Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

摘要：本研究旨在分析某私人药品配送服务的老年使用者中非甾体抗炎药（NSAIDs）的潜在药物相互作用与不良反应。
研究方法：本研究采用前瞻性、探索性描述性研究设计，结合定量研究方法。于2014年5月至9月期间，对该服务接诊的老年非甾体抗炎药使用者进行访谈，并分析其处方。药物相互作用通过计算机化数据库开展分析；不良反应售后评估采用药物不良反应概率量表进行。统计学分析采用卡方检验与费希尔精确检验。
研究结果：本研究共纳入200名老年受试者，其中女性占比56.5%，为主要群体。受试者平均年龄为65±10岁。非甾体抗炎药占所用处方药物的38.7%，涵盖安乃近（26.9%）、尼美舒利（22.8%）与酮洛芬（16.3%）。总计8.5%的此类药物被判定为老年患者不适宜用药。共识别出104种潜在药物相互作用，其中24%被认为具有高度临床意义。相互作用风险最高的非甾体抗炎药依次为酮洛芬（46.2%）、酮咯酸（14.4%）、尼美舒利（12.5%）与双氯芬酸（9.6%）。售后监测显示，30.5%的老年受试者在使用非甾体抗炎药后报告了不良症状，其中胃部不适最为常见（17%）。
研究结论：本研究证实，鉴于老年群体因年龄增长、合并疾病、多重处方与多重用药导致的药物相互作用与不良反应风险升高，对老年人的非甾体抗炎药使用进行监测具备重要意义。为老年患者选择适宜药物、整合其所有服用药物，并提供有效的药学服务，可助力非甾体抗炎药的合理与安全使用。