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      Anonymous
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      Contraindications

      WHEN TO AVOID USING NSAID.

      Do not use nonsteroidal anti-inflammatory drugs (NSAIDs) in people with:

      A history of hypersensitivity/severe allergic reaction to an NSAID (including aspirin):

      Severe skin reactions and angioedema are absolute contraindications to NSAIDs.

      Asthma. Unless NSAIDs clearly cause severe exacerbations of asthma, people with asthma should not be denied the benefits of NSAIDs without being offered the option of a trial to assess the effect on asthma control.

      Severe heart failure — NSAIDs may impair renal function.

      Liver fibrosis, cirrhosis, or acute liver failure — risk of variceal bleeding, hepatorenal syndrome, and encephalopathy.

      Severe hepatic impairment (e.g. liver enzyme levels more than three times the upper limit of the normal range; serum albumin less than 25g/L).

      Current treatment for gastrointestinal bleeding, symptomatic peptic ulcer, or gastrointestinal perforation or obstruction.

      Coxibs and diclofenac are also contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, mild, moderate, or severe heart failure.

      Where possible, avoid using NSAIDs in people with:

      Renal failure, with estimated glomerular filtration rate (eGFR) less than 30–15 mL/min/1.73 m2, or creatinine clearance less than 30–20 mL/min, or dehydration:

      NSAIDs can provoke acute renal failure if given to someone who is dehydrated, especially if they have diabetes.

      Check the summary of product characteristics for the manufacturer’s recommendation for each NSAID..STICK TO THESE RECOMMENDATIONS RIGIDLY ,IN PRACTICE , and do not deviate.

      NSAIDs should be used with caution in:

      The elderly — increased risk of serious adverse effects such as gastrointestinal bleeding and perforation, which may be fatal.

      People with a history of peptic ulceration (standard NSAIDs contraindicated), or those at high risk of gastrointestinal adverse effects.

      People with inflammatory bowel disease — NSAIDs may increase the risk of developing or cause exacerbations of ulcerative colitis or Crohn’s disease.

      People with hepatitis or cholestasis — increased risk of gastrointestinal bleeding and fluid retention.

      Dose reduction is recommended for some NSAID’s

      Renal impairment (avoid if possible) — sodium and water retention may occur leading to a deterioration in renal function and, possibly renal failure. This has also been reported with topical use.

      If the person cannot avoid using a NSAID and has impaired renal function, monitor creatinine clearance or estimated glomerular filtration rate.

      People with heart failure — NSAIDs may impair renal function.

      People with hypertension — NSAIDs may impair renal function.

      In a women trying to conceive — NSAIDs may impair female fertility.

      Dr G Mohan.

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