Pharmacy World and Science

, Volume 24, Issue 3, pp 100–103 | Cite as

Prescribing of gastroprotective drugs among elderly NSAID users in the Netherlands

  • K.N. Van Dijk
  • R.B.J. Brouwers
  • K. Ter Huurne
  • P.B. van den Berg
  • L.T.W. de Jong-van den Berg
  • C.S. de Vries


Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal toxicity, in particular when risk factors are present. Methods: A study was performed to investigate concomitant prescribing of gastroprotective agents (H2-receptor antagonists, proton pump inhibitors, or misoprostol) in an ambulatory cohort of NSAID users aged 65 years and over. The prevalence of concomitant prescribing was studied, as well as the prophylactic prescribing of gastroprotective drugs. A stepwise logistic regression was performed to determine predictive variables of prophylactic and concomitant gastroprotective drug prescribing.Results: Co-prescribing of gastroprotective drugs occurred in 1522 (23%) (of which 944 concerned prophylactic prescribing) of the NSAID users (n=6557), with an average duration of 67 days per 100 days of NSAID use.Co-prescribing of gastroprotective drugs varied among individual NSAIDs. Concomitant use of oral corticosteroids (ORadj 2.4; CI95 2.0-2.9), coumarins (ORadj 1.6; CI95 1.3-2.0), and low dose aspirin (ORadj 1.6; CI95 1.4-1.9) were significantly associated with both prophylactic and concomitant prescribing of gastroprotective agents during NSAID therapy. Discussion: Despite current guidelines recommending gastroprotective drug prescribing among high risk groups, the rate of concomitant prescribing of gastroprotective agents in NSAID users aged 65 years and over is low. Feedback to prescribers should be given to improve prescribing practices in this high risk group.

Gastroprotective agents H2 receptor antagonists Misoprostol Non-steroidal anti-inflammatory agents Proton pump inhibitors 


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  1. 1.
    Griffin MR, Piper JM, Daugherty JR, Snowdon M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med 1991;114(4):257–63Google Scholar
  2. 3.
    Plosker GL, Lamb HM. Diclofenac/misoprostol: pharmacoeconomic implications for therapy. Pharmacoeconomics 1999;16(1):85–98Google Scholar
  3. 3.
    Fries JF. NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal. J Rheumatol 1991;18 suppl.28:6–10Google Scholar
  4. 4.
    Wolfe MM, Lichenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999;24:1888–99Google Scholar
  5. 5.
    Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of non-steroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med 1991;115(10):787–96Google Scholar
  6. 6.
    Griffin MR. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 1998;104(3A):23S–29SGoogle Scholar
  7. 7.
    Shorr RI, Ray WA, Daugherty JR, Griffin MR. 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; 153(14):1665–70Google Scholar
  8. 8.
    Silverstein FE, Graham DY, Senior JR, Davies HW, Struthers BJ, Bittman RM, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs: a randomized double-blind, placebo-controlled trial. Ann Intern Med 1995;123:241–9Google Scholar
  9. 9.
    Rostom A, Wells G, Tugwell P, Welch V, Dube C, McGowan J. The prevention of chronic NSAID induced upper gastrointestinal toxicity: a Cochrane collaboration meta-analysis of randomized controlled trials. J Rheumatol 2000; 27:2203–14.Google Scholar
  10. 10.
    Agrawal NM, Aziz K. Prevention of gastrointestinal complications associated with nonsteroidal antiinflammatory drugs. J Rheumatol 1998; 25:S 51:17–20Google Scholar
  11. 11.
    Boers M. NSAIDs and selective COX-2 inhibitors: competition between gastroprotection and cardioprotection (commentary). Lancet 2001; 357: 1222–3Google Scholar
  12. 12.
    Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swannell AJ et al. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998;338:727–34Google Scholar
  13. 13.
    Brouwers JRBJ, Van Roon EN, Postma M, Al M. Altijd gastroprotectie? Kosten-effectiviteit van NSAIDs [in Dutch]. Pharm Weekbl 2000; 135(5):172–5Google Scholar
  14. 14.
    Silverstein FE, Faich G, Goldstein JL, Shapiro D, Burgos-Vargas R, Davis B, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284:1247–55Google Scholar
  15. 15.
    Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 2000; 343:1520–8Google Scholar
  16. 16.
    Van der Kuy, A (editor). Farmacotherapeutisch Kompas [in Dutch]. Amstelveen, The Netherlands: CMPC Ziekenfondsraad, 2001: p. 940.Google Scholar
  17. 17.
    Tobi H, Van den Berg PB, De Jong-van den Berg LTW (2000) The InterAction database: synergy of science and practice in pharmacy. In: Brause RW, Hanisch E (ed) Medical data analysis: first international symposium; proceedings/ISMDA. Springer, Berlin, pp 206–211.Google Scholar
  18. 18.
    Anonymous (2000) Anatomical therapeutical chemical (ATC) classification index including defined daily dosages (DDDs) for plain substances. Oslo: World Health Organisation Collaborating Centre for Drug Statistics Methodology.Google Scholar
  19. 19.
    Henry D, Lim LLY, Garcia Rodriguez LA, Perez Gutthann S, Carson JL, Griffin M, et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996;312:1563–6Google Scholar
  20. 20.
    Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, eet al. Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. Br J Rheumatol 1998;37:937–45Google Scholar
  21. 21.
    Lanes SF, Garcia Rodriguez LA, Hwang E. Baseline risk of gastrointestinal disorders among new users of meloxicam, ibuprofen, diclofenac, naproxen and indomethacin. Pharmacoepidemiol Drug Saf 2000; 9:113–7Google Scholar
  22. 22.
    Hogan DB, Campbell NRC, Crutcher R, Jennett P, MacLeod N. Prescription of nonsteroidal anti-inflammatory drugs for elderly in Alberta. CMAJ 1994; 151(3): 315–22Google Scholar
  23. 23.
    Schubert I, Ihle P, Köster I, Ferber von L. Markers to analyse the prescribing of non-steroidal anti-inflammatory drugs in ambulatory care. Eur J Clin Pharmacol 1999;55:479–86Google Scholar
  24. 24.
    LeLorier J. Patterns of prescription of nonsteroidal antiinflammatory drugs and gastroprotective agents. J Rheumatol 1995;(suppl 43): 22:26–7Google Scholar
  25. 25.
    Pertusi RM, Godwin KS, House KJ, Knebl JA, Alexander JH, Rubin BR, et al. Gastropathy induced by nonsteroidal antiinflammatory drugs: pescribing patterns among geriatric practitioners. J Am Osteopath Assoc 1999;99(6):305–10.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • K.N. Van Dijk
    • 1
    • 2
  • R.B.J. Brouwers
    • 1
    • 3
  • K. Ter Huurne
    • 1
  • P.B. van den Berg
    • 1
  • L.T.W. de Jong-van den Berg
    • 1
  • C.S. de Vries
    • 4
  1. 1.Groningen University Institute for Drug Exploration (GUIDE)GroningenThe Netherlands
  2. 2.Department of Clinical PharmacyZorggroep NoorderbreedteLeeuwardenThe Netherlands
  3. 3.Department of Clinical PharmacyDe Tjongerschans HospitalHeerenveenThe Netherlands
  4. 4.Department of Pharmacoepidemiology, Postgraduate Medical SchoolUniversity of SurreyGuildfordUK

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