General advice on prescribing oral nonsteroidal anti-inflammatory drugs (NSAIDs).

• Consider whether an alternative treatment would be appropriate.
• Prescribe the lowest effective dose of NSAID for the shortest time necessary.
• Take account of the person's risk of serious adverse effects, the safety profiles of individual standard NSAIDs or coxibs, and the person's ability to tolerate individual NSAIDs.
• Older people are at increased risk of the gastrointestinal, cardiovascular, and renal adverse effects of NSAIDs.
• The risk for serious gastrointestinal adverse effects is increased in people who have had peptic ulcer disease or upper gastrointestinal bleeding and in those who are taking aspirin, an anticoagulant, or a systemic corticosteroid. The risk for serious gastrointestinal adverse events correlates poorly with dyspeptic symptoms.
• The risk for serious cardiovascular and renal adverse effects is increased in people who are already at increased risk for cardiovascular or renal disease and in people who have cardiovascular, renal, or hepatic impairment.
• NSAIDs can worsen asthma. However, if NSAIDs are thought to be potentially beneficial, people with asthma should be considered for a trial of an NSAID.
• Standard NSAIDs may increase the risk for excessive bleeding after trauma or surgery.
• Periodically review the needs of people on long-term NSAID treatment.
• People's tolerance for different NSAIDs varies substantially. However, do not switch between NSAIDs without careful consideration of the overall safety profile of the products, the person's risk factors, and their preferences.