprofen (11%). The main reasons for NSAID use, as reported by subjects, were: headache (25%), osteoarticular pain (19%), unspecified pain (15%) and osteoarthrosis (9%). More than 50% of all the NSAIDs were prescribed by physicians (general practitioner, specialist, hospital physician), whereas about 44% were taken as self-treatment or following the advice of a pharmacist, relative/friend, etc.


Our study confirms that NSAIDs are widely used in the Italian general population and that, in most cases, they are used in accordance with their approved indications. However, their large and often chronic use in the elderly, as well as the high frequency of self-treatment, recommends a higher awareness by all physicians.


NSAIDs Drug utilisation Questionnaire Chronic use 



We wish to thank the Health Search coordinators Alessandro Bussotti and Ovidio Brignoli, and the GPs who participated in the study: Mauro Alba, Gregorio Baglioni, Mario Balduccelli, Antonio Barone, Pietro Bolentini, Emilio Mario Bove, Pierclaudio Brasesco, Carlo Buongiovanni, Paolo Carbonato, Antonio Caroselli, Roberto Cau, Antonio Ciriello, Giulio Corgatelli, Antonio Pompeo Coviello, Antonio De Bari, Giovanni De Cesare, Gerardo Decataldo, Giovanni Digiacomo, Alberto Dolci, Guido Endici, Tiziano Ermacora, Cinzia Farì, Carmine Marinaro, Serenella Fasulo, Pietro Diego Ferrara, Bruno Franco Novelletto, Nicola Gallicchio, Fabrizio Gangi, Elio Garaffa, Agnello Iaccarino, Alessandro Leso, Luciano Lippa, Serenella Longhi, Francesco Magliozzo, Gian Luca Mannari, Manuela Mariuz, Antonino Marsala, Carlo Fedele Marulli, Patrizia Mathieu, Vincenzo Maurici, Giovanni Merlino, Rosalba Murgia, Andrea Muscolo, Pasquale Orfanò, Italo Paolini, Lorenzo Passarini, Gionata Pessa, Patrizia Piano, Ernesto Pittana, Giuseppe Tubicini, Diego Sabbi, Marcello Salera, Giuliano Salvio, Antonio Santangelo, Margherita Santarsiero, Rita Clara Scaperrotta, Giuliana Simioni, Nicola Tarallo, Antonella Toselli, Gianni Tubaro, Marco Urago, Nicola Villani, Maria Vindigni, Piero Zaninetti, Alessandro Zennaro. We wish also to thank Claudio Voci for performing the statistical analysis. The study was supported by a research grant from Roche S.p.A., Italy


  1. 1.
    Hernandez-Diaz S, Rodriguez LA (2000) Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990 s. Arch Intern Med 160(14):2093–2099CrossRefPubMedGoogle Scholar
  2. 2.
    Griffin MR (1998) Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 104(3A):23S–29SCrossRefGoogle Scholar
  3. 3.
    Garcia Rodriguez LA (1998) Variability in risk of gastrointestinal complications with different nonsteroidal anti-inflammatory drugs. Am J Med 104(3A):30S–34SCrossRefPubMedGoogle Scholar
  4. 4.
    Henry D, Lim LL, Garcia Rodriguez LA, Perez GS, Carson JL, Griffin M et al (1996) Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 312(7046):1563–1566PubMedGoogle Scholar
  5. 5.
    Mazzaglia G, Caputi AP, Rossi A, Bettoncelli G, Stefanini G, Ventriglia G et al (2003) Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care. Eur J Clin Pharmacol 59(8–9):651–657CrossRefPubMedGoogle Scholar
  6. 6.
    Magrini N, Vaccheri A, Parma E, D’Alessandro R, Bottoni A, Occhionero M et al (1996) Use of benzodiazepines in the Italian general population: prevalence, pattern of use and risk factors for use. Eur J Clin Pharmacol 50(1–2):19–25CrossRefPubMedGoogle Scholar
  7. 7.
    WONCA International Classification Committee (1999) ICPC-2, international classification of primary care, 2nd edn. Oxford Medical Publications, OxfordGoogle Scholar
  8. 8.
    Dominick KL, Ahern FM, Gold CH, Heller DA (2003) Gender differences in NSAID use among older adults with osteoarthritis. Ann Pharmacother 37(11):1566–1571CrossRefPubMedGoogle Scholar
  9. 9.
    Pilotto A, Franceschi M, Leandro G, Di Mario F (2003) NSAID and aspirin use by the elderly in general practice: effect on gastrointestinal symptoms and therapies. Drugs Aging 20(9):701–710PubMedGoogle Scholar
  10. 10.
    Bergman U, Andersen M, Vaccheri A, Bjerrum L, Wettermark B, Montanaro N (2000) Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions. Eur J Clin Pharmacol 56(3):269–272CrossRefPubMedGoogle Scholar
  11. 11.
    Traversa G, Bianchi C, Da Cas R, Abraha I, Menniti-Ippolito F, Venegoni M (2003) Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs. BMJ 327(7405):18–22CrossRefPubMedGoogle Scholar
  12. 12.
    Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O et al (2001) Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 357(9252):251–256CrossRefPubMedGoogle Scholar
  13. 13.
    Payne RB (2001) Glucosamine sulphate and osteoarthritis. Lancet 357(9268):1617CrossRefGoogle Scholar
  14. 14.
    Swinburne LM (2001) Glucosamine sulphate and osteoarthritis. Lancet 357(9268):1617CrossRefGoogle Scholar
  15. 15.
    Halbekath J, Lehnert R, Wille H (2001) Glucosamine sulphate and osteoarthritis. Lancet 357(9268):1617CrossRefGoogle Scholar
  16. 16.
    Goldstein MR (2001) Glucosamine sulphate and osteoarthritis. Lancet 357(9268):1617–1618CrossRefGoogle Scholar
  17. 17.
    Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 287(3):337–344CrossRefPubMedGoogle Scholar
  18. 18.
    Hanlon JT, Schmader KE, Boult C, Artz MB, Gross CR, Fillenbaum GG et al (2002) Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 50(1):26–34CrossRefPubMedGoogle Scholar
  19. 19.
    Visser LE, Graatsma HH, Stricker BH (2002) Contraindicated NSAIDs are frequently prescribed to elderly patients with peptic ulcer disease. Br J Clin Pharmacol 53(2):183–188CrossRefPubMedGoogle Scholar
  20. 20.
    Moore N, Charlesworth A, Van Ganse E, LeParc JM, Jones JK, Wall R et al (2003) Risk factors for adverse events in analgesic drug users: results from the PAIN study. Pharmacoepidemiol Drug Saf 12(7):601–610CrossRefPubMedGoogle Scholar
  21. 21.
    Sturkenboom MC, Romano F, Simon G, Correa-Leite ML, Villa M, Nicolosi A et al (2002) The iatrogenic costs of NSAID therapy: a population study. Arthritis Rheum 47(2):132–140CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Domenico Motola
    • 1
  • Alberto Vaccheri
    • 1
  • Maria Chiara Silvani
    • 1
  • Elisabetta Poluzzi
    • 1
  • Ambrogio Bottoni
    • 2
  • Fabrizio De Ponti
    • 1
  • Nicola Montanaro
    • 1
    Email author
  1. 1.Department of Pharmacology and Interuniversity Research Centre for PharmacoepidemiologyUniversity of BolognaBolognaItaly
  2. 2.Drug SafetyRoche SpAMilanItaly

Personalised recommendations