Intro: NSAIDs are medications in the category of Non-Steroidal anti-inflammatory drugs such as for example Ibuprofen, Naprosyn, Diclofenac and the like available in oral, topical or injection form.
NSAIDs inhibit prostaglandins, an inflammatory and pain modulator.
So NSAIDs are used for pain, fever reduction, inflammation, reduction in menstrual flow and menstrual cramps.
NSAIDs can adversely impact renal function, cause fluid retention and lead to worsening heart failure or blood pressure elevation, as well as cause peptic ulcers.
In this guideline for medical professionals on the use of NSAIDS, there are recommendations for its use as follows:
- Consideration for avoiding NSAIDs in patients with treatment-resistant hypertension, severe chronic kidney disease (CKD) and high risk of cardiovascular disease.
- Monitoring blood pressure before treatment with an NSAID is started, evaluating for chronic kidney disease and the cause of unexplained iron-deficiency anaemia to ensure that there is no hidden peptic ulcer or gastrointestinal loss that could worsen with NSAID use.
General guidelines for use of NSAIDs:
In patients with high cardiovascular risk, if NSAIDs are the only option; naproxen or celecoxib are preferred.
For patients with a moderate risk of peptic ulcer disease,
- NSAID in addition to a proton pump inhibitor (PPI) like Omeprazole, or a selective cyclo-oxygenase-2 (COX-2) inhibitor (Celebrex) should be used;
For patients with a high risk of peptic ulcer disease, a selective COX-2 inhibitor (for example Celebrex) together with a PPI (for example Omeprazole) is needed.
For patients with pre-existing hypertension receiving renin-angiotensin system blockers (ARBs), monitor therapy if taking NSAIDs, with consideration of dose increase.
Blood pressure and renal blood tests should be monitored in patients taking medications like NSAIDs that can adversely affect function.
Compiled by Dr. N. Onuoha, MD, FACP
Disclaimer: This post serves as general information and not for diagnosis or treatment.
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