title: Co-prescription of gastroprotective agents in patients taking non-selective NSAIDs or COX-2 selective inhibitors: analysis of prescriptions.
abstract: OBJECTIVE
  To evaluate the prevalence of co-prescription of GPAs (proton pump inhibitors - PPIs and H2-receptor antagonists) and non-selective NSAIDs or COXIBs in patients registered under the local health authority (LHA) of Bergamo, a city in the north of Italy.
  
  
  METHODS
  A drug utilization analysis was done using the Bergamo prescription Health Services Electronic Database. All patients aged 35 years or older who had received at least one prescription during 2004 for non-selective NSAIDs and/or COXIBs were divided into three groups: occasional, chronic and new users.
  
  
  RESULTS
  Among chronic users, 44.8% were treated with non-selective NSAIDs, 11.6% with COXIBs, and 43.6% with both (mixed NSAIDs). For new users, non-selective NSAIDs were prescribed to 82.7%, COXIBs and mixed NSAIDs to 10.8% and 6.5%. PPIs were co-prescribed to 7.1% of COXIB users and 5.8% of non-selective NSAID occasional users. Among chronic users, the figures were 15.6% and 14%. For new users, prescriptions for COXIBs were associated with less use of GPA for patients who received the first and last prescription for NSAIDs and GPAs on the same day, while for patients who became chronic users COXIBs did not reduce the probability of co-prescription of a GPA: the number of co-prescribed medications and antithrombotics or corticosteroids were independent predictors of GPA use.
  
  
  CONCLUSIONS
  COXIBs seem to be used in patients at high risk of GI toxicity. However, the fear of GI adverse reactions and the uncertain safety profile of COXIBs leads many physicians to boost the gastroprotection by prescribing a PPI.
authors.affiliation: Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy. pasina@marionegri.it
authors.forename: L
authors.initials: L
authors.lastname: Pasina
authors.forename: A
authors.initials: A
authors.lastname: Nobili
authors.forename: M
authors.initials: M
authors.lastname: Tettamanti
authors.forename: E
authors.initials: E
authors.lastname: Riva
authors.forename: U
authors.initials: U
authors.lastname: Lucca
authors.forename: R
authors.initials: R
authors.lastname: Piccinelli
authors.forename: L
authors.initials: L
authors.lastname: Defendi
authors.forename: L
authors.initials: L
authors.lastname: Perego
authors.forename: S
authors.initials: S
authors.lastname: Lucifora
authors.forename: C
authors.initials: C
authors.lastname: Bulla
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors