Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

Abstract

Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi-prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

Quantification of ketoprofen in film-coated tablets using hydrophilic interaction liquid chromatography-Ultraviolet spectrometry

“…Globally, NSAIDs are the most frequently prescribed drugs, accounting for around 5-10% of all medications prescribed each year [2]. Because the elderly are frequent users of NSAIDs [3][4][5] and are heavily involved in prescription and non-prescription drugs [6], they are particularly vulnerable to polypharmacy, drug-drug interactions, and eventually drug-related problems and death [7][8][9]. Serious/fatal gastrointestinal issues, including ulcers and bleeding, have frequently been documented with prolonged NSAID use [10], and hence, co-prescribing gastroprotective medications is critical for avoiding such hazards [11].…”

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Usage and co-prescription with other potentially interacting drugs in elderly: A cross-sectional study

“…NSAIDs are among the most commonly prescribed class of medications globally and they account for approximately 5–10% of all medications prescribed each year [ 2 ]. For obvious reasons, elderly are among the frequent users of NSAIDs [ 3 – 5 ] and the fact that these sub-population are highly involved in prescription and non-prescription medications [ 6 ], they are highly susceptible to polypharmacy, drug-drug interactions and ultimately drug related complications and even death [ 7 – 9 ]. Serious/fatal gastrointestinal problems including ulcer and bleeding have been frequently reported with chronic use of NSAIDs [ 10 ] and thus, co-prescription of gastro-protective agents has paramount importance in preventing such risks [ 11 ].…”

Análise das interações medicamentosas e perfil epidemiológico de indivíduos com diabetes mellitus na atenção primária

“…"moderadas", quando seus efeitos podem ocasionar uma piora da condição clínica do paciente, tornando necessária alteração no plano medicamentoso; "leves", classificadas como efeitos clínicos pequenos que geralmente não requerem alteração da terapia farmacológica; e "não interage", quando os fármacos não apresentam interações entre si. 9 Para aquelas combinações farmacológicas não descritas nos verificadores on-line realizou-se busca em artigos científicos, parte da população. 24 Em virtude da variedade de produtos fabricados pela indústria, a facilidade de comercialização, a gama de informações médicas obtidas de forma acessível por meio de blogs, sites e redes sociais, a automedicação vem se constituindo um problema de saúde pública, despertando nos órgãos de prevenção à saúde preocupação.…”

“…parada cardíaca 2,11. Cabe destacar que as consequências dessas interações graves são potencialmente fatais ou capazes de causar danos irreversíveis ao paciente 9. Quanto às interações moderadas, hidroclorotiazida e metformina foi a combinação que prevaleceu, devendo-se observar os níveis de glicose sanguínea que podem ser alterados.…”