NSAIDs: Introduction

Last updated: April 09, 2019

This is Pat. She's 71 years old, and she hurt her back while gardening. She puts up with the pain for a few days, but it affects her sleep and she can't carry her shopping.

She goes to her practice and is prescribed naproxen 500mg bd. Six days later, with no warning, Pat vomits up blood, and collapses. She is admitted to hospital as an emergency and diagnosed with a NSAID-induced gastric bleed.

It’s difficult to quantify the risk of serious GI harm from NSAIDs because quoted incidence figures vary enormously according to the drug, the dose, the era, the GI toxicity concerned, and whether the patients were in a high risk category. A quoted estimate is that around 1 – 2% of chronic NSAID recipients will experience a serious gastrointestinal complication per year.

  Why did this drug-induced harm affect a patient like Pat?
  How can Pat and other patients in pain be protected from the serious GI side effects of NSAIDs?

The answers to these two questions form the learning objectives for this tutorial. It should only take 25 minutes or so to read. You will probably already know a lot of it, but this is an opportunity to consolidate your learning. We adopt a practical clinical approach, and will offer you some materials to help you with patient consultations.

When it's your own patient that gets packed off to hospital in an ambulance because of a GI bleed, and you prescribed the drug responsible, it really hits home.
- General Practitioner

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