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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Review Article

Prescribing Pattern of Non-steroidal Anti-inflammatory Drugs (NSAIDs) in the Middle East Region: A Critical Review

Author(s): Omar Yahya Al-Shargi*

Volume 19, Issue 1, 2024

Published on: 22 March, 2023

Page: [11 - 18] Pages: 8

DOI: 10.2174/1574886318666230220140810

Price: $65

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Abstract

Background: There exists a paucity of data on pharmacoepidemiologic and drug utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) in the Middle East region.

Objective: The objective of this study was to provide a critical appraisal of the prescription patterns of NSAIDs in the Middle East region.

Methods: A literature search was conducted on the electronic databases such as MEDLINE, Google Scholar, and ScienceDirect for studies conducted on prescription pattern of NSAIDs using the keywords “Non-steroidal Anti-inflammatory Drugs”, “NSAIDs”, “Non-opioid Analgesics”, “Antipyretics”, “Prescription Pattern”, “Drug Use indicators”, “Drug Utilization Pattern”, “Pharmacoepidemiology”. The search was conducted within 5 months, from January to May 2021.

Results: Studies from twelve Middle Eastern countries were analyzed and critically discussed. The findings indicated widespread and clinically significant inappropriate prescribing in all Middle East countries and territories. Furthermore, NSAIDs prescription pattern in the region extensively varies with healthcare settings, patient’s age, patient’s medical presentation, history of comorbid conditions, insurance type, and prescribers’ specialization and years of experience, among several other factors.

Conclusion: Low-quality prescribing based on indicators of the World Health Organization/ International Network of Rational Use of Drugs suggests the need to further improve the current drug utilization trend in the region.

Graphical Abstract

[1]
Turman M, Marnett E. Prostaglandin endoperoxide synthases. In: Comprehensive Natural Products II. Elsevier: Amsterdam, 2010; 35-63.
[2]
Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol 2011; 31(5): 986-1000.
[http://dx.doi.org/10.1161/ATVBAHA.110.207449] [PMID: 21508345]
[3]
Frölich JC. A classification of NSAIDs according to the relative inhibition of cyclooxygenase isoenzymes. Trends Pharmacol Sci 1997; 18(1): 30-4.
[http://dx.doi.org/10.1016/S0165-6147(96)01017-6] [PMID: 9114728]
[4]
Gudis K, Sakamoto C. The role of cyclooxygenase in gastric mucosal protection. Dig Dis Sci 2005; 50 (Suppl. 1): S16-23.
[http://dx.doi.org/10.1007/s10620-005-2802-7] [PMID: 16184416]
[5]
Scott LJ. Intravenous Ibuprofen. Drugs 2012; 72(8): 1099-109.
[http://dx.doi.org/10.2165/11209470-000000000-00000] [PMID: 22621696]
[6]
Tolba R. Nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment of Chronic Pain Conditions: A Comprehensive Handbook. Springer 2017; pp. 77-9.
[7]
Moore N, Duong M, Gulmez SE, Blin P, Droz C. Pharmacoepidemiology of non-steroidal anti-inflammatory drugs. Therapie 2019; 74(2): 271-7.
[http://dx.doi.org/10.1016/j.therap.2018.11.002] [PMID: 30477749]
[8]
Lee MC, Abrahams M. Pain and analgesics. In: Clinical Pharmacology. 11th ed. Elsevier Inc: Amsterdam, 2012; 278-94.
[http://dx.doi.org/10.1016/B978-0-7020-4084-9.00057-4]
[9]
Cron RQ, Weiser P, Beukelman T. Juvenile idiopathic arthritis. Clinical Immunology: Principles and Practice. (4th Ed..). Elsevier Inc. 2013; pp. 637-47.
[http://dx.doi.org/10.1016/B978-0-7234-3691-1.00066-0]
[10]
Marjoribanks J, Proctor ML, Farquhar C. Nonsteroidal anti-inflammatory drugs for primary dysmenorrhoea. Cochrane Database Syst Rev 2003; (4): CD001751.
[PMID: 14583938]
[11]
Marjoribanks J, Proctor M, Farquhar C, et al. Nonsteroidal antiinflammatory drugs for dysmenorrhoea. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd.: New York, 2010.
[http://dx.doi.org/10.1002/14651858.CD001751.pub2]
[12]
Aronoff DM, Neilson EG. Antipyretics: Mechanisms of action and clinical use in fever suppression. Am J Med 2001; 111(4): 304-15.
[http://dx.doi.org/10.1016/S0002-9343(01)00834-8] [PMID: 11566461]
[13]
Lee JJ, Simmons DL. Antipyretic therapy: Clinical pharmacology. In: Handbook of clinical neurology. Elsevier: Amsterdam 2018; 869-81.
[14]
Sivanandan S, Agarwal R. Pharmacological closure of patent ductus arteriosus: Selecting the agent and route of administration. Paediatr Drugs 2016; 18(2): 123-38.
[http://dx.doi.org/10.1007/s40272-016-0165-5] [PMID: 26951240]
[15]
Irmesi R, Marcialis MA, Anker JVD, Fanos V. Non-steroidal anti-inflammatory drugs (NSAIDs) in the management of patent ductus arteriosus (PDA) in preterm infants and variations in attitude in clinical practice: A flight around the world. Curr Med Chem 2014; 21(27): 3132-52.
[http://dx.doi.org/10.2174/0929867321666140304095434] [PMID: 24606507]
[16]
Gaynes BI, Fiscella R. Topical nonsteroidal anti-inflammatory drugs for ophthalmic use: A safety review. Drug Saf 2002; 25(4): 233-50.
[http://dx.doi.org/10.2165/00002018-200225040-00002] [PMID: 11994027]
[17]
Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol 2010; 55(2): 108-33.
[http://dx.doi.org/10.1016/j.survophthal.2009.07.005] [PMID: 20159228]
[18]
Nichols J, Snyder RW. Topical nonsteroidal anti-inflammatory agents in ophthalmology. Curr Opin Ophthalmol 1998; 9(4): 40-4.
[http://dx.doi.org/10.1097/00055735-199808000-00007] [PMID: 10387467]
[19]
Zhao X, Xu Z, Li H. NSAIDs use and reduced metastasis in cancer patients: Results from a meta-analysis. Sci Rep 2017; 7: 1-7.
[20]
Facciorusso A, Di Maso M, Serviddio G, Larghi A, Costamagna G, Muscatiello N. Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma. J Gastroenterol Hepatol 2017; 32(2): 439-45.
