The Society of Hospital Pharmacists of Australia
Recommendations from The Society of Hospital Pharmacists of Australia on end-of-life care, antibiotics, antipsychotic drugs, NSAIDs & codeine. The Society of Hospital Pharmacists of Australia (SHPA) is the national professional organisation for more than 3,000 pharmacists, pharmacists in training, pharmacy technicians and associates working across Australia’s health system.
4.
Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
Non-steroidal anti-inflammatory medicines (NSAIDs) are frequently used in the short term to treat moderate acute pain. They are not usually required after the cause of the acute pain has been addressed. Treatment should be re-assessed if the acute pain is ongoing and not resolved within 2 weeks.
Oral NSAIDs have considerable cardiovascular, gastrointestinal and kidney function risks. They should not be recommended without consideration of the patient’s additional diseases or conditions; in particular older people and people with kidney disease, a history of peptic ulcer disease, hypertension or heart failure.
Older people should use the lowest possible dose of an oral NSAID, for the shortest duration possible and multiple NSAIDs should not be taken at the same time.
The effectiveness of long-term oral NSAID treatment should be routinely assessed against the individual patient’s management plan. If possible the total dose should be reduced or ceased.
Supporting evidence
- Ong CKS, Lirk P, Tan CH, Seymour RA. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res 2007;5(1):19-34.
- Marcum ZA, Hanlon JT. Recognizing the risks of chronic nonsteroidal anti-inflammatory drug use in older adults. Ann Longterm Care 2010;18(9):24-7.
- Barkin RL, Beckerman M, Blum SL, Clark FM, Koh E,DS Wu. Should Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) be Prescribed to the Older Adult? Drugs Aging 2010;27(10):775-789.
- Analgesics Expert Groups. Therapeutic guidelines: analgesic. Version 6. Melbourne: Therapeutic Guidelines Limited; 2012.
How this list was made
A working party was formed and they sought suggestions from SHPA’s Committees of Specialty Practice, Reference Groups, State and Territory branches and Federal Council. More than 40 proposed statements were considered by the working party. A shortlist of 10 statements was identified for consideration by the SHPA’s membership through an online survey. All members were invited to comment on each proposed statement, specifically: whether it related to the practice of pharmacy, related to medicines that are frequently used, and if a significant cost. Members were also invited to rate the statements in order of preference. The survey results were used by the working party to identify the final six statements which were presented to SHPA’s Federal Council who ratified the choice of the five final statements.
- 1 Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.
- 2 Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
- 3 Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
- 4 Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
- 5 Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.