Risk factors for GI complications with NSAIDs
Patient related factors
- Age >60 years
- History of ulcer disease
- History of IHD or ↑BP - the use of NSAIDS is associated with AF [BMJ 2011]
Drug related factors
- Use of relatively toxic NSAID (not Diclofenac has be proven to be twice as toxic as Ibuprofen1
- Diclofenac is contra-indicated in patients with CCF, IHD PVD or cerebro-vascular disease
- High dose of NSAIDs used concurrently
- Use of anticoagulant
- Concurrent use of corticosteroid
NSAID Protection Strategies
- Use lowest possible doses of NSAIDs
- Use safer NSAIDs (Ibuprofen)
- Alternatively consider
- Cox-2 inhibitors such as Mesulid
- Made in Ireland, cheaper than Diclofenac[Ref]
- Contra-indicated in severe heart failure
- Caution in hypertension and in patients with a oedema for any other reasons
- Proton pump inhibitors
- Misoprostil
Cautions / contraindications
Contra indications
- History of hypersensitivity to Aspirin or any other NSAID
- (asthma, angio-oedema, urticaria or rhinitis precipitated by Aspirin or any other NSAID)
- Active peptic ulceration
- Diclofenac is contra-indicated in patients with CCF, IHD PVD or cerebro-vascular disease
- High dose of NSAIDs used concurrently
- Use of anticoagulant
Cautions
- In the elderly
- Renal, cardiac or hepatic impairment (causing a deterioration of renal function)
- Coagulation defects
- During pregnancy (or breast feeding)
- History of IHD or ↑BP - the use of NSAIDS is associated with AF [BMJ 2011]
Prescribing in the elderly
All patients should be advised to seek a review of their analgesic requirements by their practice nurse or GP after two days
Please read sections above.
For soft tissue injuries consider:
- Paracetamol in at reduced (1G tds) dose
- Alternatively Ibuprofen at 400 mg tds
- Both Paracetamol and Ibuprofen as above