Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used drugs. In Catalonia (Spain), this group of drugs is the fourth most used group in the number of packages dispensed in recent years. Furthermore, new NSAIDs have recently become available on the Spanish pharmaceutical market.
Objectives To study the evolution in the use of NSAIDs in the province of Tarragona (Catalonia, Spain), with 450,000 inhabitants, during the period between 1991 and 2000. We also studied the commercial impact of the new marketed drugs in recent years.
Methods Data of all NSAIDs prescribed and dispensed in the Public Health System during the period of the study were obtained from the Catalonian Pharmacy Database. These data were converted into Defined Daily Doses (DDD) per 1,000 inhabitants per day (DHD), according the definition of the Nordisk Council of Medicine. Population of the province was obtained from the official census of various years.
Results The total amount of NSAIDs used has increased in these ten years from 24.12 to 42.54 DHD. Throughout the ten years period diclofenac, piroxicam, naproxen, ibuprofen, aceclofenac and indomethacin were the most used NSAIDs. The use of ibuprofen increased greatly and in the last year was the second most used drug in the group. Diclofenac and naproxen were used a lot throughout the period and even increased in the last years. Piroxicam and indomethacin decreased slightly over the period studied.
The use of new NSAIDs (dexketoprofen, nimesulide, celecoxib, lornoxicam and particularly meloxicam and rofecoxib) increased considerably. Rofecoxib was the fourth most used drug in the group in its first year on the market. New NSAIDs are more than 20% of the total NSAIDs used in the year 2000. Since the new NSAIDs have become available, other minoritary drugs such as ketoprofen, flurbiprofen or tenoxicam have been used much less.
Conclusion Despite the considerable number of NSAIDs available in Spain, only ten represent almost 95% of the total NSAIDs used in the year 2000. Concerns about a possible overprescription of these drugs are reflected in the increase of use between 1991 and 2000. Data from the last year show that more than 40 people out of every 1,000 daily use a NSAID. The increase in the use of ibuprofen is noticeable but the new NSAIDs have had a commercial impact that was both considerable and fast. We conclude that aggressive advertising by pharmaceutical companies greatly influences the use and the selection of these drugs.
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Llop C, Paredes S, Llor C. Criteria for selecting and using non-steroidal anti-inflammatory drugs in primary health care. Fam Practice 2000;17:63–5
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