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You are here: Home / Resources / SystmOne Resource Centre / Medicine Management / Safe Prescribing of NSAIDS

Safe Prescribing of NSAIDS

The following CDRC resources are available to support safe NSAID Prescribing.

Set-up

Ensure the following protocols are active by going to Setup >Workflow Support > Protocol 

NSAID Aceclofenac Checklist 
NSAID Celecoxib Checklist 
NSAID Checklist (manual start) 
NSAID Diclofenac Checklist 
NSAID Etodolac Checklist 
NSAID Etoricoxib Checklist 
NSAID Flurbiprofen Checklist 
NSAID Generic Checklist 
NSAID Ibuprofen Checklist 
NSAID Indometacin Checklist 
NSAID Ketoprofen Checklist 
NSAID Nabumetone Checklist 
NSAID Naproxen Checklist 
NSAID Piroxicam Checklist 
NSAID Sulindac Checklist 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
OCS / Medication 
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DCS 
ocs 
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OCS
Reports

A series of reports, found in CDRC Quality > Rheumatology, are available to support safe prescribing of systemic NSAIDs. 

NSAIO safety 2 
NSAIO safety 2 
NSAIO safety 3 
NSAID safety 7 
NSAIO 
NSAID 
NSAID 
NSAID 
NSAID 
NSAID 
NSAID 
NSAID 
Safe 1 
Contraindication # 
M: Caution* 
2: Caution -1 # 
No Obvious Indication # 
Safety 4 
M: Renal impairment- 
Safety 
2: Risk of renal impairment* 
Safety 
3: Risk of renal impairment -1 # 
Safety Consider Gastroprotection # 
Safety Etoricoxib go or 120 but never had 60mg # 
Safety Very high dose etoricoxib on repeat* 
Regular NSAlDs but not on repeat* 
Safety More than one NSAID#
Report NamePatients Returned
? NSAID Safety 1: Contraindication #Patients on repeat NSAIDs with a clear contraindication 
? NSAID Safety 2.1: Caution #Patients on repeat NSAIDs with a condition suggesting caution is needed 
? NSAID Safety 2.2: Caution >1 # Patients on repeat NSAIDs with >1 condition suggesting caution is needed 
? NSAID Safety 3: No obvious indication #Patients on repeat NSAIDs without clear indication. Only applies to a small number of NSAIDs such as COX2 inhibitors. 
? NSAID Safety 4.1: Renal impairment -eGFR <30 #Patients on repeat NSAIDs whose last eGFR was <30 
? NSAID Safety 4.2: Risk of renal impairment #Patients on repeat NSAIDs with a risk factor for renal impairment 
? NSAID Safety 4.3: Risk of renal impairment >1 #Patients on repeat NSAIDs with >1 risk factor for renal impairment 
? NSAID Safety 5: Consider gastroprotection #Patients on repeat NSAIDs where presence of risk factors suggests gastroprotection should be considered* 
? NSAID Safety 6.1: Etoricoxib 90 or 120 but never had 60mg #Safety report based on MHRA alert that lowest dose of etoricoxib should be used 
? NSAID Safety 6.2: Very high dose etoricoxib on repeat #Safety report based on MHRA alert. 120mg dose not licensed for long term use.  
? NSAID Safety 7: Regular NSAIDs but not on repeat #Patients who appear to be receiving recurrent acute issues of systemic NSAIDs.  Consider adding the NSAIDs to repeat so prescribing can be monitored more systematically. 
? NSAID Safety 8: More than one NSAID #Patients on more than one repeat NSAID. 

*This is linked to the more comprehensive Gastroprotection system that covers other relevant medication such as steroids and antiplatelets. 

NSAIDs Template

How to Access:

In the lower left hand corner use the search bar, type in ‘NSAIDs’ and select the following template:

Alternatively, press F12 and search for ‘NSAIDs’, this will open the aforementioned template.

