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Frequent prescribing of drugs with potential gastrointestinal toxicity among continuous users of non-steroidal anti-inflammatory drugs

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

A number of drugs used concurrently with non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of gastrointestinal (GI) haemorrhage. We studied the prescribing of NSAIDs with corticosteroids, oral anticoagulants or selective serotonin re-uptake inhibitors (SSRIs), as well as the use of gastroprotection among continuous and non-continuous users of NSAIDs in Finland.

Methods

Concurrent use of various drugs was analysed in a nested case-control study in a population-based cohort of NSAID users in 2000 using data in the National Prescription Database.

Results

Prescribing of any other drug with the potential to increase the risk of GI bleeding with NSAIDs was five times [5.2; 95% confidence interval (CI) 4.7–5.9] more common among continuous than non-continuous NSAID users, and the odds ratio for oral corticosteroids was 8.0 (95% CI 6.6–9.6). Of patients using continuous NSAIDs with oral corticosteroids, 73.3% had rheumatoid arthritis (RA). After excluding RA patients, the odds ratio remained high (4.5; 95% CI 3.3–6.1) and at the same level as for SSRIs (3.7; 3.1–4.4). Gastroprotective drugs were prescribed for 6.8% of the continuous users of NSAIDs alone, and for 20.4% of patients taking any of the studied drug combinations with NSAIDs. The continuous users of NSAIDs alone had gastroprotection 2.9 (2.5–3.3) times more often than other users of NSAIDs. With drug combinations (NSAID+corticosteroid, NSAID+SSRI, NSAID+anticoagulants), the use of gastroprotection did not differ from patients using lower amounts of NSAIDs.

Conclusions

When prescribing NSAIDs, situations leading to habitual use should be avoided, potential complications due to clustering of risk factors recognised, and gastroprotection prescribed for patients with increased risk of GI haemorrhage.

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Acknowledgements

We thank Hilkka Ruuska, research assistant at the Social Insurance Institution, for the data management, and Jukka Martio, MD, PhD, for his valuable comments on the manuscript.

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Authors and Affiliations

  1. Centre for Pharmacotherapy Development, Box 55, FIN, 00301, Helsinki, Finland

    Arja Helin-Salmivaara

  2. Department of Pharmacology and Clinical Pharmacology, University of Turku, Itäinen pitkäkatu 4, FIN, 20520, Turku, Finland

    Risto Huupponen

  3. Department of Pharmacology and Toxicology, University of Kuopio, Box 1627, FIN, 70211, Kuopio, Finland

    Risto Huupponen

  4. Research Department, Social Insurance Institution, Peltolantie 3, FIN, 20720, Turku, Finland

    Arja Virtanen & Jari Lammela

  5. Research Department, Social Insurance Institution, Box 450, FIN, 00101, Helsinki, Finland

    Timo Klaukka

Authors
  1. Arja Helin-Salmivaara
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  2. Risto Huupponen
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  3. Arja Virtanen
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  4. Jari Lammela
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  5. Timo Klaukka
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Corresponding author

Correspondence to Arja Helin-Salmivaara.

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Helin-Salmivaara, A., Huupponen, R., Virtanen, A. et al. Frequent prescribing of drugs with potential gastrointestinal toxicity among continuous users of non-steroidal anti-inflammatory drugs. Eur J Clin Pharmacol 61, 425–431 (2005). https://doi.org/10.1007/s00228-005-0949-y

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  • DOI: https://doi.org/10.1007/s00228-005-0949-y

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