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Gastroprotection during the administration of non-steroidal anti-inflammatory drugs. A drug-utilization study

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

There has been an increase of anti-ulcer drug consumption in Spain. A high proportion of this consumption may be due to the use of those drugs as gastroprotective agents when co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to learn how these treatments are being used: the prevalence of use, the type of drug and the main features of patients. A sample of patients going to pharmacies with a NSAID prescription, with or without a gastroprotective agent, was obtained. A survey questionnaire was distributed to learn clinical and demographic data of the patients. Of the 942 patients interviewed, 41.6% were co-treated with a gastroprotective agent in addition to the NSAID. Most of these patients received proton-pump inhibitors and, to a lesser extent, histamine-2-receptor antagonists, antacids and prostaglandin analogues. The use of gastroprotective agents increased with age, treatment duration and illness chronicity; specialists prescribed a higher proportion of those co-treatments than did general practitioners. There was a high prescription rate of gastroprotective agents; in general, these were used according to recommendations. However, the type of gastroprotective agents being used does not seem to be justified by the current guidelines: histamine-2-receptor antagonists and antacid drugs have not proved their efficacy in this indication. The fact that one in four treatments with gastroprotective drugs was issued to patients without associated risk factors identifies a possible problem where an intervention could be appropriate.

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References

  1. Burrull M, Madridejos R, Gregori A, Busquets E (1996) Antiinflamatorios no esteroideos y protección gastrointestinal: ¿prescripción adecuada en atención primaria? Aten Primaria 18:507–510

    CAS  PubMed  Google Scholar 

  2. Erviti J (1999) Estudio multicéntrico prescripción-indicación de antiácidos y antiulcerosos en atención primaria. Aten Primaria 24:134–139

    CAS  PubMed  Google Scholar 

  3. Lelorier J (1995) Patterns of prescription of nonsteroidal antiinflammatory drugs and gastroprotective agents. J Rheumatol 43[Suppl]:26–27

  4. Kephart G, Sketris I, Smith M, Maheu A, Brown M (1995) Coprescribing of nonsteroidal anti-inflammatory drugs and cytoprotective and antiulcer drugs in Nova Scotia’s senior population. Clin Ther 17:1159–1173

    CAS  PubMed  Google Scholar 

  5. Pathmakanthan S, O’Donovan DG, Sheehan KM, Murray FE (1998) Prospective evaluation of the utilization of aspirin and non-steroidal anti-inflammatory drugs in acute medical admissions. Ir Med J 91:58–60

    CAS  PubMed  Google Scholar 

  6. Clinard F, Bardou M, Sgro C, Lefevre N, Raphael F, Paille F (2001) Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. A general practitioner-based survey in France. Eur J Clin Pharmacol 57:737–743

    Article  CAS  PubMed  Google Scholar 

  7. Wolfe F, Anderson J, Burke TA, Arguelles LM, Pettitt D (2002) Gastroprotective therapy and risk of gastrointestinal ulcers: risk reduction by COX-2 therapy. J Rheumatol 29:467–473

    CAS  PubMed  Google Scholar 

  8. Sánchez JI, Larrabe J, Oscar J, Ojer D, Ruíz R, Bilbao J, Sologuren A (1997) Prescripción de antiinflamatorios no esteroides y gastroprotectores. Adecuación a criterios de calidad en atención primaria. Aten Primaria 20:127–132

    PubMed  Google Scholar 

  9. Rodriguez de la Serna A (1998) Diferencias de toxicidad gastrointestinal de los distintos tipos de AINE. Gastroenterol 21[Suppl]:42–47

    Google Scholar 

  10. Wolfe MM, Lichtenstein DR, Singh G (1999) Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 340:1888–1899

    CAS  PubMed  Google Scholar 

  11. Cerezo Galán A, Díez del Pino A, Simó RM, Flores J, Freire C, Gallart MJ, Martínez Tutor MJ, Ribas i Sala J, Rodilla F, Vacas JS (1996) Estudio multicéntrico prescripción-indicación de antiácidos y antiulcerosos. Farm Hosp 20:91–103

    Google Scholar 

  12. Lanza FL (1998) A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol 93:2037–2046

    Article  CAS  PubMed  Google Scholar 

  13. Jimenez MC, Castillo Ferrando JR, Torelló J, Merino N, Máiquez P, García Heras J (1998) Appropriateness of antiulcer drugs prescribing in primary care in Andalucía. Methods Find Exp Clin Pharmacol 20[Suppl]:82

