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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I advise when prescribing an oral NSAID?

  • When prescribing an oral nonsteroidal anti-inflammatory drug (NSAID), provide advice on:
    • The option to purchase oral ibuprofen over the counter.
    • The type of NSAID prescribed (standard NSAIDs or coxib).
    • The risk of adverse effects:
      • All people are at risk of adverse effects, but some people may be at increased risk.
      • All NSAIDs have risks of adverse effects, but some NSAIDs may have higher risks for particular adverse effects.
    • The need to weigh up, in each individual, the benefits of the prescribed NSAID against its risks and the person's ability to tolerate it.
    • The main serious adverse effects (gastrointestinal, cardiovascular, renal, and hepatic).
    • Strategies to minimize the risks of adverse effects, including:
      • Using an alternative treatment to an oral NSAID.
      • Using an NSAID at the lowest effective dose and for no longer than is necessary.
      • Not to take an NSAID on an empty stomach.
      • Using a gastroprotective strategy for people at increased risk of gastrointestinal adverse effects.
      • Using a topical NSAID for knee or small joint disorders.
      • Closer monitoring of people at increased risk.
    • The need to carefully read the information leaflet enclosed with the medication.
Basis for recommendation
  • CKS found no trial evidence on giving advice to people about NSAIDs. These recommendations are therefore pragmatic. However, they do reflect the available evidence on risks and preventive strategies.

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