Choice of non-steroidal anti-inflammatory drug in persons treated for dyspepsia

Prior use of analgesics among 1327 new users of cimetidine over the age of 65 at Group Health Cooperative of Puget Sound was much more common than among 5308 members of similar age and sex who had never taken cimetidine. The excess included not only most non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin, but also extended to paracetamol. New users of cimetidine who had not received analgesics in the preceding 2 years were preferentially given recently introduced NSAIDs if an NSAID was subsequently prescribed. Review of prior studies of analgesic use and ulcer diseases reveals a regular association between ulcer and preceding use of paracetamol, a drug for which no causal association to ulcer is thought to exist. General increases in use of analgesics by elderly dyspeptic patients may have given rise to artefact in reported associations between manifestations of ulcer disease and NSAIDs.