Usage Patterns of 'over-the-counter' Vs. Prescription-strength Nonsteroidal Anti-inflammatory Drugs in France

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 2013 Oct 10

PMID 24102791

Citations 27

Authors

Mai Duong

Francesco Salvo

Antoine Pariente

Abdelilah Abouelfath

Regis Lassalle

Cecile Droz

Patrick Blin

Nicholas Moore

Affiliations

Soon will be listed here.

Abstract

Aims: Most risks of nonsteroidal anti-inflammatory drugs (NSAIDs) are pharmacological, dose and duration dependent. Usage patterns of prescription-only (POM) or 'over-the-counter (OTC)' NSAIDs may influence risks, but are not commonly described.

Methods: The Echantillon Généraliste de Bénéficiaires database, the permanent 1/97 representative sample from the French national healthcare insurance systems, was queried over 2009-2010 to identify usage patterns, concomitant chronic diseases and cardiovascular medication in OTC and POM NSAID users.

Results: Over 2 years, 229 477 of 526 108 patients had at least one NSAID dispensation; 44 484 patients (19%) were dispensed only OTC NSAIDs (93% ibuprofen) and 121 208 (53%) only POM NSAIDs. The OTC users were younger (39.9 vs. 47.4 years old) and more often female (57 vs. 53%); 69% of OTC users and 49% of POM users had only one dispensation. A mean of 14.6 defined daily doses (DDD) were dispensed over 2 years for OTC vs. 53 for POM; 93% OTC vs. 60% POM patients bought ≤ 30 DDD over 2 years, and 1.5 vs. 12% bought ≥ 90 DDD. Chronic comorbidities were found in 19% of OTC users vs. 28% of POM users; 24 vs. 37% had at least one dispensation of a cardiovascular drug over the 2 years.

Conclusions: Most of the use of NSAIDs appears to be short term, especially for OTC-type NSAIDs, such as ibuprofen. The validity of risk estimates for NSAIDs extrapolated from clinical trials or from observational studies not including OTC-type usage may need to be revised.

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References

Minuz P, Lechi A, Arosio E, Degan M, Capuzzo M, Lechi C . Antihypertensive activity of enalapril. Effect of ibuprofen and different salt intakes. J Clin Hypertens. 1987; 3(4):645-53. View

Tramer M, Moore R, Reynolds D, McQuay H . Quantitative estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use. Pain. 2000; 85(1-2):169-82. DOI: 10.1016/s0304-3959(99)00267-5. View

Wolfe M, Lichtenstein D, Singh G . Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999; 340(24):1888-99. DOI: 10.1056/NEJM199906173402407. View

Garcia Rodriguez L, Varas-Lorenzo C, Maguire A, Gonzalez-Perez A . Nonsteroidal antiinflammatory drugs and the risk of myocardial infarction in the general population. Circulation. 2004; 109(24):3000-6. DOI: 10.1161/01.CIR.0000132491.96623.04. View

Martin-Latry K, Begaud B . Pharmacoepidemiological research using French reimbursement databases: yes we can!. Pharmacoepidemiol Drug Saf. 2010; 19(3):256-65. DOI: 10.1002/pds.1912. View

Varas-Lorenzo C, Riera-Guardia N, Calingaert B, Castellsague J, Pariente A, Scotti L . Stroke risk and NSAIDs: a systematic review of observational studies. Pharmacoepidemiol Drug Saf. 2011; 20(12):1225-36. DOI: 10.1002/pds.2227. View

Pope J, Anderson J, Felson D . A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Intern Med. 1993; 153(4):477-84. View

Murray M, Black P, Kuzmik D, Haag K, Manatunga A, Mullin M . Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients. Am J Med Sci. 1995; 310(5):188-97. DOI: 10.1097/00000441-199511000-00003. View

Garcia Rodriguez L, Barreales Tolosa L . Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. Gastroenterology. 2007; 132(2):498-506. DOI: 10.1053/j.gastro.2006.12.007. View

10.

Varas-Lorenzo C, Maguire A, Castellsague J, Perez-Gutthann S . Quantitative assessment of the gastrointestinal and cardiovascular risk-benefit of celecoxib compared to individual NSAIDs at the population level. Pharmacoepidemiol Drug Saf. 2006; 16(4):366-76. DOI: 10.1002/pds.1299. View

11.

Porteous T, Bond C, Hannaford P, Sinclair H . How and why are non-prescription analgesics used in Scotland?. Fam Pract. 2005; 22(1):78-85. DOI: 10.1093/fampra/cmh719. View

12.

Layton D, Sinclair H, Bond C, Hannaford P, Shakir S . Pharmacovigilance of over-the-counter products based in community pharmacy: methodological issues from pilot work conducted in Hampshire and Grampian, UK. Pharmacoepidemiol Drug Saf. 2002; 11(6):503-13. DOI: 10.1002/pds.734. View

13.

Palmer R, Weiss R, Zusman R, Haig A, Flavin S, MacDonald B . Effects of nabumetone, celecoxib, and ibuprofen on blood pressure control in hypertensive patients on angiotensin converting enzyme inhibitors. Am J Hypertens. 2003; 16(2):135-9. DOI: 10.1016/s0895-7061(02)03203-x. View

14.

Noize P, Bazin F, Dufouil C, Lechevallier-Michel N, Ancelin M, Dartigues J . Comparison of health insurance claims and patient interviews in assessing drug use: data from the Three-City (3C) Study. Pharmacoepidemiol Drug Saf. 2009; 18(4):310-9. DOI: 10.1002/pds.1717. View

15.

Lee A, Cooper M, Craig J, Knight J, Keneally J . The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis. Anaesth Intensive Care. 2000; 27(6):574-80. DOI: 10.1177/0310057X9902700603. View

16.

Fosbol E, Gislason G, Jacobsen S, Abildstrom S, Hansen M, Schramm T . The pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4.6 million people. Pharmacoepidemiol Drug Saf. 2008; 17(8):822-33. DOI: 10.1002/pds.1592. View

17.

Salvo F, Fourrier-Reglat A, Bazin F, Robinson P, Riera-Guardia N, Haag M . Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials. Clin Pharmacol Ther. 2011; 89(6):855-66. DOI: 10.1038/clpt.2011.45. View

18.

Depont F, Fourrier A, Merliere Y, Droz C, Amouretti M, Begaud B . The CADEUS study: methods and logistics. Pharmacoepidemiol Drug Saf. 2006; 16(5):571-80. DOI: 10.1002/pds.1348. View

19.

Moore N, Diris H, Martin K, Viale R, Fourrier A, Moride Y . NSAID use profiles derived from reimbursement data in France. Therapie. 2005; 59(5):541-6. DOI: 10.2515/therapie:2004092. View

20.

Henry D, Dobson A, Turner C . Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs. Gastroenterology. 1993; 105(4):1078-88. DOI: 10.1016/0016-5085(93)90952-9. View