Anti-inflammatories source of avoidable harm and costs, study suggests

People with conditions such as heart failure and peptic ulcers are at risk of “avoidable harm” due to being prescribed common drugs such as naproxen, a study has suggested.

The estimated cost to the NHS of prescribing those at risk of complications from non-steroidal anti-inflammatory drugs (NSAIDs) is £31 million over a decade, researchers said.

NSAIDs, like ibuprofen and naproxen, are often used to provide relief from headaches, sprains, painful periods or conditions such as arthritis, which can cause long-term pain.

They are available as tablets, capsules, suppositories, creams, gels and injections.

While many people can take the drugs safely, some are at risk of side-effects such as stomach ulcers, headaches and dizziness, and in rare instances, problems with the kidneys or liver, heart attacks, and stroke.

However, medics prescribing them to people at risk of complications is “still common”, according to a study published in The BMJ.

Using data from previous research on prescribing safety in England , the study focused on five groups at a high risk of side-effects from NSAIDs.

These included people on blood thinners, those with heart failure or chronic kidney disease, people with a history of peptic ulcers, and people over the age of 65 who were not on medication to suppress the secretion of gastric acid, known as gastroprotection.

Using economic models, researchers suggest “problematic NSAID prescribing” could cost NHS England an estimated £31.4 million over 10 years, as well as leading to lost years of good health for patients.

The greatest impact was found among patients on blood thinners, costing £25.4 million, while the most common was among older people with no gastroprotection, costing £2.5 million.

Researchers said: “NSAIDs continue to be a source of avoidable harm and healthcare cost in these five high risk populations, especially in inducing an acute event in people with chronic condition and people taking oral anticoagulants.”

Primary care prescribing of NSAIDs in England fell by about 12% between 2017 and 2022, researchers said.

In 2022, naproxen – which reduces swelling and pain in the joints and muscles – accounted for 69% of NSAID prescriptions, they added.

Prescriptions of COX-2 inhibitors – which treat the pain of arthritis – increased, although NSAID prescriptions for patients with heart risks declined during the year, according to the study.

An NHS spokesperson said: “Prescribers have been acting to reduce NHS prescribing of NSAIDs in England and this has fallen by more than one in 10, over a five-year period.

“The nationally supported strategy is now focused on optimising medicines use in the NHS, including reducing the use of potentially addictive drugs such as opioid and sleeping pills.

“There is more to do so it is vital that patients and healthcare professionals discuss whether to continue, reduce or stop taking a medicine and consider non-pharmaceutical alternatives that could be more beneficial to ensure prescribing is appropriate and makes best use of taxpayers’ money.”