Drug switching patterns among patients taking non‐steroidal anti‐inflammatory drugs: a retrospective cohort study of a general practitioners database in the United Kingdom

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Abstract
Objective: To examine the frequency and determinants of switching between different non‐steroidal anti‐inflammatory drugs (NSAIDs) and the relationship with co‐prescription of gastro‐protective drugs (GPDs).Design: This was an analysis of 30 654 patients receiving a total of 209 140 NSAID prescriptions in the UK from 1 January 1997 to 31 December1998 identified through the MediPlus database. Analyses examined switching, repeat, termination and GPD co‐prescription rates in new and continuing takers according to age and sex.Results: Each patient received an average of 6.8 prescriptions in the year of study. Of the prescriptions 72.2% were for one of three NSAIDs, ibuprofen, diclofenac, or naproxen, and 7.2% of prescriptions were for fixed combination products of an NSAID plus a gastroprotective drug. At least 16.0% of continuing takers, and 28.5% of new takers switched to another NSAID in the review period. On average, new patients switched more frequently than continuing patients (0.39 switches/patient/year versus 0.23 switches/patient/year, pp<0.05). Switching was associated with a 24% and 33% increased probability of GPD prescription in new and continuing takers, respectively.Discussion: The frequency of switching, and of GPD co‐prescription at switching, suggest that dissatisfaction with NSAIDs is frequent, and that gastrointestinal intolerance is a common feature of this dissatisfaction. Copyright © 2001 John Wiley & Sons, Ltd.