Update in Prescribing and therapeutics: NSAID’s in Emergency Medicine
Feb 15, 2016
Update in Prescribing and therapeutics: NSAID’s in Emergency Medicine
Relative risk comparison – GI and vascular side
effects
The Lancet Aug 2013, 382:9894 pp769 – 779
Recommendations• 1. ALL NSAIDS should be used at the lowest dose possible for the shortest time period
possible• • 2. Ibuprofen & Naproxen are considered to have the safest cardiovascular risk profile of
all the NSAIDS• • 3. Patients with Ischaemic heart disease, Peripheral artery disease, cerebrovascular
disease and congestive cardiac failure should NOT be prescribed diclofenac.• • 4. Careful consideration should be given to initiating Diclofenac in those with significant
risk factors for cardiovascular disease;( e.g. smoking, diabetes mellitus, hypertension and hyperlipidaemia.)
Recommendations• Consideration should be given to PPI prescribing with
NSAID’s in those at high risk of GI complications - >65yrs, PMH of ulcers and other medications with GI risks
• Concomitant prescribing with ACE inhibitors should be avoided
• Concomitant prescribing with Aspirin should be avoided
References• P, Henry D (2011) Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs:
Systematic Review of Population-Based Controlled Observational Studies. PLoS Med 8(9): e1001098. doi:10.1371/journal.pmed.1001098
• Vascular and Upper Gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials by the Coxib and traditional NSAID trialists collaboration The Lancet Aug 2013, 382:9894 pp769 – 779
• http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON286975 MHRA drug safety update on diclofenac accessed 30th May 2014
• http://www.nice.org.uk/CG59 - Recommendations relating to PPI prescribing• http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON088004 MHRA drug
safety update relating to renal risk and ACE inhibitors