Oral NSAIDs – What’s new?
The GGC Oral NSAID guideline has recently been updated. Ibuprofen and naproxen remain the NSAIDs of choice. The prescribing notes have been updated and include additional information on acute kidney injury and hepatic impairment.
Key messages for NSAIDs:
- Ibuprofen and naproxen are the drugs of choice
- Mefenamic acid (previously on the total formulary) is now non-formulary and not recommended in GGC
- Only prescribe after an assessment of each patient’s risk factors including any history of cardiovascular (CV) and gastrointestinal illness
- Avoid where possible in patients with a history of vascular disease or high risk of CV disease
- Prescribe at the lowest effective dose for the shortest duration possible
- Consider the use of ‘as required’ dosing
PPIs (omeprazole or lansoprazole) should only be prescribed along with an NSAID where indicated in the guideline and where the risks and benefits of PPI use have been considered.
New evidence since the last update includes the European Medicines Agency’s Pharmacovigilance Risk Assessment Committee review in 2015 on the CV safety of ibuprofen. The review concluded that high daily doses (>2.4g daily) are associated with an increased risk of CV events which may be similar to COX-2 inhibitors and diclofenac. This review confirmed the findings of previous EU reviews and does not suggest that ibuprofen at low doses (≤1.2g daily) is associated with an increased risk of CV events.
The Medicines Update Extra bulletin on NSAIDs has also been updated. It supplements the guideline and discusses the evidence base and place in therapy of NSAIDs. It includes evidence from two recent BMJ articles on the risk of heart failure and MI with NSAIDs.