Practice advisory on the appropriate use of NSAIDs in primary care

Kok Yuen Ho, Mary S. Cardosa, Sumapa Chaiamnuay, Rudy Hidayat, Huynh Quang Tri Ho, Ozlan Kamil, Sabarul A. Mokhtar, Ken Nakata, Sandra V. Navarra, Van Hung Nguyen, Rizaldy Pinzon, Shuichi Tsuruoka, Heng Boon Yim, Ernest Choy

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)


Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflamma-tory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflamma-tion. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.

Original languageEnglish
Pages (from-to)1925-1939
Number of pages15
JournalJournal of Pain Research
Publication statusPublished - 2020


  • Cardiovascular risk
  • COX-2 selective inhibitors
  • Gastrointestinal risk
  • Inflammation
  • Nonsteroidal anti-inflammatory drugs
  • Osteoarthritis


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