Trends in prescribing gastroprotective agents with non steroidal anti-inflammatory drugs in an orthopaedic outpatient unit of a tertiary care hospital

Background: Non steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs prescribed the world over. However, they have many adverse effects, especially gastrointestinal toxicity, which is the reason for their frequent co-prescription with gastroprotective agents. Misoprostol has been specifically approved for prevention of NSAID-induced ulcers in high-risk patients. Proton pump inhibitors too have been used with outstanding efficacy for this indication. Aim: This drug utilization study was conducted to study the co-administration of NSAIDs with gastroprotective drugs in an Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital. Settings and Design: A prospective drug utilization study. Patients and Methods: This was a prospective study conducted in the Orthopaedic Outpatient Unit of an urban, tertiary care, teaching hospital, for six months. Prescriptions were collected from patients attending the Orthopaedic Outpatients Department. The co-prescription of NSAIDs with gastroprotective agents was analyzed. Results: A total of 1008 prescriptions were studied; 884 prescriptions contained NSAIDs, out of which 288 (32.58%) were co-prescribed with gastroprotective agents. The most common gastroprotective agents combined with NSAIDs were Proton pump inhibitors (81.19%). H₂ receptor blockers were a distant second (17.81%), while Misoprostol was not used at all. Conclusion: NSAIDs are commonly co-prescribed with gastroprotectives. Diclofenac is the most commonly co-prescribed NSAID, while Naproxen was least commonly co-prescribed with gastroprotectives. Proton pump inhibitors were most frequently used, while Misoprostol was not used at all, probably because of its higher costs, frequent side effects and the need for multiple daily dosing.