NSAIDs

Question 1

What is the main serious side effect of NSAIDs?

Answer 1

• GI bleeding, ulcers and perforation
• Cardiovascular events
• Renal injury

Question 2

What are the risks dependent on?

Answer 2

• Dose
• Age (increases with age)
• Polypharmacy
• History of peptic ulcers
• Renal impairment

Question 3

What NICE recommendation may prevent GI side effects when using NSAIDs?

Answer 3

• Using PPI with NSAIDs in patients over >45 years

Question 4

What are the cardiovascular side effects for NSAIDs?

Answer 4

• All associated with small increased risk of MI and stroke
• Risks are higher in those with IHD risk factors (diabetes and hypertension)
• Coxibs & Diclofenac are higher risk
  
  • Contraindicated in those with prior history of MI, PVD, stroke or heart failure
• Naproxen has the lowest risk

Question 5

What are the renal risks for NSAIDs?

Answer 5

• Risk is higher for patients already on diuretics
  
  • ARB or ACE
• Risks are also increased in the elderly, those with hypertension, T2DM
  
  • Naproxen or ibuprofen plus PPI may be the safest options

Question 6

What are some alternatives to NSAIDs?

Answer 6

• Paracetamol
• Topical NSAIDs
• Opioids
• Strengthening exercises may be more beneficial than mild oral analgesics

Question 7

What counselling advice would you give patients taking NSAIDS, particularly long term?

Answer 7

• Only take it when you need it
• STOP if you get abdominal pain or symptoms of GI bleeding (black stools and faints)
• Do not mix over the counter NSAIDs with prescription NSAIDs
  
  • Mixing them can increase risks by 20 fod
• Smoking and alcohol increase risk profile of NSAIDs