An increased risk of peptic ulcers should be considered when cholinesterase inhibitors (ChEIs) are prescribed to older adults who are using NSAIDs, a study shows. “Our findings suggest that physicians should consider deprescribing NSAIDs in chronic users if possible (e.g., for people without inflammatory arthropathies) who are starting ChEI treatment and instead consider alternative solutions,” the authors write. “Further, chronic ChEI users should refrain from starting NSAID treatment. Maybe, NSAIDs should be substituted with an alternative drug (e.g., paracetamol or acetaminophen for pain relief) to prevent unnecessary complications for individuals aged 65 years and older. We suggest including the ChEIs and NSAIDs drug–drug interaction in potentially inappropriate medication use criteria to raise awareness among prescribers.”
The register-based study of older adults was conducted in Sweden from 2007 to 2020. “Of 70,060 individuals initiating both ChEIs and NSAIDs, we identified 1,500 persons with peptic ulcer (median age at peptic ulcer 80 years), of whom 58% were females,” the authors write. “Compared with the non-treatment periods, the risk of peptic ulcer substantially increased for the combination of ChEIs and NSAIDs (IRR: 9.0, [6.8–11.8]), more than for NSAIDs alone (5.2, [4.4–6.0]). No increased risks were found for the use of ChEIs alone (1.0, [0.9–1.2]).”