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Concomitant Use of SSRIs, NSAIDs/Aspirin and Gastroprotective Drugs among Residents of Long-Term Care Facilities

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Abstract

Background and Objectives: Concomitant use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) [including aspirin (acetylsalicylic acid)] may potentiate the likelihood of upper gastrointestinal haemorrhage (UGIH). The objectives of this study were to determine the prevalence and factors associated with concomitant SSRI/ NSAID use among residents of long-term care facilities, and to investigate the use of gastroprotective drugs among concomitant SSRI/NSAID users.

Methods: The study sample comprised 1087 out of 1444 residents of all 53 long-term care wards in Helsinki, Finland, in September 2003. Data were extracted from residents’ medication charts and medical records by trained nurses. Medication, diagnostic and mortality data were available for 1004 residents.

Results: Among the 1004 residents (mean ± SD age 81.3±10.9 years), 28% used an SSRI, 38% used an NSAID and 24% used a gastroprotective drug. Thirteen percent of residents were concomitant users of SSRIs/NSAIDs. Concomitant use was associated with diabetes mellitus (ps < 0.001), previous stroke (ps < 0.001) and a higher degree of co-morbidity (ps < 0.001). Gastroprotective drugs were used by 27% of concomitant users of SSRIs/NSAIDs compared with 37%, 20% and 22% of SSRI users, NSAID users and non-users of SSRIs/NSAIDs, respectively. One-year all-cause mortality was similar among all groups.

Conclusion: The long-term facility residents in this study sample were frequently exposed to drug-drug interactions that potentiate the risk of UGIH. Only about one-quarter of concomitant users of SSRIs/NSAIDs were prescribed a gastroprotective drug. Further initiatives are needed to optimize the use of SSRIs, NSAIDs and gastroprotective drugs.

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Acknowledgements

No external sources of funding were used to assist in the preparation of this manuscript. The authors declare they have no conflicts of interest relevant to the content of this study. The data analysed and reported in this study were collected as part of a larger study of nutritional care conducted by the City of Helsinki. The authors thank all the staff of the long-term care wards in Helsinki for their enthusiastic support and participation. The authors also thank Mariko Teramura-Grönblad, MD, for commenting on a draft version of the manuscript.

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Authors and Affiliations

  1. Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland

    J. Simon Bell & Heidi T. Taipale

  2. Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy University of Eastern Finland, Kuopio, Finland

    J. Simon Bell & Heidi T. Taipale

  3. City of Helsinki, Health Centre, Social Services, Helsinki, Finland

    Helena Soini

  4. Unit of General Practice, Helsinki University Hospital, Helsinki, Finland

    Kaisu H. Pitkälä

  5. Department of General Practice and Primary Health Care, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Kaisu H. Pitkälä

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  1. J. Simon Bell
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Correspondence to J. Simon Bell.

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Bell, J.S., Taipale, H.T., Soini, H. et al. Concomitant Use of SSRIs, NSAIDs/Aspirin and Gastroprotective Drugs among Residents of Long-Term Care Facilities. Clin. Drug Investig. 31, 337–344 (2011). https://doi.org/10.1007/BF03256932

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