Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Abstract

Background:Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population.Objective:To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety.Methods:A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved.Results:A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects.Conclusion:Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Pain assessment and management in haemophilia: A survey among Italian patients and specialist physicians

“…This percentage is probably underestimated, in particular for NSAIDs. Several low‐dose formulations are easily available without a prescription and in the general population NSAID self‐medication is reported in up to 50% of individuals . Nevertheless, only 10% of patients stated to have had adverse effects with analgesic therapy.…”

“…Several low-dose formulations are easily available without a prescription and in the general population NSAID self-medication is reported in up to 50% of individuals. 31 Nevertheless, only 10% of patients stated to have had adverse effects with analgesic therapy. A similar relevant proportion of patients (36%) reported to use NSAIDs in the US National Pain Study, 5 involving 764 PWH comparable for severity of disease, but higher median age (42 years).…”

Automedicación de analgésicos y antibióticos en estudiantes de pregrado de medicina

“…La automedicación con antinflamatorios no esteroideos y opioides se ha asociado con efectos adversos renales, cardiovasculares y gastrointestinales, además del potencial de mal uso, abuso y dependencia que encierra esta práctica [9][10][11][12] .…”

Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing

“…These PIM-lists can be classified into explicit, implicit and mixed approach criteria. 24,36 Non-steroidal antiinflammatory drugs (NSAIDs) are one example of a pharmacological class that is widely used by older people 41 and is described in these lists. 10 Implicit criteria tend to be more person-centred and rely on clinical judgement.…”

“…11,40 In Europe, the first list was developed in 2007 in France, and many others have been released since. 24,36 Non-steroidal antiinflammatory drugs (NSAIDs) are one example of a pharmacological class that is widely used by older people 41 and is described in these lists. For example, ibuprofen has been associated with higher risk of stroke (relative risk-RR: 3.36; confidence interval-CI: 1.0-11.6), while etoricoxib (RR: 4.07; CI: 1.23-15.7) and diclofenac (RR: 3.98; CI: 1.48-12.7) were associated with higher risk of cardiovascular death.…”