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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
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Who is at increased risk of cardiovascular or renal complications of NSAIDs?
- The risk for serious cardiac or renal adverse events (including myocardial infarction, heart failure, and hypertension) is increased in people with:
- Ischaemic heart disease, cerebrovascular disease, or peripheral arterial disease.
- Renal impairment (e.g. creatinine clearance less than about 20 mL/min).
- Heart failure.
- Hypertension
- People risk factors for cardiovascular disease and all elderly people (e.g. > 65 years of age) are also at increased risk.
In depth
How should people at increased risk of cardiovascular or renal adverse events from NSAIDs be managed?
- People with heart failure.
- People with severe heart failure should not use NSAIDs.
- Those with moderate heart failure should not use coxibs.
- A standard NSAID may be used if necessary, but the individual should be closely monitored.
- Ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line options.
- People with ischaemic heart disease, cerebrovascular disease, or peripheral arterial disease.
- Coxibs are contraindicated.
- Ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line options.
- People with renal impairment (e.g. creatinine clearance less than about 20 mL/min).
- Ideally, avoid using NSAIDs.
- If an NSAID is used, the person should be closely monitored.
- People with risk factors for cardiovascular disease and all elderly people.
- Ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line options.
- People with hypertension
- Ideally, avoid using etoricoxib — etoricoxib may be associated with more frequent and severe effects on blood pressure than other coxibs and standard NSAIDs, particularly at high doses.
- Consider whether monitoring is needed.
In depth
How should I monitor people at increased risk for cardiovascular and renal adverse effects associated with NSAIDs?
- For advice regarding monitoring for people at increased risk of cardiovascular and renal adverse effects with NSAIDs, see What monitoring is needed?.
In depth
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