Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1994 Aug 1;151(3):315–322.

Prescription of nonsteroidal anti-inflammatory drugs for elderly people in Alberta.

D B Hogan 1, N R Campbell 1, R Crutcher 1, P Jennett 1, N MacLeod 1
PMCID: PMC1336922  PMID: 8039085

Abstract

OBJECTIVE: To examine the extent prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are used by elderly people in Alberta as well as the degree of concurrent use of multiple NSAIDs, of peptic ulcer medications and of certain medications known to have clinically significant adverse interactions with NSAIDs. DESIGN: Retrospective analysis of the Alberta Blue Cross database. SETTING: Alberta. PATIENTS: All people 65 years of age and older using the subsidized drug benefit plan for whom prescription claims were submitted for reimbursement between Jan. 1 and June 30, 1991. OUTCOME MEASURES: Number of people who received one or more prescriptions for NSAIDs, rates of prescribing peptic ulcer medications and drugs with the potential for clinically significant interactions with NSAIDs among NSAID users and non-NSAID users, and rate of prescribing more than one NSAID concurrently. RESULTS: Of the Albertan population 65 years of age and over 61,601 (26.7%) received at least one prescription for an NSAID during the study period. In decreasing order, the five most commonly prescribed NSAIDs were acetylsalicylic acid, diclofenac, naproxen, indomethacin and ibuprofen. The total cost of NSAID therapy was $5,415,974. Of the people prescribed an NSAID 25.8% were also prescribed a peptic ulcer medication, as compared with 10.5% of the non-NSAID users. There was a significant relation between the increasing number of NSAID prescriptions and the likelihood of receiving a peptic ulcer medication. Those who received a prescription for an NSAID were more likely than non-NSAID users to have been prescribed coumarin anticoagulants, diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, oral corticosteroids, methotrexate and lithium, all of which are known to have possible adverse interactions with NSAIDs. A total of 2,631 people had two or more prescriptions for NSAIDs filled on the same day. CONCLUSIONS: NSAIDs are prescribed frequently for elderly people and are associated with an increased likelihood of concurrent prescription of peptic ulcer medication and medications that could have adverse drug interactions with NSAIDs. Additional study is required to evaluate the appropriateness of NSAID use in elderly patients, to determine the degree of actual patient consumption of these medications, to document the true prevalence of clinically significant drug interactions and to formulate educational strategies to reach physicians with this information.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams K. R., Al-Hamouz S., Edmund E., Tallis R. C., Vellodi C., Lye M. Inappropriate prescribing in the elderly. J R Coll Physicians Lond. 1987 Jan;21(1):39–41. [PMC free article] [PubMed] [Google Scholar]
  2. Agrawal N. M. Making sense of NSAID gastropathy and considering the therapeutic options. Scand J Rheumatol Suppl. 1992;92:13–19. doi: 10.3109/03009749209101384. [DOI] [PubMed] [Google Scholar]
  3. Anglard P., Magal E., Louis J. C. Stimulation of glycolysis by corticotropin and phorbol ester in cultured neurons. Biochim Biophys Acta. 1992 Feb 3;1133(3):321–328. doi: 10.1016/0167-4889(92)90054-f. [DOI] [PubMed] [Google Scholar]
  4. Armstrong C. P., Blower A. L. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut. 1987 May;28(5):527–532. doi: 10.1136/gut.28.5.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Beers M. H., Storrie M., Lee G. Potential adverse drug interactions in the emergency room. An issue in the quality of care. Ann Intern Med. 1990 Jan 1;112(1):61–64. doi: 10.7326/0003-4819-112-1-61. [DOI] [PubMed] [Google Scholar]
