The following recommendations apply in relation to the safe prescribing of NSAIDs:
- Review the patient for the overall risks involved with NSAID treatment - this should include an assessment of gastro-intestinal risk, cardio-vascular risk, renal risk as well as pre-treatment assessment of blood pressure and renal function. Where possible use Paracetamol based analgesia as first line with a ladder approach if initial analgesia fails.
- Where the overall risks are low or NSAID treatment is absolutely necessary despite moderate to high risk, the NSAID of lowest risk should be used at the lowest possible dose and for the shortest possible duration.
- This will usually mean that Ibuprofen is the first line NSAID.
- If Ibuprofen therapy fails or is not tolerated, re-assess the patient for an NSAID before trying an alternative. Suitable alternatives would include diclofenac and naproxen.