Guidelines for safe use of NSAIDs in older people ignored

Nurse gives injection to woman, New Orleans, 1941. Credit: Wikipedia.

Research by the University of Sydney has found that older Australians are taking non-steroidal anti-inflammatory drugs (NSAIDs) for too long and without sufficient precautions to minimise harmful side-effects.

NSAIDs are commonly used to treat pain and inflammation associated with rheumatoid arthritis and other musculoskeletal disorders. In Australia, NSAIDs include both prescription and over-the-counter medicines, such as celecoxib (Celebrex), ibuprofen (Nurofen) and diclofenac (Voltaren).

Despite guidelines recommending the short term use of NSAIDs, the study of 1,700 older Australian men aged 70 years and older reports that patients were prescribed these drugs for five years on average.

"Prescribing doctors are not adhering to the specific guidelines for the safe use of NSAIDs in older people" said lead author of the paper Dr Danijela Gnjidic from the Faculty of Pharmacy at the University of Sydney.

"Australian and international guidelines suggest NSAIDS should be used for short-term treatment and be taken as needed. This is clearly not what is happening in reality.

"Our study found that although NSAID use was relatively low, it was more likely to be on a regular basis than an as-needed basis.

"Older people have a higher risk of developing serious complications from taking NSAIDs, so they should be used with caution.

"Use of these drugs has been linked with adverse gastrointestinal and cardiovascular effects, including ulceration and bleeding, elevated blood pressure, stroke and worsening heart failure.

"Only 25 per cent of NSAIDs users were prescribed a (PPI) to prevent or manage side-effects, despite that this should be standard.

"Our study also found that older people taking NSAIDs were more likely to take other potentially harmful interacting drugs.

"The difference between the guideline recommendations for prescribing NSAIDs and what is happening in the real world is alarming, and should be explored further. This study shines a light on a topic where little research has been done.

"Our study has highlighted the need for health practitioners and consumers to work together to determine the most effective strategies for ensuring safe and appropriate prescribing of NSAIDs for older people.

"It is important to regularly review medicines taken by to ensure they meet their treatment goals while avoiding putting patients at greater risk of harmful side effects," Dr Gnjidic said.

This research was published in PAIN journal.

More information: "Non-steroidal anti-inflammatory drugs (NSAIDs) in older people: prescribing patterns according to pain prevalence and adherence to clinical guidelines." Danijela Gnjidic, Fiona M. Blyth, David G. Le Couteur, Robert G. Cumming, Andrew J. McLachlan, David J. Handelsman, Markus Seibel, Louise Waite, Vasi Naganathan. Pain. DOI: 10.1016/j.pain.2014.06.009

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