NSAIDs

Question 1

Monitoring

Answer 1

Blood pressure (especially after dose changes), renal function, liver function, haemoglobin in those
with risk factors for GI bleeding

Question 2

Warning signs

Answer 2

• Black stools or ‘coffee ground’ vomit, suggesting chronic gastrointestinal bleeding
• Iron defciency anaemia, suggesting chronic gastrointestinal bleeding (e.g. fatigue, dizziness,
pale skin, shortness of breath)
• Progressive unintentional weight loss or diffculty swallowing
• Pregnancy and breastfeeding
• Swollen ankles or feet
• Unexplained, persistent recent-onset dyspepsia
• Worsening of asthma

Question 3

Actions required

Answer 3

• Advise patient to report immediately to a doctor if any warning signs occur
• Check that the NSAID prescribed is suitable for the patient; accounting for GI and CVS risk,
high dose or regular dose, appropriate duration of treatment
• Advise patient to take the lowest effective dose and for shortest period of time to control
symptoms. Long-term treatment to be reviewed periodically
• All patients of any age prescribed NSAIDs for osteoarthritis or rheumatoid arthritis or patients

over 45 years who are prescribed NSAIDs for lower back pain should be co-prescribed gastro-
protection (e.g. a proton pump inhibitor)

• Recommend that oral NSAID is taken with or just after food
• Inform patient of potential interactions, the need to check with a pharmacist or doctor before
taking any new medication (especially OTC NSAIDs)

Question 4

Interactions

Answer 4

• Possible increased risk of convulsions when given with quinolones
• Possible enhanced anticoagulant effect of coumarins and phenindione
• Possible enhanced effects of sulfonylureas
• Increased risk of bleeding with dabigatran, heparins, SSRIs, venlafaxine, antiplatelets
• Increased risk of nephrotoxicity when given with ciclosporin, tacrolimus, diuretics (also
antagonism of diuretic effect)
• May reduce excretion of lithium or methotrexate (increasing risk of toxicity)
• Increased side effects with concomitant use of other NSAIDs, aspirin

• NSAIDs antagonise hypotensive effect of beta-blockers, calcium-channel blockers, ACEI-
inhibitors, angiotensin-II receptor antagonists, alpha-blockers, nitrates