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Gastrointestinal (GI) and kidney toxicity due to use of nonsteroidal antiinflammatory drugs (NSAIDs) has been widely reported. Most susceptible to toxicity are the elderly, patients with a history of GI bleeding or hypertension, and individuals who are taking more than one NSAID. Although published guidelines recommend periodic complete blood cell (CBC) count and creatinine laboratory monitoring (high levels of urinary creatinine indicate kidney problems) of patients taking NSAIDs for an extended time, many physicians don't follow the guidelines.
According to a recent study by researchers at the University of Alabama, only two-thirds of chronic NSAID users in a regional managed care organization examined in the study received CBC and creatinine monitoring. Only one-third received GI cytoprotective agents, and about one-fourth had at least one prescribed period when they were simultaneously taking another NSAID (NSAID overlap). The study was supported in part by the Agency for Healthcare Research and Quality (HS10389) through the Centers for Education and Research on Therapeutics (CERTs) program.
Patients on NSAIDs who saw their physicians more frequently, had used NSAIDs longer (associated with increased risk of kidney disease), or had hypertension or a history of GI bleeding were more likely to be monitored. However, visit frequency, more than provider or patient factors, prominently influenced NSAID safety practices. Physicians should see chronic NSAID users at least intermittently as a means to trigger discussion and possible testing for potential drug toxicity, according to researchers from the University of Alabama CERT. They linked data from medical charts, pharmacy claims, and administrative files on 373 frequent NSAID users (three or more consecutive NSAID prescriptions and 1 month or more of continuous NSAID use) and examined CBC testing, use of GI cytoprotective agents, and lack of NSAID overlap.
See "Nonsteroidal antiinflammatory drug toxicity monitoring and safety practices," by Fausto G. Patino, M.D., Dr.P.H., Jason Olivieri, M.P.H., Jeroan J. Allison, M.D., M.Sc., and others, in the Journal of Rheumatology 30(12), pp. 2680-2688, 2003.
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