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Medicines Monitoring

NSAIDs monitoring

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Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents
  1. Before starting
    1. Consider
  2. After started or dose changed
    1. Consider
  3. Ongoing once stable
    1. Consider
  4. Notes
    1. When to consider NSAID monitoring
    2. Good prescribing practice
  5. Bibliography

Before starting

Consider

  • Baseline
    • Blood pressureparticularly before COX-II inhibitors
    • Estimated glomerular filtration rate
    • Full blood count
    • Serum creatinine
    • Liver function testsif hepatic impairment

After started or dose changed

Consider

  • Within 2 weeks
    • Estimated glomerular filtration rate or Serum creatinine (for creatinine clearance)
    • Full blood count
    • Liver function testsif hepatic impairment
  • Within 4 weeks; within 2 weeks if etoricoxib
    • Blood pressure
  • Within 4 weeks
    • Haemoglobinif high risk of gastrointestinal effects

Ongoing once stable

Consider

  • Periodically
    • Blood pressurein elderly, high risk patients, and patients taking COX-II inhibitors
    • Estimated glomerular filtration ratein renal impairment or where other drugs affecting renal function (e.g. ACE inhibitors)
    • Full blood count
    • Liver function testsin liver impairment or patients on long-term NSAIDs

Notes

When to consider NSAID monitoring

NSAID monitoring may be particularly important where patients are elderly, or where there is other clinical concern which may include but is not limited to:

  • ischaemic heart disease
  • cardiovascular disease
  • cerebrovascular disease
  • peripheral vascular disease
  • heart failure
  • gastrointestinal disease
  • renal disease
  • taking drugs which may interact

Good prescribing practice

Always use NSAIDs at the lowest effective dose and for the shortest possible duration. Consider risks and response to treatment. Enquire about, and manage, adverse effects. Use clinical judgement to decide what must be monitored and how frequently. Routinely appropriateness regularly, particularly in the elderly and high risk patients.

Bibliography