A Descriptive Analysis of Potential Warfarin-NSAID Interactions in Dental Prescribing in Minas Gerais, Brazil,...

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is common in dentistry, mainly for pain and inflammation. However, their coadministration with warfarin may lead to serious potential drug-drug interactions (PDDIs), increasing the risk of bleeding. This study aimed to identify and describe the frequency of PDDIs between warfarin and NSAIDs prescribed by dentists and dispensed by the Unified Health System (SUS) in Minas Gerais, Brazil, from January 2011 to December 2021.

A descriptive analysis was conducted using data from Integrated Pharmaceutical Services Management System (Sigaf), considering prescriptions of warfarin and NSAIDs issued during the same period.

The prescribed NSAIDs were diclofenac sodium 50 mg, diclofenac potassium 50 mg, ibuprofen 600 mg, nimesulide 100 mg, and nimesulide 50 mg/mL oral suspension. Warfarin sodium 5 mg is the prescribed oral anticoagulants. The results showed a marked increase in both warfarin (from 6017 to 59,945 prescriptions; +896%) and NSAID use (from 2644 to 84,408 prescriptions; +3093%), paralleling the rise in PDDIs, which grew from 2 in 2011 to 62 in 2021. Despite this 3000% relative increase, the absolute frequency of PDDIs remained low, corresponding to approximately 0.7 interactions per 1000 NSAID prescriptions in 2021.

Although these PDDIs are low, they are clinically significant and may have important implications for patients and the healthcare system. In conclusion, PDDIs between NSAIDs and warfarin, though low in absolute numbers, have increased over the years, reinforcing the need for greater awareness among dental professionals and for the implementation of clinical decision support strategies to promote safe care.