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Clinician’s Corner: Continuing with Non-Steroidal Anti-Inflammatory Drugs

We wrap up this week’s journey through the world of NSAIDS.  Your Thompson Pharmacist is a great resource to help you navigate through all of the available NSAIDS.  Here’s a list of available NSAIDS by prescription, as well as important consultation points that your Thompson Pharmacist wants you to know.

NON STEROIDAL ANTI INFLAMMATORY DRUGS (NSAIDs)

Brand Generic
Celebrex 100mg,200mg celecoxib
Voltaren  25, 50, 75 diclofenac
Lodine 300,400,500 etodolac
Motrin 400,600,800 ibuprofen
Orudis 50mg ketoprofen
Mobic  7.5, 15mg meloxican
Relafen 500,750 nabumetone
Naprosyn 250,375,500 naproxen
Anaprox 275, 550 Naproxen sod.
Daypro 600 oxaprozin
Feldene 10mg 20mg prioxicam
Indocin 25,50,75SR indomethacin
Clinoril 150mg 200mg sulindac

PRECAUTIONS  for NSAID:

  • Caution if kidney impaired, may cause more damage to kidneys.
  • All are pregnancy Category –D in third trimester, which means they must be avoided.
  • active stomach disease
  • Caution in liver impairment.
  • Avoid Aspirin & alcohol while taking NSAIDs
  • Watch for increased blood pressure
  • May make heart failure worse.
  • Increased risk of heart attacks, stroke, cardiovascular death

DRUG interactions:

  • Administer with caution with Warfarin (Coumadin) patients
  • Don’t take with other NSAIDS

Information for NSAIDS

  • Take with food to avoid GI upset
  • Asthmatics –caution with aspirin
  • Do not take over the counter NSAIDS with the prescription NSAID

Stuff worth knowing

  • All the NSAIDs are available generically and inexpensive
  • Ibuprofen is safest for the stomach
  • Naproxen has the best profile for cardiac patients if an NSAID is absolutely necessary
  • A local gastroenterologist said that most of the stomach bleeds he sees come from combining OTC ibuprofen combined with an 81mg aspirin tablet. If however a patient is on 81mg aspirin wait 30 minutes before taking their NSAID which allows aspirin time to bind to inactivate the platelets
  • Gastric ulceration from nonsteroidal anti-inflammatory drugs (NSAIDS) is common and often silent, especially with aspirin.
  • Complications from NSAID ulceration are more common in the elderly and frail
  • A life-threatening gastrointestinal complication from NSAIDs may occur after as little as 7 days’ treatment. Stomach protection for gastric and duodenal ulcers with acid blockers like Pepcid®(Famotidine) require high dose twice daily such as: Famotidine 40mg twice daily.
  • Watch the kidneys! NSAID use may lead to decreased kidney blood flow, a decline in glomerular hydraulic pressure, and acute renal failure
  • LIVER: About 10% of all cases of drug-induced liver failure are associated with use of an NSAID. Diclofenac is the worst option. Ibuprofen is probably safe due to short half-life.

NSAIDs can be of great relief for pain management, given the current climate to limit opioid (narcotic) prescribing.  Acetaminophen is the safest OTC pain reliever, however the NSAIDS are more potent.  If you have questions about what pain reliever is best for you consult your doctor and your Thompson Pharmacist.  Go Ahead and ASK, at Thompson Pharmacy it’s ALL for YOU!!!