[http://dx.doi.org/10.1111/jgh.13478] [PMID: 27356212]
[21]
Waddell WR, Loughry RW. Sulindac for polyposis of the colon. J Surg Oncol 1983; 24(1): 83-7.
[http://dx.doi.org/10.1002/jso.2930240119] [PMID: 6887943]
[22]
Gurpinar E, Grizzle WE, Piazza GA. NSAIDs inhibit tumorigenesis, but how? Clin Cancer Res 2014; 20(5): 1104-13.
[http://dx.doi.org/10.1158/1078-0432.CCR-13-1573] [PMID: 24311630]
[23]
Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2010; 24(2): 121-32.
[http://dx.doi.org/10.1016/j.bpg.2009.11.005] [PMID: 20227026]
[24]
Ofori-Asenso R, Adom AA. Irrational use of medicines- a summary of key concepts. Pharmacy 2016; 4(4): 35.
[http://dx.doi.org/10.3390/pharmacy4040035]
[25]
Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug–related morbidity and mortality. Ann Pharmacother 2018; 52(9): 829-37.
[http://dx.doi.org/10.1177/1060028018765159] [PMID: 29577766]
[26]
World Health Organization. Medication safety in polypharmacy: Technical report. 2019. Available from: https://www.who.int/publications/i/item/medication-safety-in-polypharmacy-technical-report
[27]
Akl OA, El Mahalli AA, Elkahky AA, Salem AM. WHO/INRUD drug use indicators at primary healthcare centers in Alexandria, Egypt. J Taibah Univ Med Sci 2014; 9(1): 54-64.
[http://dx.doi.org/10.1016/j.jtumed.2013.06.002]
[28]
El Mahalli AA. WHO/INRUD drug prescribing indicators at primary health care centres in Eastern province, Saudi Arabia. East Mediterr Health J 2012; 18(11): 1091-6.
[http://dx.doi.org/10.26719/2012.18.11.1091] [PMID: 23301369]
[29]
Qasrawi H, Assi S, Ghanim N, et al. A descriptive study of pain relief practices among student-athletes in palestine: Focus on non-steroidal anti-inflammatory drugs, and complementary medicine and alternative medicine use. J Community Health 2020; 1-9.
[PMID: 33067717]
[30]
Tayem YI, Qubaja MM, Shraim RK, Taha OB, Shkheidem IAA, Ibrahim MA. Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a central west bank hospital. Sultan Qaboos Univ Med J 2013; 13(4): 567-73.
[http://dx.doi.org/10.12816/0003317] [PMID: 24273668]
[31]
Khdour M, Hallak H, Hejaz H, Shaeen M, Dweib M. Patterns of NSAIDs use in Palestinian mid-territories: A prospective study of ambulatory patients in outpatient pharmacies. Curr Clin Pharmacol 2014; 9(1): 10-6.
[http://dx.doi.org/10.2174/157488470901140212145952] [PMID: 23343016]
[32]
Ali IZ. Hamzeh Al, Nisreen DR. Knowledge, attitudes and current practices of palestinian internists toward aspirin prescription title. Univ Toronto Med J 2019; 96: 14-6.
[33]
Al-Shidhani A, Al-Rawahi N, Al-Rawahi A, Sathiya Murthi P. Non-steroidal anti-inflammatory drugs (NSAIDs) use in primary health care centers in A’Seeb, Muscat: A clinical audit. Oman Med J 2015; 30(5): 366-71.
[http://dx.doi.org/10.5001/omj.2015.73] [PMID: 26421118]
[34]
Al-Azayzih A, Al-Azzam SI, Alzoubi KH, et al. Nonsteroidal anti-inflammatory drugs utilization patterns and risk of adverse events due to drug-drug interactions among elderly patients: A study from Jordan. Saudi Pharm J 2020; 28(4): 504-8.
[http://dx.doi.org/10.1016/j.jsps.2020.03.001] [PMID: 32273811]
[35]
Otoom S, Batieha A, Hadidi H, et al. Evaluation of drug use in Jordan using WHO prescribing indicators. EMHJ-Eastern Mediterr Health J 2002; 8(4-5): 537-43.
[36]
Awad A, Al-Saffar N. Evaluation of drug use practices at primary healthcare centers of Kuwait. Eur J Clin Pharmacol 2010; 66(12): 1247-55.
[http://dx.doi.org/10.1007/s00228-010-0872-8] [PMID: 20669012]
[37]
Abd ElHafeez S, Hegazy R, Naga Y, Wahdan I, Sallam S. Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: An epidemiological study. J Egypt Public Health Assoc 2019; 94(1): 8.
[http://dx.doi.org/10.1186/s42506-018-0005-2] [PMID: 30799879]
[38]
