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Practice advisory on the appropriate use of NSAIDs in primary care

Ho, Kok Yuen, Cardosa, Mary S., Chaiamnuay, Sumapa, Hidayat, Rudy, Ho, Huynh Quang Tri, Kamil, Ozlan, Mokhtar, Sabarul A., Nakata, Ken, Navarra, Sandra V., Nguyen, Van Hung, Pinzon, Rizaldy, Tsuruoka, Shuichi, Yim, Heng Boon and Choy, Ernest 2020. Practice advisory on the appropriate use of NSAIDs in primary care. Journal of Pain Research 2020 (13) , pp. 1925-1939. 10.2147/JPR.S247781

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Abstract

Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Dove Medical Press
ISSN: 1178-7090
Date of First Compliant Deposit: 17 September 2020
Date of Acceptance: 24 June 2020
Last Modified: 18 Sep 2020 13:15
URI: http://orca.cardiff.ac.uk/id/eprint/134900

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