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

Tiago Aparecido Maschio De Lima,Adriana Antônia Da Cruz Furini,Moacir Fernandes De Godoy,Ricardo Luiz Dantas Machado,Patricia Di Done,Tábata Salum Calille Atique

doi:10.1590/1809-98232016019.150062

Abstract

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.

Highlights

In order to ensure the confidentiality of the elderly individuals involved in this research, sequential numerical codes were used for each individual in all stages of the investigation
The analysis of non-steroidal anti-inflammatories (NSAIs) prescriptions included the following: the total number of drugs used by the patients during the week of the study; drug combinations containing NSAIs; and the use of NSAIs found on the list of drugs that are inappropriate for elderly individuals.[3,10,11]
Acetylsalicylic acid (ASA) was not considered an NSAI when it was prescribed at a daily dose of 100 mg and used as an antiplatelet

Summary

METHODS

This was a prospective, exploratory and descriptive study with a quantitative approach. The analysis of NSAI prescriptions included the following: the total number of drugs used by the patients during the week of the study; drug combinations containing NSAIs; and the use of NSAIs found on the list of drugs that are inappropriate for elderly individuals.[3,10,11] Acetylsalicylic acid (ASA) was not considered an NSAI when it was prescribed at a daily dose of 100 mg and used as an antiplatelet Despite their weak anti-inflammatory action (and stronger analgesic and antipyretic action), paracetamol and dipyrone are considered NSAIs due to the fact that they inhibit cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). The research was approved by the management of the pharmacy where the data was collected

Results

Variable Gender

Generic name

Prescriptions without interactions p n

Ibuprofen Escitalopram

Causal relationship