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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
How can I prevent gastrointestinal adverse effects from oral NSAIDs?
- In all people, consider using:
- An alternative to an NSAID, for example:
- For pain: paracetamol, with or without codeine.
- For gout: colchicine.
- For osteoarthritis: other analgesics, physical treatments (including exercise), surgery.
- For rheumatoid arthritis: optimization of disease modifying drugs (DMARDs). (Usually requires referral.)
- Only one (oral or topical) NSAID at a time. When possible, avoid concomitant use of an NSAID with low-dose aspirin. Low-dose aspirin for cardiovascular protection almost always has priority over an NSAID.
- The lowest NSAID dose that is compatible with symptom relief.
- In people who are at increased risk of gastrointestinal (GI) adverse effects and require an NSAID, prescribing options are:
- A standard NSAID with a proton pump inhibitor (PPI) prescribed at a dose licensed for gastroprotection (see Table 1).
- A coxib with a PPI.
- For people who have an NSAID-associated peptic ulcer, see the CKS topic on Dyspepsia - proven peptic ulcer.
In depth
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