NSAIDs are among the most commonly prescribed medications in the U.S., and they’re also widely available. A variety of over-the-counter products contain an NSAID, and if you’re not aware of what you’re taking, that can lead to an overlap in prescription and over-the-counter use of medicines that contain an NSAID. For example, you may be prescribed an NSAID for arthritic pain, but might not be aware that taking over-the-counter ibuprofen for headaches can raise your intake of NSAIDs beyond the recommended limits.
NSAIDs — both over-the-counter and prescription — are widely acknowledged to be effective for pain relief when used as directed. She also counseled her patient that NSAIDs can cause adverse events, especially when they’re not used appropriately. Risks associated with NSAIDs
Many patients and even some nurses may not realize that hundreds of over-the-counter and prescription pain-reliever products contain ibuprofen or another NSAID, including those medicines that may contain an NSAID in combination with another drug.
Over-the-counter pain relievers are considered safe and effective when used as directed on the label for mild to moderate pain, but they can pose risks to patients when they’re not used appropriately, especially in patients who may be predisposed to those risks.
NSAIDs are linked to an increased risk of cardiovascular complications, including hypertension, myocardial infarction and stroke, as well as a rise in systolic blood pressure.
In 2016, the FDA requested updates to both prescription NSAID and over-the-counter non-aspirin NSAID Drug Facts labels to strengthen the cardiovascular risk warning. You can view some of these updates and teach your patients what changes were made using this patient-friendly resource: Updates to NSAID warnings could matter to your heart.
Potential adverse events have led the FDA to recommend NSAIDs to be used for the shortest period of time and at the lowest effective dose. Understanding your patient’s health history and lifestyle are critical to ensuring the safe use of NSAIDs.
Communication is key for proper NSAID use
Patient counseling is a key component of over-the-counter analgesic recommendations.
A recent article in Therapeutics and Clinical Risk Management reinforces the role healthcare professionals can play in identifying patients with coexisting medical conditions and concomitant medications and provide those patients with ongoing guidance on the appropriate choice and use of over-the-counter analgesics.
Using data from three large U.S. healthcare insurance claim databases, the authors calculated the percentage of adults having a chronic medical condition — asthma, heart conditions, gastrointestinal bleeding risk or kidney disease — that could put them at risk of a side effect when taking an over-the-counter NSAID. The data showed at least 50% of patients had one or more of these underlying medical conditions.
Many patients usually use over-the-counter medications for common complaints, and oftentimes use them only on occasion. So when patients review their current medication list with you, they might not think to tell you about the over-the-counter pain relievers they take. They frequently think only prescription drugs need to be included on their medications list or in discussions with healthcare professionals.
Because so many medications combine an NSAID with another drug or active ingredient, it is crucial to remind patients to include all prescription and nonprescription drugs they take — even those they only take occasionally — on their current medication list to avoid exceeding dosing limits or taking a drug that may not be an appropriate choice for them.
Nurses also should be aware of the amount of alcohol their patients consume. When using NSAIDs, the consumption of three or more alcoholic beverages a day may compound the risk of GI bleeding and this precautionary warning is listed on the over-the-counter Drug Facts Label under Stomach Bleeding Warning.
To help ensure safe dosing of these medications, the entire healthcare team — nurses, prescribers and pharmacists — need to communicate important information to each other about their patients’ use of all medicines they are taking, including NSAIDs and other over-the-counter pain relievers, which can result in taking a drug that may not be an appropriate choice for them.
You can use electronic medical records to help avoid recommending too much of a medication or using a medication for which the patient is not a good candidate. You can also help counsel your patient on the safe use and choice of over-the-counter pain relievers based on their other health concerns, age or lifestyle with this patient-friendly checklist.
Nurses are in an ideal position to teach their patients about the safe use of over-the-counter NSAIDs, including ways to track daily dose limits. Taking the time to explain single and maximum daily doses and the risks of exceeding recommendations can help patients stay within the recommended dosing limits.
When counseling patients about medications, make it a point to explain the appropriate over-the-counter dose of an ingredient such as an NSAID, and reinforce that they should take only one NSAID at a time for the shortest possible period of time to avoid exceeding the maximum recommended daily dose.