Analgesic and adjuvant co-prescribing in Australian and Finnish nursing homes

Objective To explore the co-prescribing of analgesic and/or adjuvant medications among residents of Australian and Finnish nursing homes. Method Secondary cross-sectional analyses of prescribing data from residents of 12 Australian nursing homes in 2019 and 53 Finnish nursing homes or assisted living facilities in 2017−2018. Demographic characteristics and medication data were extracted from medical records and medication administration charts. Co-prescribing was defined as more than one analgesic (acetaminophen, nonsteroidal anti-inflammatory drugs and opioids) and/or adjuvant (gabapentinoids, tricyclic antidepressants and duloxetine) prescribed for regular administration. Results Overall, 550 Australian residents (89 [IQR 84−92] years; 73.3% females) and 2423 Finnish residents (84 [IQR 65−103] years; 73.9% females) were included. Of 416 Australian residents prescribed any regular analgesic or adjuvant, 181 (43.5%) were prescribed ≥two, including 66 (15.9%) who were prescribed ≥three. Of 1406 Finnish residents prescribed any regular analgesic or adjuvant, 469 (33.4%) were prescribed ≥two, including 87 (6.2%) who were prescribed ≥three. Acetaminophen was co-prescribed to >75.0% of Australian and >28.3% of Finnish residents prescribed other analgesics or adjuvants. Of 61 Australian residents and 186 Finnish residents prescribed gabapentinoids, 38 (62.3%) and 86 (46.2%) were co-prescribed opioids. Opioids were co-prescribed to 58.8%−83.3% of Australian and 25.0%−46.2% of Finnish residents prescribed adjuvants. Conclusions Analgesic and adjuvant co-prescribing was more prevalent for Australian than Finnish residents, which was largely driven by acetaminophen co-prescribing to more than three-quarters of analgesic or adjuvant users in Australia. Central nervous system-active polypharmacy arising from high rates of adjuvant and opioid co-prescribing warrants further attention in both countries.