Drug-drug interactions of non-steroidal anti-inflammatory drugs with other drugs in patients with rheumatic diseases

Background/Aim. The use and adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in outpatients with rheumatic diseases has not yet been studied enough. The aim of this study was to evaluate the data about the efficacy and safety of NSAIDs obtained from the questionnaires submitted to the outpatients receiving these drugs. Methods. The patients who had been prescribed any of NSAIDs within the period from June to September, 2004 were included in the study. The answers obtained from the questionnaires were statistically analyzed by means of ?2-test. Results. At the time of the study, 150 patients had been prescribed ibuprofen or some other NSAID. Out of the total number of dispensed questionnaires (n = 150), only 45 (30%) were shown to be correctly filled-in. Their analysis showed that 64.4% of the patients had suffered from rheumatic diseases for more than five years, and had regularly used NSAIDs. The average age of these patients was about 70 years, and the number of females was double as high as that of the males. The most frequently used NSAIDs were diclofenac and ibuprofen (46.14%, and 23.24%, respectively). According to the answers given by the patients, the most often adverse reactions were gastric complaints such as nausea (11.1%), and stomach pain (8.9%). Due to this, the majority of the patients (64.4%) used some of the antiulcer drugs, most often ranitidine (31.1%). Conclusion. The results of this pilot study revealed that among the outpatients suffering from rheumatic diseases, the number of females was double as high as the number of males, that these patients were of the mean age of 70 years, and that their diseases lasted longer than five years. Gastric complains such as nausea and gastric pain of mild intensity were the most often adverse effects of NSAIDs reported by our patients. It could be the consequence of the predominant use of diclofenac and ibuprofen, NSAIDs with mild to moderate ulcerogenic potential, as well as the concomitant use of H2-receptor antagonists.

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Action from the CRM: barbiturates

Drug and Therapeutics Bulletin ◽

10.1136/dtb.18.3.9 ◽

1980 ◽

Vol 18 (3) ◽

pp. 9-11

Keyword(s):

Rheumatic Diseases ◽

Efficacy And Safety ◽

Inflammatory Drugs ◽

Anti Inflammatory

In 1975 the Committee on the Review of Medicines (CRM) began to examine the efficacy and safety of those drugs that were already on the market before 1971, when the present licensing procedures were introduced.1 It has already made recommendations on non-steroidal anti-inflammatory drugs2 and on other drugs used in rheumatic diseases,3 and these led to improvements in the data sheets for these products but had no obvious effects in practice. However, with its most recent recommendations on barbiturates, the CRM is showing its teeth.

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Non-Steroidal Anti-Inflammatory Drugs: Usage and Co-prescription with Other Potentially Interacting Drugs in Elderly: a Cross-sectional Study

10.21203/rs.2.19183/v1 ◽

2019 ◽

Author(s):

Nuru Abdu ◽

Samuel Teweldemedhin ◽

Asmerom Mosazghi ◽

Luwam Asfaha ◽

Makda Teshale ◽

...

Keyword(s):

Adverse Effects ◽

Drug Interactions ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Protective Agents ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Introduction: Globally, non-steroidal anti-inflammatory drugs (NSAIDs) usage in the elderly with chronic pain has been reported as frequent. Though it is fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. Thus, the objective of the study was to assess the appropriateness of NSAIDs use and incidence of NSAIDs related potential interactions in elderly. Methods: A descriptive cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara between August 22 and September 29, 2018. The sampling design was two-stage random sampling and data was collected using a questionnaire, exit interview and by abstracting information from patients’ clinical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using SPSS. Results: A total of 285 elderly respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users, of which 74.6% were not prescribed prophylactic gastro-protective agents (GPAs). About 20% of the elderly were involved in polypharmacy and nearly all of the encountered potential NSAIDs related interactions (n=322) with prescribed drugs were moderate. Diabetes and hypertension were significantly associated with chronic NSAIDs use (OR=3, 95% CI: 1.54, 5.84; OR=9.99, 95% CI: 4.46, 22.38) and incidence of drug interactions (OR=3.95, 95%CI: 1.92, 8.13; OR=3.12, 95%CI: 1.81, 5.33) while diabetes and cardiac problem were significantly associated with incidence of polypharmacy (OR=4.33, 95% CI: 2.36, 7.96; OR=3.56, 95% CI: 1.05, 12.11). Conclusion: Though the overall reflection of prescription pattern of NSAIDs during the study period was almost satisfactory, gastro-protective agents were poorly prescribed as a prophylaxis.

