01.NSAID guidelines ignored
Older Australians are taking non-steroidal anti-inflammatory drugs (NSAIDs) for too long and without sufficient precautions to minimise harmful side effects, according to research conducted by the University of Sydney.
NSAIDs are commonly used to treat pain and inflammation associated with rheumatoid arthritis, osteoarthritis and other musculoskeletal disorders. The most commonly used NSAIDs in Australia are aspirin, ibuprofen (for example, Nurofen and Advil), naproxen (Naprosyn, Naprogesic and Aleve) and diclofenac (Voltaren), available over the counter, as well as celecoxib (Celebrex) which is prescription-only.
NSAIDs have been linked with side effects such as ulcers and bleeding in the stomach and other parts of the gut, cardiovascular effects, such as elevated blood pressure, stroke and worsening heart failure, fluid retention, kidney problems and rashes.
Australian and international guidelines recommend the short term use of NSAIDs. However, the study of 1700 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 the 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. 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.”
While side effects can be managed or prevented by taking a proton pump inhibitor (PPI), the study found only 25 per cent of NSAID users were prescribed one. In addition, they found that people were likely to be taking other drugs that could interact with the NSAIDs, with potentially harmful effects.
"The difference between the guideline recommendations for prescribing NSAIDs and what is happening in the real world is alarming, and should be explored further,” says Dr Gnjidic.
"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.”
Consumers can take a proactive role in their medication strategies by following some simple steps
, including regular medication reviews with your doctor, understanding what you’re taking and why, and looking at lifestyle approaches to managing chronic health problems. See our article on mixing medicines
for more about the potential harms caused by taking multiple medicines.