Choice of nonsteroidal anti-inflammatory drug

Choice of nonsteroidal anti-inflammatory drug

No single NSAID has been shown to be generally more effective than any other, but some patients seem to respond better to one than to others. Generally, NSAIDs should be used for the shortest possible time. In chronic pain management, however, it is important to give individual NSAIDs an adequate therapeutic trial of 2 to 4 weeks, as its maximum effect may be delayed.

In general, the less gastrotoxic, shorter-acting drugs should be chosen for preference, and used at the lowest dose consistent with symptom control, and for the shortest possible time. Using a short-acting drug is especially important in the elderly, and in patients with impaired renal function. Issues to consider when prescribing NSAIDs are shown in Box 1.1 below.

Issues to consider in NSAID prescribing (Box 1.1)

Consider nondrug treatment first. Consider the risk–benefit profile for NSAIDs in each patient. Use the lowest dose for the shortest time possible. Use less expensive drugs with low risk of gastrointestinal complications. Choose an NSAID with a short half-life for use in the elderly, and in patients with renal impairment  Use only one non-aspirin NSAID at a time. Monitor by assessing both adverse effects and the need for NSAID use. Fish oil and paracetamol may reduce the requirements for NSAIDs