MUSCULOSKELETAL Osteoarthritis NSAIDs (non-steroidal anti-inflammatory drugs)

AMH 2022 section 15.3.1

Active ingredients (generic names)

IBUPROFEN (i-bu-pro-fen)

INDOMETACIN (in-doe-met-a-sin)

 

Capsules and tablets

Mixture.

Suppositories.

Ointment.

Other NSAIDs (Cox 1 and Cox 2 inhibitors)

Not included in this monograph — see individual monograph or AMH for information:

  • Aspirin
  • Celecoxib
  • Diclofenac
  • Etoricoxib
  • Ketoprofen
  • Ketorolac
  • Mefenamic acid
  • Meloxicam
  • Naproxen
  • Piroxicam
What it is used for
  • Dental pain
  • Fever (ibuprofen)
  • Gout (indometacin)
  • Kidney stone (renal colic)
  • Mild to moderate pain
    • May be used with other pain medicines (eg morphine, paracetamol)
  • Period pain (ibuprofen)
  • Reducing swelling and inflammation in arthritis, sprains and injuries
How it works
  • Prostaglandins in body cause redness, swelling (inflammation), pain at site of injury. NSAIDs stop body making prostaglandins
Side effects

Nausea

Stomach trouble
(eg bleeding ulcer)

Headache.

Headache

Dizzy

Kidney trouble

BP - high.jpg

High BP
(can make worse)

Warnings
  • People who get asthma when they take aspirin

Pregnant

Old people

High BP 

Stomach trouble
or ulcer before

Kidney trouble

liver - trouble.jpg

Liver trouble

Heart trouble

Bleeding or bruising

Medical consult

if needed for more than one week
Interactions — Do not use together without medical consult

NSAID with

  • Blood thinning medicines (aspirin, clopidogrel, warfarin, rivaroxaban, apixaban)
  • ACE inhibitor
  • ARB
  • Alendronate
  • Diuretics
  • Lithium

Tiple whammy.

ACE inhibitor/ARB + diuretic + NSAID 

Dangerous medicine combination that can cause kidney failure.

Tell the patient
  • Use lowest dose for shortest period of time
  • Work best when taken at the same time as regular paracetamol (for chronic pain)
  • OK to take with low dose aspirin
    • Separate by 30 minutes
    • Talk to your Doctor if wanting to use NSAIDs

Take with food or milk

 

Return to clinic if

  • Needed for more than a short time, if long term need, may given another medicine to protect stomach
  • OR You have very dark/blood-coloured vomit or faeces (guna), swollen ankles, trouble breathing
  • OR You have chest pain, irregular heartbeat, sore leg veins and feel faint (CV adverse effects)

Drink lots of water

Warning stickers: 10axref-slash icon, 12xref-slash icon, 19bxref-slash iconBxref-slash icon – indometacin also Axref-slash icon

Check
  • Any symptoms of reflux and heartburn

Blood test

If using for a long time — check kidney function (UEC), liver function tests (LFT), FBC before starting medicine, then at least once a year

Blood pressure