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How should you respond to latest NSAID danger headlines?

Helen Williams: Pharmacists should recommend lowest doses and shortest courses of painkillers

Confusing headlines about ibuprofen risks give pharmacists a chance to be “more direct” with their painkiller advice, a heart disease specialist has suggested.

Press coverage last week of a study on non-steroidal anti-inflammatory drugs (NSAIDs) “presents pharmacists with the opportunity to have a review” with patients taking both regular and occasional doses of painkillers, said Helen Williams, consultant pharmacist for cardiovascular disease at the Royal Pharmaceutical Society.

"Terrible”-looking headlines – reporting that over-the-counter painkiller sales increase the risk of heart failure by nearly 20% – have the potential to scare patients off taking common NSAIDs such as ibuprofen, naproxen and diclofenac, Ms Williams told C+D last Friday (September 30).

While the study on painkillers, published in the British Medical Journal (BMJ), suggests that taking a prescription for any NSAID increases the risk of being hospitalised with heart failure by 19%, the findings should not be a concern for younger patients, she stressed.

“It’s important to note that the average age in the study was 77,” Ms Williams said. “So this doesn’t really apply to our younger patients who are coming to pharmacies to buy ibuprofen for sports injuries.”

Ms Williams said elderly patients are most likely being prescribed painkillers by their GPs for long-term health problems. “Pharmacists often know their regular customers” and so are well-placed to monitor and advise those taking significant amounts of NSAIDs, she pointed out.

Pharmacists should recommend the lowest doses and the shortest courses of painkillers to ease symptoms, she added.

Ms Williams offered some tips for pharmacists looking to dispel the myths around ibuprofen use:

When should you advise taking ibuprofen?

“It’s joint and muscle problems [where] you’re looking for an anti-inflammatory effect, so it is about having those discussions [with patients] and looking at what they want the painkiller for."

While "ibuprofen is one of the safe ones", Ms Williams says "you don’t really need an anti-inflammatory for a headache. Paracetamol is best for that."

"We’re so used to supplying paracetamol and ibuprofen at a patient’s request that we kind of leave it up to them to decide which one they want," she adds. "But perhaps we should be more direct."

What are the signs of over-use of painkillers?

“If a patient is on regular [NSAIDs] and complaining about swollen ankles, restlessness and tiredness – these are the sort of warning signs that they are retaining fluid, usually because their kidneys or their heart are not doing their job properly," Ms Williams says.

"These are the sorts of [symptoms] in older people that pharmacists should be looking out for.”

What should you do next?

If you have established that a patient is experiencing these symptoms, the next step should be a discussion with their GP, Ms Williams advises.

"If people are taking [NSAIDs] long-term – even at a relatively young age – they should be getting their fitness checked by their GP at least once a year, just to make sure there are no issues evolving."

“Any pharmacist who sees a patient who is struggling for breath, and is obviously clinically unwell, would be referring them to a GP anyway," she adds.

2 Comments
Question: 
Have you noticed more patients asking about the risk of ibuprofen?

Shenu Barclay, Community pharmacist

YES PEOPLE ARE MORE AWARE OF RECENT HEADLINES AND ARE OFTEN BRINGING THEIR REPEAT SLIPS TO FIND OUT WHETHER IBUPROFEN IS COMPATIBLE WITH THEIR PRESCRIBED MEDS.I AM ALSO REINFORCING MESSAGE OF LOWEST STRENGTH OF IBUPROFEN FOR SHORTEST POSSIBLE TIME FOR CUSTOMERS OOVER 70YRS. AGE SHENU BARCLAY,LOCUM,WEST MIDLANDS

Shenu Barclay, Community pharmacist

YES PEOPLE ARE MORE AWARE OF RECENT HEADLINES AND ARE OFTEN BRINGING THEIR REPEAT SLIPS TO FIND OUT WHETHER IBUPROFEN IS COMPATIBLE WITH THEIR PRESCRIBED MEDS.I AM ALSO REINFORCING MESSAGE OF LOWEST STRENGTH OF IBUPROFEN FOR SHORTEST POSSIBLE TIME FOR CUSTOMERS OVER 70YRS. AGE SHENU BARCLAY,LOCUM,WEST MIDLANDS

Valentine Trodd, Community pharmacist

Don't think anybody cares... we're all too busy discussing MURs on other thread.

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