Study of usage pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) among different practice categories in Indian clinical setting

Abstract

The aim of the study was to evaluate the usage pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in diverse clinical practice settings in India. The study was conducted in Mumbai city and its suburbs, involving 1,916 doctors from among general practice to specialist practice. The data were collected with the help of a semi-structured questionnaire and were analysed statistically to bring out differences in NSAID usage among different groups of prescribers. All the 1,916 doctors prescribed NSAIDs frequently with prescriptions ranging from 1 to 15 daily; they short-listed and prescribed only two to five NSAIDs from among a plethora of drugs available including fixed-dose combinations (FDCs). It is significant that FDCs were prescribed by more than 39% of doctors in all the categories, the highest prescribers being orthopaedic surgeons (76%) and lowest general practitioners (GPs; 39%). Apart from recommended usage, NSAIDs such as ibuprofen, diclofenac and aspirin were used for pelvic inflammatory disease, and indomethacin for pre-term labour and patent ductus arteriosus. Dosage variation, both in terms of dose and frequency of administration, has been observed for several NSAIDs in the GPs category as well as in the specialist categories-except that of paediatricians. In patients suffering from bronchial asthma, there has been significant use of aspirin and ibuprofen by GPs despite contra-indication for their use in such patients. Most prescribers perceived that NSAIDs are associated with mild gastrointestinal (GI) adverse events. Ibuprofen, a drug with reportedly better gastric tolerance, was perceived to cause GI adverse events, though to a lesser extent than aspirin; fewer prescribers perceived that diclofenac and piroxicam cause GI adverse events when compared with aspirin and ibuprofen. There were significant differences among the five practice categories with regard to preferences for NSAIDs. The first choice NSAIDs were ibuprofen, aspirin, diclofenac, paracetamol, piroxicam and ibuprofen+paracetamol FDC. This study has shown that there exist significant differences in the usage pattern and preferences of NSAIDs among different practice categories in India. The data have also revealed that there is a need for awareness programmes on rational prescribing of NSAIDs towards optimal therapeutics and improved patient care in India.