Who should avoid using NSAIDs?
A variety of patients are advised against the use of NSAIDs based on the properties of such medicines and their potential for certain side effects in light of the patient’s coexisting condition.
Understanding the mechanism of removal or excretion from our body for NSAIDs occurs by way of the kidneys, patients with conditions that may involve the kidneys must largely avoid such medicines. It should be noted that this restriction exists even in regard to those NSAIDs available over the counter. Kidney or renal disease is often diagnosed by lab tests by the primary doctor, and once discovered are often followed by a nephrologist/kidney specialist. Diabetics have a predilection for kidney dysfunction and, as such, should prompt close scrutiny.
As the anti-inflammatory medicine flows through the stomach and ultimately the blood stream, patients with stomach/gastrointestinal histories must navigate the concept of NSAID usage with extra caution. Key to this discussion is an accurate history of such conditions such as, but not limited to, ulcers, Crohn’s disease, Ulcerative Colitis and gastroesophageal reflux disease (GERD). History taking and current review of symptoms may not be enough; often invasive diagnostic studies are required to accurately deduce the degree of such conditions. The concern with such conditions lies in the predilection of the anti-inflammatory class to induce, as a dose effect or over time, an erosion of the gastrointestinal wall. How this process occurs has multiple theories, among them is the fact that as an anti-inflammatory reaction is blocked so is the formation of a gastrointestinal (GI) protective substance, namely prostaglandin. A patient with one of these conditions and has concerns regarding NSAID side effects should speak with their primary doctor or GI specialist. They may advise avoidance or possibly proceeding with the course of medication, while also monitoring or providing additional medications that protect the GI system.
Blood pressure concerns can arise while taking anti-inflammatory medicines. Though the overall incidence is low, a mindfulness of blood pressure history and current status is paramount. Typically, an NSAID can be safely introduced after clearance by the supervising or prescribing doctor for the condition. It may be started at a less than full dose and gradually increased if no ill effects become present. Monitoring closely with a home blood pressure machine is advised to catch any variability in the readings as soon as possible. Should any increases be seen, the medicine should be stopped and increased blood pressure reported to the involved doctors immediately.
Those with heart conditions should be made aware that studies have tied the incidence of some cardiac events and stroke to the use of NSAIDs. While the percentages are low, those with recent cardiac surgeries or instability in their status should pause any such medicines until their specialists approves. Higher risks were found tied to higher doses or longer term use. Some cardiac states require blood thinners, of special concern, addressed below. If ever any doubt whether NSAIDs are safely started, defer starting until cleared by your specialist.