NSAIDs Template:

The NSAID template provides the key information needed to support safe prescribing.  An example is shown below from a patient at high risk of complications. There are also:  

  • Links to tabs showing more specific information for individual NSAIDs. 
  • Link to a patient information leaflet 
  • Link to CKS guidelines 
  • Link to BNF section on NSAIDs 
Aceclofenac 
Etoricoxib 
Ketoprofen 
Sulindac 
NSAlDs Aceclofenac Celecokib Diclofenac Etodolac 
Etoricokib Flurbiprofen Ibuprofen 
O Print NSAID PILO CKS- NSAIOs 
Naproxen 250mg tablets 
NSAlDs 
! NSAID RISK OF RENAL IMPAIRMENT ! - RENIN ANGIOTENSIN SYSTEM MEDS 
Indometacin Ketoprofen Nabumetone Naproxen 
27 Dec 201g take on... 84 tablet 
! NSAID CONTRAINDICATION 
! NSAID CAUTION(S) 
! RISK FACTOR FOR BLEEDING ! - SUSPECTED PROLONGED NSAID USE 
! RISK FACTOR FOR BLEEDING ! - ON ASPIRIN 
! RISK FACTOR FOR BLEEDING ! - OVER 65 
! RISK FACTOR FOR BLEEDING ! - HAS CKD3-5 
! RISK FACTOR FOR BLEEDING ! - HAS CARDIOVASCULAR DISEASE 
! NSAID RISK OF RENAL IMPAIRMENT ! - OVER 75Y 
! NSAID RISK OF RENAL IMPAIRMENT ! - HEART FAILURE 
! NSAID RISK OF RENAL IMPAIRMENT ! - CKD3-5 OR eGFR 
! NSAID RISK OF RENAL IMPAIRMENT ! - ON DIURETICS 
Latest Renal Function 
Pirokicam 
Sulinda( 
Celecoxib Diclofenac 
NabumetoneNaproxen 
Etodolac 
Indometacin 
Piroxicam 
NSAID Comparison 
BNF - NSAIOs 
Gastroprotection for NSAIDs 
NSAID Checklist 
NSAID Scripts in the last year 
04 sep 201g GFR calculated abbreviated MORO rxaK8y) 
Lansoprazole 15mg gastro-resistant cam„27 Dec 201g take omn 28 cam„ 
53 ml-imin/1 73m*2 
02 Jan 2020 06 22 
NSAID Checklist 
Entered by 
FORBES, Gareth (Dr) (General Medical Practitioner) 
NSAID Checklist 
NSAlD(s) being used 
Indication 
Advised to take with food 
Advised to take minimum needed 
Risk of Gl complications discussel 
Gastroprotection 
Risk of CVD complications discussed 
Risk of renal complications discussed 
Sick day rules discussed 
PIL Issued 
Naproxen 
Arlhritis 
Yes 
Yes 
Yes 
Recommended 
Yes 
Yes 
Yes 
Yes

The NSAID Comparison page provides an overview of the relative risks and benefits of various NSAIDs. 

NSAID Comparison 
Effectiveness 
Less effective 
Ibuprofen 
Ketoprofen 
Moderately Effective 
Aceclofenac 
Celecoxib 
Diclofenac 
Etodolac 
Etoricoxib 
Nabumetone 
Naproxen 
Piroxicam 
Sulindac 
Highly Effective 
Flurbiprofen 
Indometacine 
Gl Tolerability 
Lower Gl Effects 
Ibuprofen 
Celecoxib 
Etoricoxib 
Higher Gl Effects 
Flurbiprofen 
Indometacin 
Piroxicam 
Cardiovascular Disease Risk 
Lowest risk 
Ibuprofen 200mg per day 
Naproxen 
Highest Risk 
Celecoxib 
Etoricoxib 
Diclofenac

The Gastroprotection for NSAIDs button is a link to more detailed information to support measures to reduce gastrointestinal adverse reactions. 

