Most OEM providers frequently prescribe nonsteroidal anti-inflammatory drugs (NSAIDs). While the drug group offers significant therapeutic benefit, not infrequently patients experience major or minor side effects. A recent article in American Family Physician offers a review of NSAID related precautions.

 

Key recommendations regarding GI side effects for those who must take NSAIDs includes considering the concurrent use of proton pump inhibitors (PPIs), double dose H2 blocker, or misoprotol, although women who are or might become pregnant should not take misoprotol. Celebrex can be used alone in this group but one should consider cardiovascular risk. Cox-2 inhibitors have been associated with potential for myocardial infarction but Celebrex, the only Cox-2 NSAID currently used in the US, seems to be safer.

 

When possible, NSAIDs should be avoided in persons with preexisting renal disease, congestive heart failure, or cirrhosis in order to prevent acute renal failure. Consider monitoring serum creatinine after initiation of NSAIDs for those taking angiotensin-converting enzyme inhibitors.

 

NSAIDs and aspirin should be avoided in persons taking anticoagulants.

 

Ibuprofen, Indomethacin, and Naproxen are safe to use in breastfeeding women. Although most NSAIDs are likely safe in pregnancy, they should be avoided in the last six to eight weeks of pregnancy to prevent prolonged gestation inhibition of prostaglandin synthesis, premature closure of the ducts arteriosus, and maternal and fetal complications from antiplatelet activity.

 

Most of the recommendations are level C evidence- based on consensus guidelines and literature review.