International Journal of Clinical Pharmacy

, Volume 33, Issue 2, pp 155–164 | Cite as

Use of gastrointestinal prophylaxis in NSAID patients: a cross sectional study in community pharmacies

  • Elsa López-PintorEmail author
  • Blanca Lumbreras
Short Research Report


Objective To assess the appropriateness of gastroprotective agents (GPA)\ NSAID use in patients’ access medication through community pharmacy and the factors associated with any inappropriateness found. Methods A cross-sectional study in which patients requesting NSAIDs through community pharmacy was undertaken. Information was collected through a structured questionnaire included data of patients’ pharmacotherapy and gastropathy risk factors. Patients were classified as “overprotected” or “underprotected” according to the use of gastroprotective-drugs and presence/absence of gastropathy risk factors. We calculated the risk for under-or over-protection using logistic regression controlling for potential confounders. Results Twenty-seven community pharmacies of Southeast of Spain participated in the study. Out of 670 NSAID users recruited in the study, 243 (36.3%) were not appropriately protected: 197(81.1%) patients were underprotected, and 46 (18.9%) patients were overprotected. Compared to patients with ulcer history, patients with cardiovascular disease or chronic morbidity (aOR 18.55; 95% CI l 3.68–93.52, P < 0.001) and aged over 60 years (aOR 23.97; 95% CI 3.93–145.9) were associated with underuse of gastroprotective-drugs. OTC-NSAID-users were more likely to be underprotected than those with medical prescription (aOR 3.47; 95% CI l 1.84–6.55). Conclusions Inappropriate GPA use is relatively frequent among NSAD users, especially in those using OTC-NSAIDs. Community pharmacists should be aware of factors contributing to NSAID-induced GI complications and assess its presence in the consumer when dispensing an OTC-NSAID.


Community pharmacy Gastroprotective drugs Non Steroidal Antiinflammatory Drugs OTC-drugs Risk factors Spain 



The authors would like to acknowledge the pharmacy students and the 27 participating community pharmacies for their support to the project.


We have not received any external financing for this project.

Conflicts of interest



  1. 1.
    Balbuena FR, Aranda AB, Figueras A. Self-medication in older urban mexicans: an observational, descriptive, cross-sectional study. Drugs Aging. 2009;26:51–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Paulose-Ram R, Hirsch R, Dillon C, Gu Q. Frequent monthly use of selected non-prescription and prescription non-narcotic analgesics among US adults. Pharmacoepidemiol Drug Saf. 2005;14:257–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Singh G, Triadafilopoulos G. Epidemiology of NSAID induced gastrointestinal complications. J Rheumatol Suppl. 1999;56:18–24.PubMedGoogle Scholar
  4. 4.
    De Abajo F, García Del Pozo J, Del Pino A. Trends of Non-Steroidal anti-inflammatory drugs use in Spain, 1990 through 2003. Aten Primaria. 2005;36:424–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Dirección General de Farmacia y Productos Sanitarios. Prestación Farmacéutica y Ortoprotésica de la Comunitat Valenciana, 2009;3.Google Scholar
  6. 6.
    Lanas A, Perez-Aisa MA, Feu F, Ponce J, Saperas E, Santolaria S, et al. Investigators of the Asociación Española de Gastroenterología (AEG). A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal antiinflammatory drug use. Am J Gastroenterol. 2005;100:1685–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Patterson MK, Castellsague J, Walker AM. Hospitalization for peptic ulcer and bleeding in users of selective COX-2 inhibitors and nonselective NSAIDs with special reference to celecoxib. Pharmacoepidemiol Drug Saf. 2008;10:982–8.CrossRefGoogle Scholar
  8. 8.
    Rahme E, Barkun A, Nedjar H, Gaugris S, Watson D. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol. 2008;103:872–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Rivkin A. Admissions to a medical intensive care unit related to adverse drug reactions. Am J Health Syst Pharm. 2007;64:1840–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Lanas A, Tornero J, Zamorano JL. Assessment of gastrointestinal and cardiovascular risk in patients with osteoarthritis who require NSAIDs: the LOGICA study. Ann Rheum Dis. 2010;69:1453–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Lanas A. Cost stratification of nonsteroidal anti-inflammatory drug-associated gastrointestinal side effects. Med Clin (Barc) 2000;114(3):46–53.Google Scholar
  12. 12.
    Hallas J, Jensen KB, Grodum E, Damsbo N, Gram LF. Drug-related admissions to a department of medical gastroenterology. The role of self-medicated and prescribed drugs. Scand J Gastroenterol. 1991;26:174–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Association of the European Self-Medication Industry. The economic and public health value of self medication 2004: Accessed 7 Feb 2011.
  14. 14.
    Knijff-Dutmer EA, Schut GA, Van de Laar MA. Concomitant coumarin-NSAID therapy and risk for bleeding. Ann Pharmacother. 2002;37:12–6.CrossRefGoogle Scholar
  15. 15.
    Lanza FL, Chan FK, Quigley EM. Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2002;4:CD002296.Google Scholar
  17. 17.
    Arboleya LR, De la Figuera E, García M, Aragón B, VICOXX Study Group. Management pattern for patients with osteoarthritis treated with traditional non-steroidal anti-inflammatory drugs in Spain prior to introduction of Coxibs. Curr Med Res Opin 2003;19:278–287.Google Scholar
  18. 18.
    Hartnell NR, Flanagan PS, MacKinnon NJ, Bakowsky VS. Use of gastrointestinal preventive therapy among elderly persons receiving antiarthritic agents in Nova Scotia, Canada. Am J Geriatr Pharmacother. 2004;2:171–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Henry D, Lim LL, Garcia Rodriguez LA, Perez Gutthann S, Carson JL, Griffin M, et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ. 1996;312:1563–6.PubMedGoogle Scholar
  20. 20.
    Clinard F, Bardou M, Sgro C, Lefevre N, Raphael F, Paille F. Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. A general practitioner-based survey in France. Eur J Clin Pharmacol. 2001;57:737–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Barkin RL. The pharmacist’s role in the nonsteroidal anti-inflammatory drug selection process. Am J Ther. 2008;15:S17–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Glew CM, Rentler RJ. Use of proton pump inhibitors and other acid suppressive medications in newly admitted nursing facility patients. J Am Med Dir Assoc. 2007;8:607–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, et al. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int. 2009;84:13–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Van Dijk KN, Ter Huurne K, De Vries CS, Van den Berg PB, Brouwers JR, De Jong-van den Berg LT. Prescribing of gastroprotective drugs among elderly NSAID users in The Netherlands. Pharm World Sci. 2002;24:100–3.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Pharmacy and Pharmaceutics Division, Department of EngineeringUniversity Miguel HernandezSan Juan de Alicante, AlicanteSpain
  2. 2.Department of Public Health, CIBER en Epidemiología y Salud Pública, History of Science and GinecologyUniversity Miguel HernandezSan Juan de Alicante, AlicanteSpain

Personalised recommendations