Paracetamol remains treatment of choice, say GI experts

November 07, 1999

November 8, 1999 - A clear picture of the true extent of gastrointestinal (GI) complications with over-the-counter (OTC) doses of non-steroidal anti-inflammatory drugs (NSAIDs) is not yet available, according to researchers who addressed healthcare professionals and international experts at a symposium held today in Sydney, Australia.

Dr Daniel Stiel, Clinical Associate Professor, University of Sydney, Australia told delegates at the 'Clinical Consensus - An International Update on Paracetamol' symposium that Australian hospital data indicated that there were as many as 2300 serious GI complications partially attributed to prescription NSAID use each year. The vast majority of people - around 81% - had no prior warnings.

"The increasing trend toward self medication raises questions about the potential for GI complications with OTC doses of NSAIDs. There is some data emerging which suggests that GI problems at prescription doses are less evident in OTC doses but there are also some confounding factors," said Dr Stiel. "The jury is still out. In the light of current knowledge, since paracetamol continues to enjoy a favourable side effect profile, it remains a first-line analgesic for every day pain."

Dr Gurkirpal Singh, Clinical Assistant Professor of Medicine, Division of Rheumatology and Immunology, Stanford University, California, USA, presented results from the ARAMIS database (Arthritis, Rheumatism and Ageing Medical Information System) on the GI risks of OTC doses of aspirin, ibuprofen, naproxen, paracetamol and no medication from 4164 consecutively diagnosed patients with rheumatoid arthritis from eight centres in North America.

The results showed the relative risk of OTC doses of NSAIDs was "clinically significant" (ie, a three to four fold increased risk of serious GI complications) and a matter of serious concern despite being less than the previously published risk of prescription doses.

"Paracetamol was not associated with increased risk of GI complications and should be considered first line therapy," said Dr Singh.
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