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Many Patients Don't Report Use of OTC Pain Drugs
Date:10/15/2007

Aspirin, ibuprofen and similar medicines pose big stomach risks, study notes

MONDAY, Oct. 15 (HealthDay News) -- Large numbers of patients don't tell their doctors that they take common over-the-counter painkillers, such as aspirin and ibuprofen, a potentially dangerous omission, a new study has found.

"With nearly one out of five patients underreporting their medicine intake, it is no wonder that adverse events are increasing yearly," said study lead author Dr. Raj T. Majithia, an internist at Eastern Virginia Medical School. "It is important that patients report all medications that they take."

An estimated 30 million Americans take so-called non-steroidal anti-inflammatory drugs (NSAIDs) each day, and many have no adverse effects. But in people with gastrointestinal problems, the painkillers can worsen indigestion, upset stomachs and peptic ulcer disease. With prolonged use, they can also cause bleeding or liver problems.

The problem can be particularly worrisome for people with arthritic conditions. More than 14 million such patients consume NSAIDs regularly. Up to 60 percent will have gastrointestinal side effects related to these drugs, and more than 10 percent will stop taking recommended medications because of troublesome gastrointestinal symptoms, the researchers said.

In the new study, Majithia and a colleague gave questionnaires to 100 patients at a private gastrointestinal practice. The surveys asked about the medications the patients were taking. Then the patients were asked whether they took any of 30 drugs that contain the painkillers in question.

Eighteen percent of the patients reported taking a painkiller that they hadn't mentioned to their nurse. Of those, eight percent said they took the drugs once a day, 15 percent once a week and the rest within the past month.

Of those who didn't report their medication use, 14 percent said they were never asked about it, and 22 percent said they thought the drugs weren't important enough to list. About one-third said they didn't mention their medication, because their doctor didn't prescribe the drugs.

The study findings, which have not yet been peer reviewed, were to be presented Monday at the American College of Gastroenterology annual meeting, in Philadelphia.

Majithia said that if patients don't report use of the painkillers to their gastroenterologists, they could put themselves at risk for a variety of complications, including gastrointestinal, kidney, heart and neurological problems.

"While some of these adverse effects are rare, physicians can better treat and expect such problems if they are aware of their patients' medications," he said.

Majithia also said doctors "need better methods of asking patients about their medications." One way might be for physicians to emphasize that patients mention all drugs, including herbal and over-the-counter medications, he said.

In another study to be released Monday at the gastroenterology meeting, researchers found that the Veterans Administration system would save money if it were to adopt a specific drug treatment for patients at risk of developing stomach ulcers because they've taken painkillers like aspirin, ibuprofen or coxibs (like Celebrex) for long periods of time.

Gastrointestinal bleeding, which can be caused by ulcers that perforate the stomach wall, occurs in an estimated 4.5 percent of patients who take these painkillers over the long term. The elderly are at especially high risk.

Previous research has shown that the risk of bleeding can be reduced if patients take a proton pump inhibitor, which limits production of stomach acid, as a preventive measure. Proton pump inhibitors include widely advertised drugs such as Nexium and Prilosec.

In the new study, researchers found that it's cost-effective to prescribe the proton pump inhibitors as a preventative.

"The bottom line was the reduction in medical costs outweighs the increase in pharmacy-related costs," said study senior author Dr. Neena S. Abraham, assistant professor of medicine at Baylor College of Medicine in Houston.

More information

Learn more about non-steroidal anti-inflammatory drugs from the American Academy of Orthopaedic Surgeons.



SOURCES: Raj T. Majithia, M.D., internist, Eastern Virginia Medical School, Norfolk; Neena S. Abraham, M.D., assistant professor, medicine, Baylor College of Medicine, Houston; Oct. 15, 2007, presentation, American College of Gastroenterology annual meeting, Philadelphia


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