15% of NSAIDs’ users exceed maximum recommended dosage

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Chances are you or someone you know has used non-steroidal anti-inflammatory drugs (NSAIDs) within the last month. NSAIDs, such as Advil (ibuprofen), Aleve (naproxen) and Celebrex, are among the most commonly used medicines in the US. These drugs can have serious side effects, including GI bleeding and sometimes heart attacks, and are often taken without medical oversight because many are available over-the-counter.

Now, for the first time, researchers have found that 15% of adult ibuprofen users exceed the maximum recommended dose of ibuprofen or other NSAIDs in a one-week period. Exceeding the daily limit often followed taking too much of a single NSAID at one time, taking two different NSAIDs at the same time, or failing to wait long enough before taking another dose.

“It is important to understand how many users exceed the maximum, how they do it and what characteristics are associated with over-use. This knowledge can help guide consumer interventions to promote safer use,” explained lead author Dr David Kaufman, director of Boston University’s Slone Epidemiology Centre and professor of epidemiology at Boston University School of Public Health.

The study was a collaborative effort of Slone, Pinney Associates (Pittsburgh, PA), and Appleseed Consumer Insight (Arlington, MA), co-directed by Kaufman and Dr Saul Shiffman, senior scientific advisor to Pinney Associates.

Approximately 1,300 individuals who reported taking an ibuprofen medication in the preceding month completed a daily diary of their NSAID use for one week, and took ibuprofen during that time. The researchers then were able to compute their ingested daily dosage and compare it with the recommended daily maximum dose.

Those who exceed the recommended dosage tend to have a combination of medical factors such as chronic pain and poor physical state, attitudes conducive to ignoring the label recommendations, and poor knowledge of those recommendations. The authors suggest that attitudes and knowledge, along with specific dosing behaviour and compliance with label directions, are potentially modifiable, which could lead to safer use of NSAIDs.

Abstract
Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective and very commonly used, but also have side effects. We determined prevalence of NSAID dosing exceeding the daily limit (EDL) and identified related user characteristics and dosing patterns among current ibuprofen users.
Methods: Online 1-week diary study of 1326 ibuprofen users. NSAIDs were identified by list-based prompting; respondents were not required to know their medications were NSAIDs. Details of hourly use were recorded by respondents daily. Deviations from dosing directions were programmatically determined afterwards. An exit survey obtained information on demographics, medical history, physical and mental health status, attitudes regarding label reading and dosing behavior, and knowledge of product label instructions.
Results: Most diary users (90%) took over-the-counter ibuprofen during the week; 37% also took non-ibuprofen NSAIDs. Most did not recognize all products taken as NSAIDs. EDL occurred among 11% of users for ibuprofen, 4% of users for other NSAIDs, and on 9.1% of NSAID usage days. EDL was associated with deviations from detailed dosing directions, particularly exceeding the 1-time dose, which occurred more often with medications with 1-pill doses. Personal characteristics associated with EDL included male sex, ongoing pain, poor physical function, daily smoking, having the attitudes of “choosing my own dose” and not starting with the lowest dose, and poor knowledge of the recommended 1-time and 24-hour doses.
Conclusions: The prevalence of EDL among NSAID users is nontrivial, and it is associated with potentially modifiable factors. Educating consumers about NSAIDs and their dosing directions could reduce excess dosing.

Authors
David W Kaufman, Judith P Kelly, Deena R Battista, Mary Kathryn Malone, Rachel B Weinstein, Saul Shiffman

Boston University School of Medicine material
Pharmacoepidemiology and Drug Safety abstract


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