Nonsteroidal anti-inflammatory drugs (NSAIDs) are approved for use as antipyretic, anti-inflammatory, and analgesic agents. These effects make NSAIDs useful for treating muscle pain, dysmenorrhea, arthritic conditions, pyrexia, gout, migraines, and used as opioid-sparing agents in certain acute trauma cases 

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible.   

When pharmacists dispense nonsteroidal anti-inflammatory drugs (NSAIDs), they should take several precautions to ensure patient safety and optimise therapy. 

Pharmacy Magazine spoke to pharmacist and ICPA COO, Ahmed Bayat, who shared five tips that pharmacists should keep in mind when dispensing NSAIDs to ensure patient safety and optimise therapy. 

1. ASSESS PATIENT'S MEDICAL HISTORY

• Kidney and liver function: NSAIDs can cause kidney damage, especially in patients with pre-existing kidney or liver conditions. Always ask about the patient's history of kidney or liver disease.
• Cardiovascular risk: NSAIDs may increase the risk of heart attack or stroke, especially in patients with a history of heart disease, hypertension, or high cholesterol. Consider recommending alternative pain relief options if the patient is at high cardiovascular risk.

2. EVALUATE GASTROINTESTINAL (GI) RISK

• NSAIDs can cause GI irritation, ulcers, and bleeding. Ask about the patient's history of GI problems and concurrent use of medications like corticosteroids or anticoagulants, which may increase GI risks.
• Recommend a proton pump inhibitor (PPI) for patients at high risk of GI complications, especially if NSAIDs must be used long-term.

3. REVIEW CONCURRENT MEDICATIONS

Check for potential drug interactions with the patient's current medications. NSAIDs can interact with:

• Antihypertensives: NSAIDs may reduce the effectiveness of blood pressure medications, including ACE inhibitors and diuretics.
• Anticoagulants: Increased risk of bleeding when taken with warfarin or newer anticoagulants (e.g., rivaroxaban, dabigatran).
• SSRIs/SNRIs: Concomitant use with antidepressants can increase the risk of GI bleeding.

4. EDUCATE ON PROPER USE & DOSING

• Lowest effective dose: Encourage patients to use the lowest effective dose for the shortest duration to minimise adverse effects.
• Take with food: Advise patients to take NSAIDs with food or milk to reduce GI irritation.
• Avoid alcohol: Warn patients against excessive alcohol consumption while using NSAIDs to reduce the risk of GI issues.

5. COUNSEL ON SIGNS OF ADVERSE EFFECTS

Educate patients on recognising early signs of NSAID-related adverse effects:

• GI symptoms
• Cardiovascular symptoms
• Kidney issues

These steps help ensure NSAIDs are used safely and effectively, tailored to each patient's health status.