Non-Steriodal inflammatory drugs (NSAID)
Only prescribe an NSAID if the benefits of treatment clearly outweigh the risks and a need for an anti-inflammatory agent is identified.
3 Steps to NSAID Prescribing
Don’t use them unless you have to
- The only way to avoid NSAID side-effects is not to use them
- Paracetamol works for many
- Employ non-drug interventions routinely
- Consider short-term course (1-2 weeks) of topical NSAID
If you have to use them, use them wisely
- The balance of benefits and risks needs to be carefully assessed; think about CV, GI and renal issues routinely.
- Use a safer drug (ibuprofen, then naproxen) in the lowest effective dose for the shortest period
- NSAID users should be a high priority for medication review: are NSAIDs effective/needed? Drug holidays? Don’t issue repeat prescriptions without review.
- Short acting NSAIDs are preferred for the majority of patients as they allow flexible dosing leading to better control of symptoms using lower daily doses.
Consider gastroprotection in those at high risk (NICE definition)
- Options are PPIs, double-dose H2RAs, Misoprostol
- COX-2 should be considered only in those at high GI risk, but also consider the CV risks.
- Systemic as well as local effects of NSAIDs contribute to gastrointestinal damage. This damage may not be prevented by the use of enteric-coated tablets or suppositories.