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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
Who is at increased risk of gastrointestinal adverse effects from oral NSAIDs?
- People are at high risk of serious nonsteroidal anti-inflammatory drug (NSAID)–induced gastrointestinal (GI) adverse events if they have one or more of the following risk factors:
- Age 65 years or older.
- History of gastroduodenal ulcer, GI bleeding, or gastroduodenal perforation.
- Concomitant use of medications that are known to increase the likelihood of upper GI adverse events (e.g. anticoagulants, aspirin [even low-dose], corticosteroids, and selective serotonin reuptake inhibitors [SSRIs], venlafaxine, or duloxetine).
- Serious comorbidity, such as cardiovascular disease, hepatic or renal impairment (including dehydration), diabetes, or hypertension.
- Requirement for prolonged NSAID use, including people with:
- Osteoarthritis or rheumatoid arthritis of any age.
- Chronic low back pain and 45 years of age or older.
- Use of the maximum recommended dose of an NSAID.
- Additional risk factors for NSAID-induced GI adverse events have also been identified, including:
- The NSAID used.
- The presence of Helicobacter pylori infection.
- Excessive alcohol use.
- Heavy smoking.
In depth
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