Prescription of Nonsteroidal Anti-inflammatory Drugs and Co-prescribed Drugs for Mucosal Protection: Analysis of the Present Status Based on Questionnaires Obtained from Orthopedists in Japan
Open Access
- 1 January 2007
- journal article
- Published by Japanese Society of Internal Medicine in Internal Medicine
- Vol. 46 (13), 927-931
- https://doi.org/10.2169/internalmedicine.46.0003
Abstract
Objective Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events. Methods We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name, pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs. Results Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%). Conclusion Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics.Keywords
This publication has 15 references indexed in Scilit:
- Cyclooxygenase-2 inhibitors and cardiovascular riskCurrent Opinion in Cardiology, 2006
- Risk of Death or Reinfarction Associated With the Use of Selective Cyclooxygenase-2 Inhibitors and Nonselective Nonsteroidal Antiinflammatory Drugs After Acute Myocardial InfarctionCirculation, 2006
- Cardiovascular outcomes in new users of coxibs and nonsteroidal antiinflammatory drugs: High‐risk subgroups and time course of riskArthritis & Rheumatism, 2006
- National Adherence to Evidence-Based Guidelines for the Prescription of Nonsteroidal Anti-Inflammatory DrugsGastroenterology, 2005
- Gastroprotective Agent Rebamipide Induces Cyclooxygenase-2 (COX-2) in Gastric Epithelial CellsDigestive Diseases and Sciences, 2005
- Factors that Influence Prescribers in their Selection and use of COX-2 Selective Inhibitors as Opposed to Non-selective NSAIDs*International Journal of Clinical Pharmacy, 2005
- Update of ACR Guidelines for Osteoarthritis: Role of the CoxibsJournal of Pain and Symptom Management, 2002
- ABC of the upper gastrointestinal tract: Indigestion and non-steroidal anti-inflammatory drugsBMJ, 2001
- IntroductionAmerican Journal Of Medicine, 2001
- Risk for Serious Gastrointestinal Complications Related to Use of Nonsteroidal Anti-inflammatory DrugsAnnals of Internal Medicine, 1991