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Drug interactions between the anti-inflammatory drugs and with other agents

Side-Effects of Anti-Inflammatory Drugs - Inflammation and Drug Therapy Series ◽

10.1007/978-94-010-9772-7_14 ◽

1987 ◽

pp. 179-193 ◽

Cited By ~ 1

Author(s):

P. F. D’Arcy ◽

J. C. McElnay

Keyword(s):

Drug Interactions ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Pharmacokinetic-Pharmacodynamic Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs

Clinical Pharmacokinetics ◽

10.2165/00003088-199427060-00005 ◽

1994 ◽

Vol 27 (6) ◽

pp. 462-485 ◽

Cited By ~ 43

Author(s):

Jacobus R.B.J. Brouwers ◽

Peter A.G.M. de Smet

Keyword(s):

Drug Interactions ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

Pharmacopsychiatry ◽

10.1055/a-1157-9433 ◽

2020 ◽

Vol 53 (05) ◽

pp. 229-234

Author(s):

Maike Scherf-Clavel ◽

Susanne Treiber ◽

Jürgen Deckert ◽

Stefan Unterecker ◽

Leif Hommers

Keyword(s):

Blood Flow ◽

Renal Function ◽

Serum Concentration ◽

Drug Interactions ◽

Renal Blood Flow ◽

Serum Levels ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

And Function ◽

Bipolar Affective Disorders

Abstract Introduction Lithium is the gold standard in treating bipolar affective disorders. As patients become increasingly older, drug-drug interactions leading to decreased excretion of lithium represent a key issue in lithium safety. As no study considered the effect of comedications on lithium serum concentration in combination, we aimed to quantify the impact of drugs affecting renal blood flow and function and thus potentially interacting drugs (diuretics, ACE inhibitors, AT1 antagonists, and non-steroidal anti-inflammatory drugs) on lithium serum levels in addition to age, sex, and sodium and potassium serum levels as well as renal function. Methods Retrospective data of lithium serum levels were analyzed in 501 psychiatric inpatients (2008–2015) by means of linear regression modelling. Results The number of potentially interacting drugs was significantly associated with increasing serum levels of lithium in addition to the established factors of age, renal function, and sodium concentration. Additionally, absolute lithium levels were dependent on sex, with higher values in females. However, only NSAIDs were identified to increase lithium levels independently. Discussion Routine clinical practice needs to focus on drugs affecting renal blood flow and function, especially on NSAIDs as over-the-counter medication that may lead to an increase in lithium serum concentration. To prevent intoxications, clinicians should carefully monitor the comedications, and they should inform patients about possible intoxications due to NSAIDs.

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Pharmacological Studies on Drug Interaction. II. Drug Interactions of Nonsteroidal Anti-inflammatory Drugs on the Hypothermic Action, the Antipyretic Action and the Acute Toxidty

YAKUGAKU ZASSHI ◽

10.1248/yakushi1947.96.1_91 ◽

1976 ◽

Vol 96 (1) ◽

pp. 91-98

Author(s):

HIKARU OZAWA ◽

MAKOTO IKEDA ◽

YOSHIO TOYOGUCHI

Keyword(s):

Drug Interaction ◽

Drug Interactions ◽

Pharmacological Studies ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Antipyretic Action

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Shared Decision Making for Drug Interactions: Design and Usability of an Application for Warfarin and Non-steroidal Anti-inflammatory Drugs (Preprint)

10.2196/preprints.28618 ◽

2021 ◽

Author(s):

Thomas Reese ◽

Guilherme Del Fiol ◽

Keaton Morgan ◽

Jason T. Hurwitz ◽

Kensaku Kawamoto ◽

...

Keyword(s):

Decision Making ◽

Drug Interactions ◽

Shared Decision Making ◽

Critical Role ◽

Patient Specific ◽

Shared Decision ◽

System Usability Scale ◽

Life Threatening ◽

Inflammatory Drugs ◽

Anti Inflammatory

BACKGROUND Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and non-steroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a critical role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician-centric. OBJECTIVE To design and study the usability of DDInteract, a tool to support shared decision making (SDM) between a patient and provider for the DDI between warfarin and non-steroidal anti-inflammatory drugs. METHODS We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract – an SDM electronic health record (EHR) app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale. RESULTS The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. Four patients and eleven clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean (standard deviation) of 144 (74) seconds and rated the usability of DDInteract as 4.32 (0.52) out of 5. CONCLUSIONS This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology.

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