NSAlDs 
CKS Guidance 
To avoid Gl adverse effects try to use the lowest dose for the shortest tim4 
Risk Factors For NSAID Induced Gl ADRs 
• Max dose NSAlDs 
• over 65} 
• History peptic ulcer, Gl bleeding or perforation 
• Concomitant drugs that increase Gl bleeding risk 
• aspirin, steroids, SSRI, duloxetine, venlafaxine and anticoagulants 
• Comorbidity, cardiovascular disease, hepatic or renal impairment 
diabetes, hypenensiom 
• Requirement for prolonged use, including 
• OA or rheumatoid arthritis at any age 
• Chronic low back pain over 45 
Additional Risk Factors 
• NSAID type - lowest risk with ibuprofen 
• Presence of heliocbacter infection 
• Excessive alcohol use 
• Heav,'/ smoking 
Risk Reduction 
NSAID Gastroprotection Information 
Naproxen 250mg tablets 
27 Dec 
take 84 ta 
Lansoprazole 15mg gastro-n 27 Dec 
take 28 c 
! RISK FACTOR FOR BLEEDING ! - SUSPECTED PROLONGED NSAID USE 
! RISK FACTOR FOR BLEEDING ! - HAS CARDIOVASCULAR DISEASE 
! RISK FACTOR FOR BLEEDING ! - ON ASPIRIN 
! RISK FACTOR FOR BLEEDING ! - OVER 65 
! RISK FACTOR FOR BLEEDING ! - HAS CKD3-5 
Ex smoker 
Alcohol intake 
0 unitsmeek 
18 sep 201g 
High risk 
Mod risk 
Low risk 
h/o complicated ulcer or -2 risk factors 
consider COX2* and PPI 
1-2 risk factors 
NSAIO and PPI 
No risk factors 
NSAIO 
*Balance Gl risk against CVD/hear1 failure risk

The NSAID Checklist button runs the NSAID safety protocol and prompts users to complete the safety checklist with the patient – more details below. 

The NSAID Scripts in the last year button displays all issues of NSAIDs in the last year 

! NSAID RISK OF RENAL IMPAIRMENT ! - OVER 75Y 
OCS NSAID Issues (last year) 
NSAID Issues 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
Naproxen 250mg tablets 
NSAID Checklist 
NSAlD(s) being used 
take one tablet up to 3 times 
take one tablet up to 3 times 
take one tablet up to 3 times 
take one tablet up to 3 times 
take one tablet up to 3 times 
take one tablet up to 3 times 
take one tablet up to 3 times 
Naproxen 
26 dun 201g 
18 dui 201g 
13 Aug 
11 Oct 201g 
04 Nov 
02 Dec 201g 
27 Dec 201g
NSAIDs Checklist

The NSAID checklist is a protocol that runs a series of checks and provides warnings to support safe NSAID prescribing. The checklist can be triggered in the following ways: 

  • By clicking the NSAID Checklist button on the NSAID template 
  • By adding the protocol to one of your own toolbars 
  • (If activated at the practice) Will launch automatically if: 
    • An NSAID is added to repeat medication OR 
    • An NSAID is prescribed for the first time in the last 12 months 

The protocol runs the following checks: 

  • Are there contraindications to NSAID use e.g. celecoxib and previous stroke? 
  • Are there issues that suggest caution is needed? 
  • For certain drugs (such as COX2 inhibitors) is there a clear licensed indication? 
  • Is more than one NSAID being used? 
  • Are there risk factors for GI adverse reactions and is gastroprotection being prescribed? 
  • Are there risk factors for renal impairment? 

Each warning is accompanied by a link to the NSAID template so the relevant issues can be seen in more detail. 

Question 
This patient appears to have more than one condition suggesting diclotenac should 
only be used with caution 
Liew Cautions 
Continue Anyway 
Close 
Pause

The protocol provides recommendations on monitoring that may be required such as follow up blood pressure, renal and anaemia testing 

Question 
If long term use proposed, check BP 2w after starting

Finally the protocol offers a link to a checklist to run through with the patient. 

Question 
Complete NSAID Checklist? 
Qpen Template To Check For Previous Checklists 
Close 
Pause
NSAID Checklist 
O Yes 
O No 
O Not known 
Advised to take minimum needed 
O Yes 
O No 
O Not known 
Risk of Gl complications discussed 
O Yes 
O No 
O Not known 
Gastroprotection 
O Recommended 
O Not indicated 
O Not discussed 
O No information 
Risk ofCVD complications discussed 
O Yes 
O No 
O Not known 
Risk of renal complications discussed 
O Yes 
O No 
O Not known

Once completed, information from the checklist is displayed on the NSAID Template. 

NSAIDs Monitoring

The CDRC Drugs Requiring Monitoring system includes 12 monthly renal function monitoring for patients on repeat NSAIDs if they have at least one risk factor for renal impairment.  An additional six monthly check is prompted by the system if more than one risk factor is present. 

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