Nice guidelines topical nsaids

In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). For ibuprofen, avoid in severe impairment. With topical use in adults: Caution (deterioration in renal function has also been reported after topical use). Dose adjustments By Amy Orciari Herman. Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD. Topical nonsteroidal anti-inflammatory drugs (NSAIDs), with or without menthol gel, should be first-line treatment for acute pain from musculoskeletal injuries, according to a new guideline from the American College of Physicians and the American Academy of Family Physicians. This makes topical diclofenac a useful first line therapy, particularly for older people who are more susceptible to gastrointestinal harm from oral NSAIDs, and underscores current NICE guidance . There is an absence of evidence regarding topical NSAIDs other than diclofenac, or for chronic painful conditions other than knee or hand osteoarthritis. A review has stated that age of >= 60 years is an indication for co-prescribing a PPI if a patient is on a NSAID (11) "Various national and organisational guidance states the need for use of a PPI with a NSAIDs (based on the age of the patient) in order to reduce risk of GI bleeding. Previous NICE guidance (CG88) was specific about the age for If treatment with simple analgesia is ineffective, consider use of an oral NSAID when required (topical NSAID use should be discontinued), or a weak opioid analgesic (such as codeine phosphate) when required, or topical capsaicin 0.025%, particularly in knee or hand osteoarthritis. A topical NSAID. Physiotherapy, or referral for consideration of surgery. A different oral analgesic (such as paracetamol, or an opioid). The person has any contraindications to oral NSAIDs. There are any potentially hazardous drug interactions. The person is already using an NSAID — for example, ibuprofen or aspirin purchased over-the-counter. The five topical NSAIDs were all significantly better than placebo, but in the case of indomethacin just so. Ketoprofen had the lowest (best) NNT of 2.6 (2.2 to 3.3). Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Health Serv Res Policy. 2002; 7:51 The National Institute for Care and Excellence (NICE) Clinical Guidelines (CG) which cover treatment with NSAIDs are: • CG177 Osteoarthritis care and management in adults. • Consider paracetamol and/or topical NSAIDs before oral NSAIDs, COX-2 inhibitors or opioids. • The Guideline Development Group (GDG) have highlighted reduced Ibuprofen combines anti-inflammatory, analgesic, and antipyretic properties. It has fewer side-effects than other NSAIDs but its anti-inflammatory properties are weaker. Naproxen combines good efficacy with a low incidence of side-effects. Diclofenac sodium, diclofenac potassium, indometacin, mefenamic acid, and piroxicam have properties NICE Guidance (Management of osteoarthritis 2008) suggests the use of PPI's with COX-2 selective inhibitors or non-selective NSAIDs should be considered in all patients with GI risk factors. This combination offers the lowest potential risk of GI adverse events 6,7,8. PPI cover should only be used for the duration of NSAID use. 2. Topical NSAIDs The use of a NSAID by mouth is effective for reliev