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Update in Prescribing and therapeutics: NSAID’s in Emergency Medicine

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

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Update in Prescribing and therapeutics: NSAID’s in Emergency Medicine

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  1. Update in Prescribing and therapeutics: NSAID’s in Emergency Medicine

  2. Relative risk comparison – GI and vascular side effects The Lancet Aug 2013, 382:9894 pp769 – 779

  3. 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.)

  4. 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

  5. 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

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