  6. Bergman U. Pharmacoepidemiological perspectives. J Clin Epidemiol. 1992 Mar;45(3):313–317. doi: 10.1016/0895-4356(92)90092-2. [DOI] [PubMed] [Google Scholar]
  7. Bloom B. S. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med. 1988 Feb 22;84(2A):20–24. doi: 10.1016/0002-9343(88)90250-1. [DOI] [PubMed] [Google Scholar]
  8. Bradley J. D., Brandt K. D., Katz B. P., Kalasinski L. A., Ryan S. I. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991 Jul 11;325(2):87–91. doi: 10.1056/NEJM199107113250203. [DOI] [PubMed] [Google Scholar]
  9. Buechler J. R., Malloy W. Drug therapy in the elderly. How to achieve optimum results. Postgrad Med. 1989 May 1;85(6):87-94, 97-9. doi: 10.1080/00325481.1989.11700690. [DOI] [PubMed] [Google Scholar]
  10. Cartwright A. Medicine taking by people aged 65 or more. Br Med Bull. 1990 Jan;46(1):63–76. doi: 10.1093/oxfordjournals.bmb.a072395. [DOI] [PubMed] [Google Scholar]
  11. Clinch D., Banerjee A. K., Levy D. W., Ostick G., Faragher E. B. Non-steroidal anti-inflammatory drugs and peptic ulceration. J R Coll Physicians Lond. 1987 Jul;21(3):183–187. [PMC free article] [PubMed] [Google Scholar]
  12. Col N., Fanale J. E., Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990 Apr;150(4):841–845. [PubMed] [Google Scholar]
  13. Dieppe P. A., Frankel S. J., Toth B. Is research into the treatment of osteoarthritis with non-steroidal anti-inflammatory drugs misdirected? Lancet. 1993 Feb 6;341(8841):353–354. doi: 10.1016/0140-6736(93)90147-9. [DOI] [PubMed] [Google Scholar]
  14. Felson D. T., Zhang Y., Anthony J. M., Naimark A., Anderson J. J. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1992 Apr 1;116(7):535–539. doi: 10.7326/0003-4819-116-7-535. [DOI] [PubMed] [Google Scholar]
  15. Gabriel S. E., Jaakkimainen L., Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991 Nov 15;115(10):787–796. doi: 10.7326/0003-4819-115-10-787. [DOI] [PubMed] [Google Scholar]
  16. Gosney M., Tallis R. Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital. Lancet. 1984 Sep 8;2(8402):564–567. doi: 10.1016/s0140-6736(84)90775-x. [DOI] [PubMed] [Google Scholar]
  17. Graham D. Y., White R. H., Moreland L. W., Schubert T. T., Katz R., Jaszewski R., Tindall E., Triadafilopoulos G., Stromatt S. C., Teoh L. S. Duodenal and gastric ulcer prevention with misoprostol in arthritis patients taking NSAIDs. Misoprostol Study Group. Ann Intern Med. 1993 Aug 15;119(4):257–262. doi: 10.7326/0003-4819-119-4-199308150-00001. [DOI] [PubMed] [Google Scholar]
  18. Griffin M. R., Piper J. M., Daugherty J. R., Snowden M., Ray W. A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991 Feb 15;114(4):257–263. doi: 10.7326/0003-4819-114-4-257. [DOI] [PubMed] [Google Scholar]
  19. Griffin M. R., Piper J. M., Daugherty J. R., Snowden M., Ray W. A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991 Feb 15;114(4):257–263. doi: 10.7326/0003-4819-114-4-257. [DOI] [PubMed] [Google Scholar]
  20. Gurwitz J. H., Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991 Jun 1;114(11):956–966. doi: 10.7326/0003-4819-114-11-956. [DOI] [PubMed] [Google Scholar]
  21. Hobson M. Medications in older patients. West J Med. 1992 Nov;157(5):539–543. [PMC free article] [PubMed] [Google Scholar]
  22. Inman W. H. Non-steroidal anti-inflammatory drugs: assessment of risks. Eur J Rheumatol Inflamm. 1987;8(1):71–85. [PubMed] [Google Scholar]
  23. Jacobs J., Goldstein A. G., Kelly M. E., Bloom B. S. NSAID dosing schedule and compliance. Drug Intell Clin Pharm. 1988 Sep;22(9):727–728. doi: 10.1177/106002808802200927. [DOI] [PubMed] [Google Scholar]
  24. Johnson A. G., Day R. O. The problems and pitfalls of NSAID therapy in the elderly (Part I). Drugs Aging. 1991 Mar;1(2):130–143. doi: 10.2165/00002512-199101020-00005. [DOI] [PubMed] [Google Scholar]