  14. Carvajal A, García del Pozo J, Del Olmo L, Rueda AM, Alvarez Requejo A (1999) Consumo de fármacos antiulcerosos en España. Aten Primaria 23:218–221

    CAS  PubMed  Google Scholar 

  15. Morales Serna JC, Ignacio Garcia JM, Moreno Brea R, Alguacil Herrero MD (1997) Estudio de utilización de antiulcerosos e hipolipemiantes en el Distrito de Atención Primaria de Jerez (Cádiz). Aten Primaria 20:462–467

    PubMed  Google Scholar 

  16. Rostom A, Wells G, Tugwell P, Welch V, Dubi C, McGowan J (2000) The prevention of chronic NSAID induced upper gastrointestinal toxicity: a Cochrane collaboration metaanalysis of randomized controlled trials. J Rheumatol 27:2203–2214

    CAS  PubMed  Google Scholar 

  17. Castillo JR, Torello J, Hernandez A (2000) Liver injury caused by ebrotidine: a new example of the utility of the postmarketing surveillance. Eur J Clin Pharmacol 56:187–189

    Article  CAS  PubMed  Google Scholar 

  18. Fisher AA, Le Couteur DG (2001) Nephrotoxicity and hepatotoxicity of histamine H2 receptor antagonists. Drug Saf 24:39–57

    CAS  PubMed  Google Scholar 

  19. Vial T, Goubier C, Bergeret A, Cabrera F, Evreux JC, Descotes J (1991) Side effects of ranitidine. Drug Saf 6:94–117

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank the valuable assistance of the Colegio de Farmacéuticos of Valladolid and León. We wish to mention explicitly the collaboration of the following pharmacists: María Luisa Alonso Peláez, Ana Álvarez García, Mª Encarnación Álvarez Villoria, Asunción Balado Insunza, Esther Belzuz Guerrero, Gloria Carrasco, Joaquín Carrasco Fernández, Antonio Carrasco Fernández, Manuela Cerezales Pérez, Carmen Cuadrado Luis, Pedro del Río Pérez, Mª José Díez García, Josefina Díez Sahagún, Yasmín El-Asi Seco, Magda El-Asi Seco, Ana Espeso Núñez, Mª Luz Fernández Arias-Argüello, Ana Mª Fernández De Mata, Julián Fernández-Mellado, Dolores García del Pozo, Victorina García del Pozo, Alicia García Morate, Alejandro García Nogueiras, Esther García Pinilla, Maria Victoria García Vázquez, Elena Gómez Vaamonde, Javier Martínez del Castillo, Ana Teresa Jódar Pereña, Mª Jesús Lera Alija, Marián Liñan, Candelas Lora López, Adoración Marcos, María del Carmen Martínez Rodríguez, Purificación Mediero Hernández, María José Monsalvo Torrón, Fernando Nieto González, Susana Pérez López, Casilda Represa Vázquez, Carmen Riaño Esteban, Teresa Román Victoria, Jesús Ángel Ruiz Alonso, Alberto Sainz Arnáiz, José A. Sánchez, Carlos Sanz Del Río, Patricia Téllez Valdés, Asunción Turrado Turrado, Mª Jesús Viejo Hernando and Rosa María Villar Ramos. This study was supported by a grant of the Consejería de Educación y Cultura, Junta de Castilla y León, research project no. VA068/01, order of 6 February 2001 (B.O.C. y L, no. 33 of 15th February).

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Authors and Affiliations

  1. Instituto de Farmacoepidemiología de la Universidad de Valladolid, Facultad de Medicina, Avda. Ramón y Cajal 7, 47005 , Valladolid, Spain

    Alfonso Carvajal, Luis H. Martín Arias, Eva Vega, José Antonio García Sánchez, Igor Martín Rodríguez, Pilar García Ortega & Javier García del Pozo

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  1. Alfonso Carvajal
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  2. Luis H. Martín Arias
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  3. Eva Vega
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  4. José Antonio García Sánchez
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  5. Igor Martín Rodríguez
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  6. Pilar García Ortega
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  7. Javier García del Pozo
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Correspondence to Alfonso Carvajal.

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Carvajal, A., Arias, L.H.M., Vega, E. et al. Gastroprotection during the administration of non-steroidal anti-inflammatory drugs. A drug-utilization study. Eur J Clin Pharmacol 60, 439–444 (2004). https://doi.org/10.1007/s00228-004-0782-8

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  • DOI: https://doi.org/10.1007/s00228-004-0782-8

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