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Older people using NSAIDs
for too long
Research by the University of Sydney
has found that older Australians are
taking non-steroidal anti-inflammatory
drugs (NSAIDs) for too long and without
sufficient precautions to minimise
harmful side effects.
In Australia, NSAIDs include both
prescription and over-the-counter
medicines, such as celecoxib (Celebrex),
ibuprofen (Nurofen) and diclofenac
In response, the Australian Self Medication
Industry (ASMI) recommended that
over-the-counter (OTC) non-steroidal
anti-inflammatory drugs (NSAIDs) be
taken at the recommended dose for
short-term pain relief.
Despite guidelines recommending the
short-term use of NSAIDs, the study
of 1,700 older Australian men aged 70
years and older reports that patients
were prescribed these drugs for five
years on average.
Lead author of the paper, Dr Danijela
Gnjidic from the Faculty of Pharmacy
at the University of Sydney, said that
prescribing doctors are not adhering to
the specific guidelines for the safe use of
NSAIDs in older people.
'Australian and international guidelines
suggest NSAIDS should be used for
short-term treatment and be taken
as needed. This is clearly not what is
happening in reality.
'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,'
Dr Gnjidic said the use of these
drugs has been linked with adverse
gastrointestinal and cardiovascular
effects, including ulceration and
bleeding, elevated blood pressure,
stroke and worsening heart failure.
'Only 25% of NSAIDs users were
prescribed a proton pump inhibitor
(PPI) to prevent or manage side-effects,
despite guideline recommendations
that this should be standard. Our study
also found that older people taking
NSAIDs were more likely to take other
potentially harmful interacting drugs.
'The difference between the guideline
recommendations for prescribing
NSAIDs and what is happening in the
real world is alarming, and should be
explored further. This study shines a
light on a topic where little research has
been done. 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.
'It is important to regularly review
medicines taken by older people to
ensure they meet their treatment
goals while avoiding putting patients
at greater risk of harmful side effects,'
Dr Gnjidic said.
ASMI Director of Regulatory and
Scientific Affairs Steve Scarff said:
'Consumers normally take OTC NSAIDs
at a much lower dose and for a shorter
period of time than is being examined
in this study of prescription NSAIDs.
NSAIDs are one of the most widely used
medicines for pain and inflammation and
they have a well-known safety profile,
particularly at recommended doses.
'It is important that consumers do
not confuse the safety profiles of OTC
NSAIDs with those of prescription
NSAIDs. The lower dose of OTC NSAIDs
and their short term use means that
their safety profile is different to their
higher dose, prescription counterpart,'
The research was published in
Report highlights need for
The need to fast track real-time
prescription reporting for some drugs
has been given renewed impetus in a
study highlighting the increasing risks of
The study, An overview of the patterns of
prescription opioid use, costs and related
harms in Australia, published in the June
edition of the British Journal of Clinical
Pharmacology, finds that between 1992
and 2012, opioid dispensing increased
15-fold (500,000 to 7.5 million) and the
corresponding cost to the Australian
government increased 32-fold ($8.5
million to $271 million).
'Opioid-related harms also increased;
opioid-related hospitalisations increased
from 605 to 1,464 cases (1998--2009),
outnumbering hospitalisations due
to heroin poisonings since 2001.
Deaths due to accidental poisoning
(pharmaceutical opioids and illicit
substances combined) increased from
151 to 266 (2002--11), resulting in a
rise in the death rate of 0.78 to 1.19
deaths/100,000 population over 10
years. Death rates increased 1.8 fold
in males and 1.4 fold in females,' the
The Pharmaceutical Society of Australia's
NSW Branch President, Dr Stephen
Carter, said the report reinforced calls for
the introduction of real-time reporting
to be addressed as a matter of urgency.
'The PSA has long been advocating
strongly for this system and recently we
put a submission to the NSW Coroner
on this matter, a submission which was
supported in the coronial findings,'
Dr Carter said.
'We must stop talking about acting, and
start acting. The introduction of real-
time reporting is a public health issue.
PSA has been told there are resource
and other issues for the NSW Ministry
of Health in implementing real-time
reporting but we must stop making
excuses for finding ways not to do
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