Non-opioid analgesics are one of the most commonly used medicines, but their use can lead to several adverse effects. A higher risk for those may especially represent the use of non-steroid anti-inflammatory drugs (NSAIDs).
In the study, we have analyzed the use of non-opioid analgesics in internistic patients of University Clinic Golnik before hospital admission. Additionally, we have investigated the risk for adverse effects on digestive organs, kidneys, and cardiovascular system in patients with NSAIDs. Based on that, the safety of treatment with NSAIDs was assessed. The main sources of information were the hospital information system BIRPIS and conversations with the patients.
The study included 306 patients and 209 of them (68%) had been taking non-opioid analgesics. Most of the patients (62%) had prescription for non-opioid analgesics, but only 14% of them had been taking them regularly. The most often used drug was paracetamol (45%), followed by metamizole (15%) and naproxen (14%). In most cases, non-opioid analgesics have successfully relieved the pain. 92 patients (30%) had been taking NSAIDs, mainly obtained on prescription and taken as needed. We have estimated that 62% of patients in our study had moderate risk and 29% had high risk for the adverse effects of NSAIDs on digestive organs. Five patients with moderate risk had been using NSAIDs regularly without gastroprotective drug, which is not appropriate according to the guidelines. No one in the group of 29 patients with high risk for adverse effects on digestive organs had been taking NSAIDs appropriately, but only two of them had NSAIDs in regular therapy. Two patients with high risk for adverse effects on digestive organs and with naproxen in their therapy, had an active gastrointestinal tract ulcer, which is contraindicated to NSAIDs according to the guidelines. Regarding the risk for adverse effects on kidneys, we have noted only two patients with contradictions for NSAIDs. Both had been taking NSAIDs despite their age above 65 years and severely reduced kidney function (stage 4 or 5 of chronic kidney disease). Additionally, one of them was exposed to the risk of acute kidney failure due to the concurrent use of an angiotensin converting enzyme inhibitor with a diuretic and a NSAID. 4/15 patients (27%) with heart failure diagnosis had been taking problematic NSAIDs. High risk for cardiovascular adverse effects of NSAID has been determined in patients, who've had heart attack/stroke in the past or had been diagnosed with cardiovascular disease (43%), and patients, which had three or more risk factors for cardiovascular complications (38%).
Based on the results of this study we can conclude that the use of NSAIDs was suitable in most cases. Nevertheless, before the prescription of NSAID we recommend more attention to the patient’s risk factors for adverse effects.