Drug utilization study of co-administration of nonsteroidal anti-inflammatory drugs and gastroprotective agents in an orthopaedics outpatients department of a tertiary care hospital in West Bengal

Ajay Kumar, Chanchal Kumar Dalai, Amit Kumar Ghosh, Madhumita Ray

Abstract


Background: Non steroidal anti-inflammatory drugs (NSAIDs) are the commonly prescribed analgesic in the orthopaedics department. NSAIDs are prescribed for a long period in both acute condition (like fracture of bones, muscle injury, postoperative procedures etc) or chronic conditions (osteoarthritis etc). However, they have many adverse effects, especially gastrointestinal toxicity when use regularly. For this reason NSAIDs are frequently co-prescribed with gastro protective agents. Common gastroprotective agents are proton pump inhibitors (PPI), H2 blockers, sucralfate, antacids and misoprostol (prostaglandin analogue).

Methods: A cross-sectional, unicentric drug utilization study was conducted. Prescriptions were collected from patients attending the orthopaedic outpatients department. The prescription pattern of NSAIDs, gastroprotective agents or co-administration of NSAIDS and gastroprotective agents were analyzed.

Results: A total of 977 prescriptions were studied; in which 928 prescriptions contained NSAIDs with gastroprotective agents (97.92%). The most common gastroprotective agents combined with NSAIDs was H2 receptor blockers (60.56%), followed by proton pump inhibitors (PPIs) (21.65%), while antacids are prescribed least (17.78%). Misoprostol or sucralfate were not used at all.

Conclusions: NSAIDs are commonly co-prescribed with gastroprotective agents in high percentage.


Keywords


Drug Utilization Study, NSAIDs, Gastroprotective agents

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References


Sharma T, Dutta S, Dhasmana DC. Prescribing Pattern of NSAIDs in Orthopaedic OPD of a Tertiary Care Teaching Hospital in Uttaranchal. JK Sci 2006;8:160-2.

Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin like drugs. Nat New Biol 1971;231:232-5.

Warner TD, Mitchell JA. Cyclooxygenase: new forms, new inhibitors and lessons from the clinic. FASEB J 2004;18:790-804.

Marnett LJ, Rowlinson SW, Goodwin DC, Kalgutkar AS, Lanzo CA. Arachidonic acid oxygenation by COX-1 and COX-2. Mechanisms of catalysis and inhibition. J Biol Chem 1999;274:22903-6.

Chandrasekharan NV, Dai H, Roos KC, et al. COX-3,a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure and expression. Proc Natl Acad Sci USA 2002;99:13926-31.

Graumlich JF. Preventing gastrointestinal complications of NSAID's: risk factors, recent advances, and latest strategies. Postgrad Med 2001;109:117-28.

Hawkey CJ. COX – 2 inhibitors. Lancet 1999;353:307-14.

Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001;286:954-9.

Jain S, Gupta M, Malhotra S, Pandhi P. Effect of Rofecoxib on antihypertensive effects of Candesartan in experimental models of hypertension. Methods Find Exp Clin Pharmacol 2005;27:11-6.

McQuaid KR. Drugs used in the treatment of Gastrointestinal Diseases. In: Katzung BG, editor. Basic and Clinical Pharmacology, 10th ed. McGraw Hill; 2007:1009-19.

Raghavendra B, Sanji N, Ullal SD, et al. Trends in Prescribing Gastroprotective Agents with Non Steroidal Anti-Inflammatory Drugs in an Orthopaedic Outpatient Unit of a Tertiary Care Hospital. J Clin Diagn Res 2009;3:1553-6.

Hopkinson N, Doherty M. NSAIDS-associated gastropathy- a role for misoprostol? Br J Rheumatol 1990;29:133-6.

Walt RP. Misoprostol for the treatrment of peptic ulcer and antiinflamatory-drug induced gastroduodenal ulceration. N Engl J Med 1992;327:1575-80.

Gisbert JP, Gonzalez L, Calvet X, Roque M, Gabriel R, Pajares JM. Proton pump inhibitors versus H2-antagonists: a meta-analysis of their efficacy in treating bleeding peptic ulcer. Aliment Pharmacol Ther 2001;15:917-26.

La Corte R, Caselli M, Castellino G, Bajocchi G, Trotta F. Prophylaxis and treatment of NSAID-induced gastroduodenal disorders. Drug Saf 1999;20:527-43.

Dupas JL, Grigy C. Curative and preventive treatment of NSAID-associated gastroduodenal ulcers. Gastroenterol Clin Biol 2004;28:C77-83.

Lazzaroni M, Porro GB. Management of NSAID-induced gastrointestinal toxicity: focus on proton pump inhibitors. Drugs 2009;69:51-69.