Al-Taie A, Hussein AN, Albasry Z. Prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) among community patients with musculoskeletal and co-morbid conditions: A crosssectional study from an Iraqi province. Trop J Pharm Res 2021; 20(1): 203-10.
[http://dx.doi.org/10.4314/tjpr.v20i1.29]
[39]
Taherzadeh Z, Zeinali M, Tabeshpour J, et al. Prescription pattern analysis of nonsteroidal anti-inflammatory drugs in the northeastern Iranian population. J Res Pharm Pract 2017; 6(4): 206-10.
[http://dx.doi.org/10.4103/jrpp.JRPP_17_45] [PMID: 29417079]
[40]
Kamel Escalante MC, Abbas A, Farah A, et al. Prescription patterns of analgesics, antipyretics, and non steroidal anti-inflammatory drugs for the management of fever and pain in pediatric patients: A cross-sectional, multicenter study in Latin America, Africa, and the Middle East. Pragmat Obs Res 2019; 10: 41-51.
[http://dx.doi.org/10.2147/POR.S168140] [PMID: 31616200]
[41]
Türedi Ö, Aypak C, Solmaz N, Yıkılkan H, Görpelioğlu S. Concurrent prescription rate of non-steroidal anti-inflammatory drugs with antihypertensive agents. J Clin Pharmacol 2014; 54(3): 358-9.
[http://dx.doi.org/10.1002/jcph.188] [PMID: 24123149]
[42]
Kartal M, Maral I, Coskun O. Prescribing pattern of general practitioners for osteoarthritis in primary care settings in Bolu, Turkey. Saudi Med J 2007; 28(12): 1885-9.
[PMID: 18060222]
[43]
Sharif SI, Al-Shaqra M, Hajjar H, Shamout A, Wess L. Patterns of drug prescribing in a hospital in Dubai, United Arab Emirates. Libyan J Med 2008; 3(1): 10-2.
[http://dx.doi.org/10.3402/ljm.v3i1.4744] [PMID: 21516163]
[44]
Yezli S, Zaraa S, Yassin Y, Mushi A, Stergachis A, Khan A. Medication utilization pattern among outpatients during the Hajj mass gathering. Saudi Pharm J 2020; 28(9): 1122-8.
[http://dx.doi.org/10.1016/j.jsps.2020.07.014] [PMID: 32922144]
[45]
Irshaid YM, Al-Homrany MA, Hamdi AA, Adjepon-Yamoah KK, Mahfouz AA. A pharmacoepidemiological study of prescription pattern in outpatient clinics in Southwestern Saudi Arabia. Saudi Med J 2004; 25(12): 1864-70.
[PMID: 15711656]
[46]
Mousavi S, Tabrizian K, Afshari A, Ashrafi MH, Dirin MM. Potential drug-drug interactions in prescriptions dispensed in community and hospital pharmacies in East of Iran. J Res Pharm Pract 2014; 3(3): 104-7.
[http://dx.doi.org/10.4103/2279-042X.141118] [PMID: 25328901]
[47]
Ghadimi H, Esmaily HM, Wahlstrom R. General practitioners’ prescribing patterns for the elderly in a province of Iran. Pharmacoepidemiol Drug Saf 2011; 20(5): 482-7.
[http://dx.doi.org/10.1002/pds.2106] [PMID: 21523850]
[48]
Al Khaja KAJ, Veeramuthu S, Isa HA, Sequeira RP. Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care. Int J Risk Saf Med 2017; 29(1-2): 57-68.
[http://dx.doi.org/10.3233/JRS-170742] [PMID: 28885223]
[49]
Alhmoud E, Khalifa S, Bahi AA. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. Int J Clin Pharm 2015; 37(5): 815-21.
[http://dx.doi.org/10.1007/s11096-015-0125-0] [PMID: 25986290]
[50]
Ali MD, Ahmad A. A retrospective study on prescribing pattern and cost analysis of proton-pump inhibitors used among adults of Saudi Arabia. J Pharm Health Serv Res 2020; 11(4): 343-7.
[http://dx.doi.org/10.1111/jphs.12369]
[51]
Aging and Geriatric Urology – Clinical Key. Available from: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323546 423001294 (Accessed on: 2 March 2022).
[52]
Mazhar F, Haider N, Sultana J, Akram S, Ahmed Y. Prospective study of NSAIDs prescribing in Saudi Arabia: Cardiovascular and gastrointestinal risk in patients with diabetes mellitus. Int J Clin Pharmacol Ther 2018; 56(2): 64-71.
[http://dx.doi.org/10.5414/CP203071] [PMID: 29208206]
[53]
Hogerzeil HV. Promoting rational prescribing: An international perspective. Br J Clin Pharmacol 1995; 39(1): 1-6.
[http://dx.doi.org/10.1111/j.1365-2125.1995.tb04402.x] [PMID: 7756093]

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