OTC analgesic consumption by coxib users

Patients at increased risk of gastrointestinal complications are often prescribed a COX-2 selective NSAID and advised to avoid non-selective agents. However, people with arthritis often self-medicate with an OTC analgesic to treat breakthrough pain and, because non-COX selective NSAIDs are freely available without prescription, they may unwittingly be exposing themselves to risk.

Outside the realms of clinical trials, little is known about the scale of this potential problem. Now a US study has revealed the extent to which patients taking a COX-2 selective NSAID also use OTC NSAIDs - and the figure for OTC ibuprofen is reassuringly low (Cox E et al. Arch Intern Med 2004;164:1243-6).

The telephone survey of 324 adults taking rofecoxib or celecoxib showed that three-quarters had taken an OTC analgesic on at least one day during the previous month. Forty-eight percent of respondents took aspirin, virtually all for cardioprotection; paracetamol use was reported by 43 percent, and ibuprofen and naproxen use by 7 and 3 percent respectively.

However, a substantial group of respondents reported more frequent use of analgesics. In the previous month, a quarter had taken two or more OTC drugs and just over half had used an OTC analgesic on at least 15 days. Aspirin was still the most widely used drug by far (45 percent), with frequent ibuprofen use reported by 2 percent of respondents.

These findings indicate a low level of self-medication with NSAIDs among people prescribed a COX-2 selective agent. Instead, the risk from the widespread use of low-dose aspirin is probably more important.

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