Avoiding Concurrent NSAID Use

Rationale for Avoiding Concurrent NSAID Use

The American Geriatrics Society recommends using only one NSAID at the lowest effective dose for the shortest duration possible to minimize risks 1
Combined use of ibuprofen and ketorolac significantly increases the risk of gastrointestinal bleeding and perforation, acute kidney injury, and cardiovascular thrombotic events in patients 1

Ibuprofen's effects on platelet function and COX inhibition can persist longer than its half-life of approximately 2-4 hours 1

Acetaminophen can be considered as an alternative pain management option if not already at maximum daily dose, according to the American College of Rheumatology 2
Tramadol may be appropriate for pain severity, and opioid analgesics can be used for short-term relief of severe pain, as suggested by the American Pain Society 2
Intra-articular corticosteroid injections may be considered for patients with osteoarthritis pain, as recommended by the American College of Rheumatology 2

The American Heart Association notes that ibuprofen can interfere with aspirin's cardioprotective effects in patients taking low-dose aspirin for cardioprotection 4
The American Geriatrics Society advises that elderly patients (>60 years) are at substantially higher risk for adverse events from NSAID use, and special caution should be exercised 1
Patients with a history of cardiovascular disease, renal impairment, or GI disorders are at high risk for complications from concurrent NSAID use, according to the National Kidney Foundation 1

The American College of Physicians recommends monitoring blood pressure, BUN, creatinine, liver function tests, and signs of GI bleeding if NSAID therapy is necessary 1
Co-prescribing a proton pump inhibitor can reduce GI complication risk, as suggested by the American Gastroenterological Association 1