  25. Johnson A. G., Day R. O. The problems and pitfalls of NSAID therapy in the elderly (Part II). Drugs Aging. 1991 May;1(3):212–227. doi: 10.2165/00002512-199101030-00005. [DOI] [PubMed] [Google Scholar]
  26. Jones A. C., Berman P., Doherty M. Non-steroidal anti-inflammatory drug usage and requirement in elderly acute hospital admissions. Br J Rheumatol. 1992 Jan;31(1):45–48. doi: 10.1093/rheumatology/31.1.45. [DOI] [PubMed] [Google Scholar]
  27. Knodel L. C. NSAID adverse effects & interactions: who is at risk? Am Pharm. 1992 Mar;NS32(3):39–47. doi: 10.1016/s0160-3450(15)31182-x. [DOI] [PubMed] [Google Scholar]
  28. Kovar P. A., Allegrante J. P., MacKenzie C. R., Peterson M. G., Gutin B., Charlson M. E. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992 Apr 1;116(7):529–534. doi: 10.7326/0003-4819-116-7-529. [DOI] [PubMed] [Google Scholar]
  29. Lamy P. P. The elderly and drug interactions. J Am Geriatr Soc. 1986 Aug;34(8):586–592. doi: 10.1111/j.1532-5415.1986.tb05764.x. [DOI] [PubMed] [Google Scholar]
  30. Lanza F. L., Royer G. L., Jr, Nelson R. S. Endoscopic evaluation of the effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa. N Engl J Med. 1980 Jul 17;303(3):136–138. doi: 10.1056/NEJM198007173030305. [DOI] [PubMed] [Google Scholar]
  31. Leufkens H. G., Ameling C. B., Hekster Y. A., Bakker A. Utilization patterns of non-steroidal anti-inflammatory drugs in an open Dutch population. Pharm Weekbl Sci. 1990 Jun 22;12(3):97–103. doi: 10.1007/BF01967602. [DOI] [PubMed] [Google Scholar]
  32. Levy R. A., Smith D. L. Clinical differences among nonsteroidal antiinflammatory drugs: implications for therapeutic substitution in ambulatory patients. DICP. 1989 Jan;23(1):76–85. doi: 10.1177/106002808902300122. [DOI] [PubMed] [Google Scholar]
  33. Liang M. H., Fortin P. Management of osteoarthritis of the hip and knee. N Engl J Med. 1991 Jul 11;325(2):125–127. doi: 10.1056/NEJM199107113250210. [DOI] [PubMed] [Google Scholar]
  34. Lindley C. M., Tully M. P., Paramsothy V., Tallis R. C. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing. 1992 Jul;21(4):294–300. doi: 10.1093/ageing/21.4.294. [DOI] [PubMed] [Google Scholar]
  35. Mahon W. A., Godden J. O. Control of therapy. Can Med Assoc J. 1973 Jul 21;109(2):89–90. [PMC free article] [PubMed] [Google Scholar]
  36. Murray M. D., Brater D. C. Nonsteroidal anti-inflammatory drugs. Clin Geriatr Med. 1990 May;6(2):365–397. [PubMed] [Google Scholar]
  37. Piper J. M., Ray W. A., Daugherty J. R., Griffin M. R. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991 May 1;114(9):735–740. doi: 10.7326/0003-4819-114-9-735. [DOI] [PubMed] [Google Scholar]
  38. Shorr R. I., Ray W. A., Daugherty J. R., Griffin M. R. Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Arch Intern Med. 1993 Jul 26;153(14):1665–1670. [PubMed] [Google Scholar]
  39. Silagy C. A., McNeil J. J., Donnan G. A., Tonkin A. M., Worsam B., Campion K. Adverse effects of low-dose aspirin in a healthy elderly population. Clin Pharmacol Ther. 1993 Jul;54(1):84–89. doi: 10.1038/clpt.1993.115. [DOI] [PubMed] [Google Scholar]
  40. Stalnikowicz R., Pollak D., Eliakim A., Wengrower D., Fich A., Goldin E., Ligumsky M., Rachmilewitz D. Cimetidine decreases indomethacin induced duodenal mucosal damage in patients with acute musculoskeletal disorders. Gut. 1988 Nov;29(11):1578–1582. doi: 10.1136/gut.29.11.1578. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Verbeeck R. K. Pharmacokinetic drug interactions with nonsteroidal anti-inflammatory drugs. Clin Pharmacokinet. 1990 Jul;19(1):44–66. doi: 10.2165/00003088-199019010-00004. [DOI] [PubMed] [Google Scholar]
  42. Walt R. P. Misoprostol for the treatment of peptic ulcer and antiinflammatory-drug-induced gastroduodenal ulceration. N Engl J Med. 1992 Nov 26;327(22):1575–1580. doi: 10.1056/NEJM199211263272207. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES